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Dyshidrosis, is a type of dermatitis, that is characterized by itchy blisters on the palms of the hands and bottoms of the feet.[5] Blisters are generally one to two millimeters in size and heal over three weeks.[6][7] However, they often recur.[7] Redness is not usually present.[6] Repeated attacks may result in fissures and skin thickening.[6]

Dyshidrosis
Synonyms Acute vesiculobullous hand eczema,[1] dyshidrotic dermatitis,[2] cheiropompholyx, dyshidrotic eczema, pompholyx, podopompholyx[3]
Finger Pompholyx 1.tif
The characteristic vesicles of dyshidrosis on a finger
Pronunciation
Specialty Dermatology
Symptoms Itchy blisters on the palms of the hands and bottoms of the feet[5]
Complications Skin thickening[6]
Usual onset Often recurrent[7]
Duration Heal over 3 weeks[6][7]
Causes Unknown[7]
Diagnostic method Based on symptoms[7]
Similar conditions Pustular psoriasis, scabies[6]
Treatment Avoiding triggers, barrier cream, steroid cream, antihistamines[7][6]
Frequency ~1 in 2,000 (Sweden)[6]

The cause is unknown. Triggers may include allergens, physical or mental stress, frequent hand washing, or metals. Diagnosis is typically based on what it looks like and the symptoms. Allergy testing and culture may be done to rule out other problems.[7] Other conditions that produce similar symptoms include pustular psoriasis and scabies.[6]

Avoiding triggers may be useful as may a barrier cream.[6] Treatment is generally with steroid cream.[7] High strength steroid creams may be required for the first week or two.[6] Antihistamines may be used to help with the itch.[7] If this is not effective steroid pills, tacrolimus, or psoralen plus ultraviolet A (PUVA) may be tried.[6][7]

About 1 in 2,000 people are affected in Sweden. Males and females appear to be affected equally. The first description was in 1873. The name comes from the word "dyshidrotic," meaning "difficult sweating," as problems with sweating was once believed to be the cause.[6]

Contents

Signs and symptoms

Dyshidrosis has been described as having the following characteristics:

  • Itchiness of the palms or soles, followed the a sudden development of intensely itchy small blisters on the sides of the fingers, the palms or the feet.[8]
  • These blisters are often described as having a "tapioca pudding" appearance.[9]
  • After a few weeks, the small blisters eventually disappear as the top layer of skin falls off.[6][10][11]
  • These eruptions do not occur elsewhere on the body.[6]
  • The eruptions may be symmetrical.[12]

Causes

The exact causes of dyshidrosis are unknown. In 2013, a randomized, double-blind, placebo-controlled cross-over study by the University Medical Center Groningen reported that dyshydrosis outbreaks on the hands increased significantly among those allergic to house dust mites, following inhalation of house dust mite allergen.[13]

Food allergens may be involved in certain cases.[14] Cases studies have implicated a wide range of foods including tuna, tomato, pineapple, chocolate, coffee, and spices among others.[14] A number of studies have implicated balsam of Peru.[14]

Diagnosis

Dyshidrosis is diagnosed clinically, by gathering a patient's history and making careful observations (see signs and symptoms section).[7] Severity of symptoms can also be assessed using the dyshidrotic eczema area and severity index (DASI).[15] The DASI has been designed for clinical trials and is not typically used in practice.

Treatment

There are many treatments available for dyshidrosis. However, few of them have been developed or tested specifically on the condition.

  • Barriers to moisture and irritants, including barrier creams and gloves.[12]
  • Topical steroids[16] - while useful, can be dangerous long-term due to the skin-thinning side-effects, which are particularly troublesome in the context of hand dyshidrosis, due to the amount of toxins and bacteria the hands typically come in contact with.
  • Potassium permanganate dilute solution soaks - also popular, and used to 'dry out' the vesicles,[17] and kill off superficial Staphylococcus aureus,[18] but it can also be very painful. Undiluted it may cause significant burning.[19]
  • Dapsone (diamino-diphenyl sulfone), an antibacterial, has been recommended for the treatment of dyshidrosis in some chronic cases.[20]
  • Antihistamines: Fexofenadine up to 180 mg per day.[21]
  • Alitretinoin (9-cis-retinoic acid) has been approved for prescription in the UK. It is specifically used for chronic hand and foot eczema.[22][23][24] It is made by Basilea of Switzerland (BAL 4079).
  • Systemic steroids can be taken orally to treat especially acute and severe cases of dyshidrosis.[12]

Epidemiology

About 1 in 2,000 people are affected in Sweden. Males and females appear to be affected equally.[6]

See also

References

  1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. ISBN 0-7216-2921-0.
  2. ^ "Pompholyx". Patient. 2014-02-26. Retrieved 11 August 2016. 
  3. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0. 
  4. ^ "Dyshidrosis". Merriam-Webster Online. Merriam-Webster. 2014. Retrieved 14 April 2014. 
  5. ^ a b "What Is Atopic Dermatitis? Fast Facts". NIAMS. November 2014. Retrieved 11 August 2016. 
  6. ^ a b c d e f g h i j k l m n o p Lofgren, SM; Warshaw, EM (December 2006). "Dyshidrosis: epidemiology, clinical characteristics, and therapy.". Dermatitis : contact, atopic, occupational, drug. 17 (4): 165–81. PMID 17150166. 
  7. ^ a b c d e f g h i j k l Colomb-Lippa, D; Klingler, AM (July 2011). "Dyshidrosis.". JAAPA : official journal of the American Academy of Physician Assistants. 24 (7): 54. PMID 21748961. 
  8. ^ Shelley, W. B. (1953-09-01). "Dysidrosis (pompholyx)". A.M.A. Archives of Dermatology and Syphilology. 68 (3): 314–319. ISSN 0096-5979. PMID 13079297. 
  9. ^ Bielan, Barbara (1996-04-01). "Dyshidrotic eczema". Dermatology Nursing. 8 (2). 
  10. ^ Veien, Niels K. (2009-07-01). "Acute and recurrent vesicular hand dermatitis". Dermatologic Clinics. 27 (3): 337–353, vii. ISSN 1558-0520. PMID 19580928. doi:10.1016/j.det.2009.05.013. 
  11. ^ Lofgren, Sabra M.; Warshaw, Erin M. (2006-12-01). "Dyshidrosis: epidemiology, clinical characteristics, and therapy". Dermatitis: Contact, Atopic, Occupational, Drug. 17 (4): 165–181. ISSN 1710-3568. PMID 17150166. 
  12. ^ a b c Perry, Adam D.; Trafeli, John P. (2009-05-01). "Hand Dermatitis: Review of Etiology, Diagnosis, and Treatment". The Journal of the American Board of Family Medicine. 22 (3): 325–330. ISSN 1557-2625. PMID 19429739. doi:10.3122/jabfm.2009.03.080118. 
  13. ^ Schuttelaar ML, Coenraads PJ, Huizinga J, De Monchy JG, Vermeulen KM (2013). "Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study". Contact Dermatitis. 68 (2): 76–85. PMID 23046099. doi:10.1111/j.1600-0536.2012.02172.x. 
  14. ^ a b c Veien, Niels K. (2009-07-01). "Acute and recurrent vesicular hand dermatitis". Dermatologic Clinics. 27 (3): 337–353, vii. ISSN 1558-0520. PMID 19580928. doi:10.1016/j.det.2009.05.013. 
  15. ^ Vocks, E.; Plötz, S. G.; Ring, J. (1999-01-01). "The Dyshidrotic Eczema Area and Severity Index - A score developed for the assessment of dyshidrotic eczema". Dermatology (Basel, Switzerland). 198 (3): 265–269. ISSN 1018-8665. PMID 10393450. doi:10.1159/000018127. 
  16. ^ "eMedicine - Dyshidrotic Eczema : Article by Camila K Janniger". Retrieved 2007-07-10. 
  17. ^ BIRT AR (March 1964). "Drugs for Eczema of Children". Can Med Assoc J. 90 (11): 693–4. PMC 1922428 . PMID 14127384. 
  18. ^ Stalder JF, Fleury M, Sourisse M, et al. (1992). "Comparative effects of two topical antiseptics (chlorhexidine vs KMn04) on bacterial skin flora in atopic dermatitis". Acta Derm Venereol Suppl (Stockh). 176: 132–4. PMID 1476027. 
  19. ^ Baron S, Moss C (February 2003). "Caustic burn caused by potassium permanganate". Arch. Dis. Child. 88 (2): 96. PMC 1719457 . PMID 12538301. doi:10.1136/adc.88.2.96. 
  20. ^ http://www.dermnet.org.nz/dermatitis/pompholyx.html
  21. ^ Diepgen, Thomas L.; Agner, Tove; Aberer, Werner; Berth-Jones, John; Cambazard, Frédéric; Elsner, Peter; McFadden, John; Coenraads, Pieter Jan (2007-10-01). "Management of chronic hand eczema". Contact Dermatitis. 57 (4): 203–210. ISSN 1600-0536. doi:10.1111/j.1600-0536.2007.01179.x. 
  22. ^ Ruzicka T, Lynde C, Jemec G et al. Efficacy and safety of oral alitretinoin in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomised, double-blind, placebo-controlled, multicentre trial. British Journal of Dermatology April 2008; 158(4): 808-817.
  23. ^ Dermatology 1999;199:308-312 doi:10.1159/000018280
  24. ^ Vol. 140 No. 12, December 2004 Archives of Dermatology Oral Al1itretinoin (9-cis-Retinoic Acid) Therapy for Chronic Hand Dermatitis in Patients Refractory to Standard Therapy Results of a Randomized, Double-blind, Placebo-Controlled, Multicenter Trial Thomas Ruzicka, MD; Frederik Grønhøj Larsen, MD, PhD; Dorota Galewicz, MD; Attila Horváth, MD; Peter Jan Coenraads, MD; Kristian Thestrup-Pedersen, MD; Jean Paul Ortonne, MD; Christos C. Zouboulis, MD; Martin Harsch, PhD; Thomas C. Brown, PhD; Maurice Zultak

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