Dyshidrosis

Dyshidrosis
Synonyms	Acute vesiculobullous hand eczema,[1] dyshidrotic dermatitis,[2] cheiropompholyx, dyshidrotic eczema, pompholyx, podopompholyx[3]
The characteristic vesicles of dyshidrosis on a finger
Pronunciation	/dɪs.haɪˈdroʊ.sɪs/[4]
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]

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]

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]

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]

• 
  Advanced stage of dyshidrosis on the fingers
• 
  Palmar dyshidrosis
• 
  Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin
• 
  Advanced stage of dyshidrosis on the foot.
• 
  Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flare

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

• Epidermolysis bullosa - a genetic disorder that causes similar, albeit more severe, symptoms to those of dyshidrosis.
• Dermatitis herpetiformis - a similar condition caused by celiac and often mistaken for dyshidrosis.

References

External links

Wikimedia Commons has media related to Dyshidrosis.

• Images of dyshidrotic eczema at Skinsight
• Pompholyx at DermNet NZ (New Zealand Dermatological Society Incorporated)