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dyshidrotic eczematous dermatitis; pompholyx
A vesicular hand & foot dermatitis. Despite the name (dyshidrotic), there are no associated abnormalities of sweat glands.
Etiology:
1) frequent wetting & drying, sweating
2) allergies, reaction to Tinea
3) typically observed in patients with a history of atopic dermatitis [5]
4) emotional stress may be a precipitating factor
Epidemiology:
1) ages 12-40 years
2) no sex predilection
3) often appear with the summer heat [6]
4) case report of 22 year old woman who recently started a job as a dishwasher [5]
Pathology:
1) NO dysfunction of sweat glands
2) eczematous inflammation
- spongiosis & intraepidermal edema
3) intraepidermal vesicles
Clinical manifestations:
1) acute vesicular eruption on the palms & soles
a) initially, lateral aspects of fingers, palms & soles
b) later, dorsa of fingers
- small, itchy blisters during summer heat [6]
2) abrupt appearance of clear, pruritic vesicles
3) later papules, scaling, fissures & lichenification
4) erosions may result from coalescence of ruptured vesicles
5) outbreaks generally last for several weeks
6) pruritus at sites of new vesicles
7) pain in fissures & secondarily infected lesions
8) lesions spread peripherally, but have a tendency to clear centrally
*images [4]
Laboratory:
1) bacterial culture, rule-out Staphylococcus aureus
2) KOH preparation, rule-out dermatophytosis
3) skin biopsy
Differential diagnosis:
1) contact (allergic or irritant) dermatitis
2) atopic dermatitis
3) bullous tinea pedis 'id reaction'
4) scabies
Complications:
-> secondary infection
a) Staphylococcus aureus (most common)
b) group A streptococcus
Management:
1) generally difficult to treat
2) emollients (petrolatum)
3) avoid corticosteroids except in rare, short-term flare-ups
a) high-potency topical steroids with plastic occlusive dressings for 1-2 weeks
b) intralesional triamcinolone injection 3 mg/mL
c) prednisone taper: state 70 mg PO QD; taper over 1-2 weeks
4) wet dressing for early vesicular stage
5) large bullae should be drained with a puncture wound, but NOT unroofed
6) systemic antibiotics for secondary bacterial infection
7) PUVA, oral or topical as soaks for severe cases
8) white cottom glove liners inside rubber gloves
9) spontaneous remissions in 2-3 weeks
Related
dyshidrosis
General
vesiculobullous dermatitis
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 70-71
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18.
American College of Physicians, Philadelphia 1998, 2015, 2018.
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- DermNet NZ. Pompholyx (images)
http://www.dermnetnz.org/dermatitis/pompholyx.html
- NEJM Knowledge+ Dermatology
- AMA Morning Rounds
American Medical Association. August 3, 2024