18.104.22.168 Dyshidrotic Dermatitis
Grading & Level of Importance: B
Dyshidrosis; cheiro-podo-pompholyx; vesicular dermatitis of hands and feet.
Vesicular to bullous palmoplantar dermatitis.
Aetiology & Pathogenesis
Idiopathic, allergic contact reactions, atopy, eczematous reaction to infections such as tinea (so called id reaction) or bacterial infections. No connection with eccrine sweat gland activity or malfunction.
Signs & Symptoms
Tiny pruritic, fluid-filled vesicles or bullae on palms and soles. Patients often report pruritus as the first symptom, then tiny vesicles become visible, later followed by erythema and scaling.
Hands and feet, palmar and plantar and on lateral areas of the fingers and toes.
Acute, subacute and chronic types.
Laboratory & other workups
When associated fungal or bacterial infection is suspected, microbiological cultures may be useful. Patch test to rule out an associated allergic contact dermatitis.
Intraepidermal spongiotic vesicles with consecutive closure of acrosyringia and subepidermal accumulation of eccrine gland fluid. The image of the dyshidrotic vesicles is that of any eczema with large spongiotic vesicles and discrete dermal inflammatory reaction.
Depends on the cause. Idiopathic and atopic forms are often chronic and recurrent. Seasonal or non- seasonal cases.
Superinfection with gram negative bacteria, allergic contact dermatitis.
Typical clinical features. To distinguish from atopic dermatitis: look for atopic stigmata. Patch test is useful to exclude allergic contact dermatitis.
Prevention & Therapy
Topical non-occlusive galenic formulations of corticosteroids; on occasions, short courses of systemic corticosteroids; wet dressings with antiseptic solutions, topical calcineurin antagonists. Sedative antihistamines are sometimes useful in cases of intense pruritus.
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