Dyshidrotic dermatitis L30.8

Hutchinson, 1875.

A polyetiological, usually episodic, acute, subacute, or chronically recurrent, vesicular, or vesiculosquamous dermatitis on the palms and soles, characterized by clear, approximately 0.1 cm in size, intraepidermal vesicles with a grayish sheen or (more rarely) blisters. The acute form is usually a single episode triggered by irritants; less commonly, by allergens (e.g., poison ivy). In the latter case, a scattered distribution may occur, sometimes with a multiform appearance.  

If large blisters predominate , the clinical term “pompholyx” is used; on the hands, “cheiropompholyx”; and on the feet, “podopompholyx.”  

If dyshidrotic eczema persists for a longer period, coarse, macularscaling and hyperkeratotic plaques may also develop. The clinical picture then predominantly reflects subacute or chronic hand/foot dermatitis with increasing callosity and the formation of painful rhagades.

During the healing phase of a relapsing vesicular dermatitis, the clinical picture of so-called dyshidrosis lamellosa sicca becomes apparent, characterized by circinate, raised, scaly ridges. These are often picked at, which carries the risk of tearing the skin.

The clinically visible vesicles of dyshidrotic eczema are a manifestation of spongiotic dermatitis of the epidermis.

Occurs in the context of atopic diathesis (see below: Atopy).

Less commonly, it may also occur in association with palmoplantar psoriasis (see below: dyshidrotic psoriasis),allergic contact dermatitis ( e.g., due to nickel allergy), a fungal infection (vesicular mycosis), a Gram-negative foot infection, or idiopathically for unknown reasons.

It may also occur as a drug reaction (e.g., following IVIG therapy). 

Dyshidrotic eczema tends to occur predominantly during the warmer months.

Palmae, Plantae and finger/toe edges. Hands are significantly more frequently and intensively affected than the feet.

Acute dyshidrotic dermatitis, an acute dermatitis of the hands or feet, is characterized by the eruptive flare-up of tiny, usually closely grouped, water-clear, itchy vesicles on the lateral parts of the fingers of the toes and on the palms and soles of the feet.

The backs of the hands and fingers as well as the interdigital folds are frequently involved, but show less the picture of the so-called dyshidrosis than that of the classic acute dermatitis of the field skin with inflammatory papules about 0.1 cm in size, or larger plaques, as well as intact and burst vesicles, possibly also oozing.

When the inflammatory quality of the dermatitic reaction is high (often in the summer months), the vesicles can expand into large blisters, resulting in the clinical picture of pompholyx.

If large-bubble dyshidrotic eczema develops, there is an acute risk of superinfection with acutely occurring painful pustulation, fever, lymphangitis and lymphadenitis.

A so-called gram-negative foot infection can graft itself complicatively on the feet.

In case of non-infectious genesis (e.g. atopic eczema; allergic contact dermatitis) in the acute stage glucocorticoid tinctures such as 0.1% triamcinolone tincture or 0.1% mometasone solution (e.g. Ecural solution) and compresses with tanning additives such as synthetic tanning agents (e.g. Tannolact, Tannosynt). If collerette-like scaling is present, glucocorticoids in cream base such as 0.1% triamcinolone cream R259, 0.25% prednicarbate cream (e.g. Dermatop), if necessary under occlusion.

Accompanying gentle alkali-free skin cleansing (e.g. Eucerin, Sebamed), no irritating noxae. Re-greasing externals (e.g. Linola Fett, Ash Basis Ointment), if necessary with tar-containing additives such as 10% LCD cream(Liquor carbonis detergens cream, Hydrophile 5/10 or 20% (NRF 11.86.).

If necessary, after the acute phase has subsided, zinc oxide paste with bismuth gallate(zinc oxide paste 50% with bismuth gallate 10%) alternating with oak bark extract baths (see above).

In subacute stages and especially in the presence of hyperhidrosis, tap water iontophoresis is also described as successful.

In case of pronounced impetiginization,antibiotic system therapy(antibiotics) with cephalosporins such as cephadroxil (e.g. Cedrox) 1 time/day 1 g p.o. or cephalexin (e.g. Cephalexin-ratiopharm) 1-3 g/day p.o. in 3 ED.

Diet: The association with oral nickel or chromate intake seen by some authors is controversial. According to the authors, nickel- or chromate-free diets are not promising.

A historical and misunderstood term describing acute of subacute vesicular dermatitis of the hands and feet. The term "dyshidrotic" refers to the manifestation of spongiotic dermatitis resulting from the particular anatomical nature of the skin on the palms of the hands and soles of the feet (so-called inguinal skin).

The skin of the groin is characterized by the absence of hair follicles and by the formation of a protective, thick horny layer. In the case of a vesicular dermatitic reaction of the groin skin, the spongiotic vesicles remain much longer in the epidermis and are perceived as fine, barely 0.1 cm large, gray dots in the horny layer, in the case of more severe "eczema reaction" also as gray shiny, protruding vesicles. The term"dyshidrosis" aims at a defective sweat gland function, which is actually not present, even if sweat plays an indirect role in the maintenance of the process.

Equally misleading and thus superfluous is the term "dyshidrosiform", which is intended to characterize the vesicle formations in atopic hand/foot dermatitis.

Large vesicular acute dermatitis of the groin skin is referred to by the term pompholyx(cheiropompholyx, podopompholyx).

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