1.1.2.7 Dyshidrotic Dermatitis

Grading & Level of Importance: B

Review:
2021

W. Burgdorf, Munich; Lwin, J. McGrath, London
Revised by RM. Pujol; A. Gimenez-Arnau, Barcelona

ICD-11

EA85.0 

Synonyms

Dyshidrosis; cheiro-podo-pompholyx; vesicular dermatitis of hands and feet.

Definition

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.
 

Localisation

Hands and feet, palmar and plantar and on lateral areas of the fingers and toes. 

Classification

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.  

Dermatopathology

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.

Course

Depends on the cause. Idiopathic and atopic forms are often chronic and recurrent. Seasonal or non- seasonal cases.

Complications

Superinfection with gram negative bacteria, allergic contact dermatitis.

Diagnosis

Typical clinical features. To distinguish from atopic dermatitis: look for atopic stigmata. Patch test is useful to exclude allergic contact dermatitis.

Differential diagnosis

Tinea pedis, early stages of palmoplantar pustulosis, pustular psoriasis, atopic dermatitis and allergic contact dermatitis. Dyshisdrosis per se of fingers.

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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