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Dyshidrosis

January 01, 1970

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
Other namesAcute vesiculobullous hand eczema,[1] dyshidrotic dermatitis,[2] cheiropompholyx,[3] dyshidrotic eczema,[3] pompholyx,[3] podopompholyx[3]
The characteristic vesicles of dyshidrosis on a finger
Pronunciation
SpecialtyDermatology
SymptomsItchy blisters on the palms of the hands and bottoms of the feet[5]
ComplicationsSkin thickening[6]
Usual onsetOften recurrent[7]
DurationHeal over 3 weeks[6][7]
CausesUnknown[7]
Diagnostic methodBased on symptoms[7]
Differential diagnosisPustular psoriasis, scabies[6]
TreatmentAvoiding triggers, barrier cream, steroid cream, antihistamines[6][7]
Frequency~1 in 2,000 (Sweden)[6]

The cause is unknown.[7] Triggers may include allergens, physical or mental stress, frequent hand washing, or metals.[7] Diagnosis is typically based on what it looks like and the symptoms.[7] 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.[6] Males and females appear to be affected equally.[6] It explains about one in five cases of hand dermatitis.[8] The first description was in 1873.[6] 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 by the sudden development of intensely itchy small blisters on the sides of the fingers, the palms or the feet.[9]
  • These blisters are often described as having a "tapioca pudding" appearance.[10]
  • After a few weeks, the small blisters eventually disappear as the top layer of skin falls off.[6][11][12]
  • These eruptions do not occur elsewhere on the body.[6]
  • The eruptions may be symmetrical.[13]
  •  
    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. Food allergens may be involved in certain cases.[11] Cases studies have implicated a wide range of foods including tuna, tomato, pineapple, chocolate, coffee, and spices among others.[11] A number of studies have implicated balsam of Peru.[11] A 2013 study found that dyshydrosis on the hands increased among those allergic to house dust mites, following inhalation of house dust mite allergen.[14]

Id reaction and irritant contact dermatitis are possible causes.[8]

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.[13]
  • 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.[13]

Epidemiology

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

Synonyms

Dyshidrosis is also known as pompholyx,[25] a term originating from the Greek word for "bubble".[8]

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. from the original on 3 August 2016. Retrieved 11 August 2016.
  3. ^ a b c d Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  4. ^ "Dyshidrosis". Merriam-Webster Online. Merriam-Webster. 2014. from the original on 15 April 2014. Retrieved 14 April 2014.
  5. ^ a b "What Is Atopic Dermatitis? Fast Facts". NIAMS. November 2014. from the original on 27 July 2016. Retrieved 11 August 2016.
  6. ^ a b c d e f g h i j k l m n o p q r s Lofgren, SM; Warshaw, EM (December 2006). "Dyshidrosis: epidemiology, clinical characteristics, and therapy". Dermatitis: Contact, Atopic, Occupational, Drug. 17 (4): 165–81. doi:10.2310/6620.2006.05021. PMID 17150166.
  7. ^ a b c d e f g h i j k l m n o Colomb-Lippa, D; Klingler, AM (July 2011). "Dyshidrosis". Journal of the American Academy of Physician Assistants. 24 (7): 54. PMID 21748961.
  8. ^ a b c Fitzpatrick, James (2016). "8". Dermatology Secrets Plus. Elsevier. pp. 70–81. ISBN 978-0-323-31029-1.
  9. ^ Shelley, W. B. (1953-09-01). "Dysidrosis (pompholyx)". AMA Archives of Dermatology and Syphilology. 68 (3): 314–319. doi:10.1001/archderm.1953.01540090076008. ISSN 0096-5979. PMID 13079297.
  10. ^ Bielan, Barbara (1996-04-01). "Dyshidrotic eczema". Dermatology Nursing. 8 (2). from the original on 2017-04-02.
  11. ^ a b c d Veien, Niels K. (2009-07-01). "Acute and recurrent vesicular hand dermatitis". Dermatologic Clinics. 27 (3): 337–353, vii. doi:10.1016/j.det.2009.05.013. ISSN 1558-0520. PMID 19580928.
  12. ^ Lofgren, Sabra M.; Warshaw, Erin M. (2006-12-01). "Dyshidrosis: epidemiology, clinical characteristics, and therapy". Dermatitis: Contact, Atopic, Occupational, Drug. 17 (4): 165–181. doi:10.2310/6620.2006.05021. ISSN 1710-3568. PMID 17150166.
  13. ^ 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. doi:10.3122/jabfm.2009.03.080118. ISSN 1557-2625. PMID 19429739.
  14. ^ 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" (PDF). Contact Dermatitis. 68 (2): 76–85. doi:10.1111/j.1600-0536.2012.02172.x. hdl:11370/69c0f80d-e6f3-4dff-ad75-aadf46b5aaa4. PMID 23046099. S2CID 4609200.
  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. 198 (3): 265–269. doi:10.1159/000018127. ISSN 1018-8665. PMID 10393450. S2CID 22978226.
  16. ^ "eMedicine – Dyshidrotic Eczema: Article by Camila K Janniger". from the original on 2007-07-07. 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. doi:10.1136/adc.88.2.96. PMC 1719457. PMID 12538301.
  20. ^ "Vesicular hand dermatitis". from the original on 2010-03-30. Retrieved 2010-04-07.
  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. doi:10.1111/j.1600-0536.2007.01179.x. ISSN 1600-0536. PMID 17868211. S2CID 34639884.
  22. ^ Ruzicka T, Lynde CW, Jemec GB, Diepgen T, Berth-Jones J, Coenraads PJ, et al. (April 2008). (PDF). Br. J. Dermatol. 158 (4): 808–17. doi:10.1111/j.1365-2133.2008.08487.x. PMID 18294310. S2CID 205256947. Archived from the original (PDF) on 2019-02-18. Retrieved 2019-02-05.
  23. ^ Bollag W, Ott F (1999). "Successful treatment of chronic hand eczema with oral 9-cis-retinoic acid". Dermatology (Basel). 199 (4): 308–12. doi:10.1159/000018280. PMID 10640839. S2CID 35358182.
  24. ^ Ruzicka T, Larsen FG, Galewicz D, Horváth A, Coenraads PJ, Thestrup-Pedersen K, Ortonne JP, Zouboulis CC, Harsch M, Brown TC, Zultak M (December 2004). "Oral alitretinoin (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". Arch Dermatol. 140 (12): 1453–9. doi:10.1001/archderm.140.12.1453. PMID 15611422.
  25. ^ "ICD 11 Beta Draft".

External links

 
Wikimedia Commons has media related to Dyshidrosis.
  • Pompholyx at DermNet NZ (New Zealand Dermatological Society Incorporated)

January 01, 1970
dyshidrosis, type, dermatitis, that, characterized, itchy, blisters, palms, hands, bottoms, feet, blisters, generally, millimeters, size, heal, over, three, weeks, however, they, often, recur, redness, usually, present, repeated, attacks, result, fissures, ski. 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 DyshidrosisOther namesAcute vesiculobullous hand eczema 1 dyshidrotic dermatitis 2 cheiropompholyx 3 dyshidrotic eczema 3 pompholyx 3 podopompholyx 3 The characteristic vesicles of dyshidrosis on a fingerPronunciation ˌ d ɪ s h aɪ ˈ d r oʊ s ɪ s 4 SpecialtyDermatologySymptomsItchy blisters on the palms of the hands and bottoms of the feet 5 ComplicationsSkin thickening 6 Usual onsetOften recurrent 7 DurationHeal over 3 weeks 6 7 CausesUnknown 7 Diagnostic methodBased on symptoms 7 Differential diagnosisPustular psoriasis scabies 6 TreatmentAvoiding triggers barrier cream steroid cream antihistamines 6 7 Frequency 1 in 2 000 Sweden 6 The cause is unknown 7 Triggers may include allergens physical or mental stress frequent hand washing or metals 7 Diagnosis is typically based on what it looks like and the symptoms 7 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 6 Males and females appear to be affected equally 6 It explains about one in five cases of hand dermatitis 8 The first description was in 1873 6 The name comes from the word dyshidrotic meaning difficult sweating as problems with sweating was once believed to be the cause 6 Contents 1 Signs and symptoms 2 Causes 3 Diagnosis 4 Treatment 5 Epidemiology 6 Synonyms 7 See also 8 References 9 External linksSigns and symptomsDyshidrosis has been described as having the following characteristics Itchiness of the palms or soles followed by the sudden development of intensely itchy small blisters on the sides of the fingers the palms or the feet 9 These blisters are often described as having a tapioca pudding appearance 10 After a few weeks the small blisters eventually disappear as the top layer of skin falls off 6 11 12 These eruptions do not occur elsewhere on the body 6 The eruptions may be symmetrical 13 nbsp Advanced stage of dyshidrosis on the fingers nbsp Palmar dyshidrosis nbsp Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin nbsp Advanced stage of dyshidrosis on the foot nbsp Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flareCausesThe exact causes of dyshidrosis are unknown Food allergens may be involved in certain cases 11 Cases studies have implicated a wide range of foods including tuna tomato pineapple chocolate coffee and spices among others 11 A number of studies have implicated balsam of Peru 11 A 2013 study found that dyshydrosis on the hands increased among those allergic to house dust mites following inhalation of house dust mite allergen 14 Id reaction and irritant contact dermatitis are possible causes 8 DiagnosisDyshidrosis 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 TreatmentThere 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 13 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 13 EpidemiologyAbout 1 in 2 000 people are affected in Sweden Males and females appear to be affected equally 6 SynonymsDyshidrosis is also known as pompholyx 25 a term originating from the Greek word for bubble 8 See alsoDermatitis herpetiformis a similar condition caused by celiac and often mistaken for dyshidrosis Epidermolysis bullosa a genetic disorder that causes similar albeit more severe symptoms to those of dyshidrosis References James William Berger Timothy Elston Dirk 2005 Andrews Diseases of the Skin Clinical Dermatology 10th ed Saunders ISBN 0 7216 2921 0 Pompholyx Patient 2014 02 26 Archived from the original on 3 August 2016 Retrieved 11 August 2016 a b c d Rapini Ronald P Bolognia Jean L Jorizzo Joseph L 2007 Dermatology 2 Volume Set St Louis Mosby ISBN 978 1 4160 2999 1 Dyshidrosis Merriam Webster Online Merriam Webster 2014 Archived from the original on 15 April 2014 Retrieved 14 April 2014 a b What Is Atopic Dermatitis Fast Facts NIAMS November 2014 Archived from the original on 27 July 2016 Retrieved 11 August 2016 a b c d e f g h i j k l m n o p q r s Lofgren SM Warshaw EM December 2006 Dyshidrosis epidemiology clinical characteristics and therapy Dermatitis Contact Atopic Occupational Drug 17 4 165 81 doi 10 2310 6620 2006 05021 PMID 17150166 a b c d e f g h i j k l m n o Colomb Lippa D Klingler AM July 2011 Dyshidrosis Journal of the American Academy of Physician Assistants 24 7 54 PMID 21748961 a b c Fitzpatrick James 2016 8 Dermatology Secrets Plus Elsevier pp 70 81 ISBN 978 0 323 31029 1 Shelley W B 1953 09 01 Dysidrosis pompholyx AMA Archives of Dermatology and Syphilology 68 3 314 319 doi 10 1001 archderm 1953 01540090076008 ISSN 0096 5979 PMID 13079297 Bielan Barbara 1996 04 01 Dyshidrotic eczema Dermatology Nursing 8 2 Archived from the original on 2017 04 02 a b c d Veien Niels K 2009 07 01 Acute and recurrent vesicular hand dermatitis Dermatologic Clinics 27 3 337 353 vii doi 10 1016 j det 2009 05 013 ISSN 1558 0520 PMID 19580928 Lofgren Sabra M Warshaw Erin M 2006 12 01 Dyshidrosis epidemiology clinical characteristics and therapy Dermatitis Contact Atopic Occupational Drug 17 4 165 181 doi 10 2310 6620 2006 05021 ISSN 1710 3568 PMID 17150166 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 doi 10 3122 jabfm 2009 03 080118 ISSN 1557 2625 PMID 19429739 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 PDF Contact Dermatitis 68 2 76 85 doi 10 1111 j 1600 0536 2012 02172 x hdl 11370 69c0f80d e6f3 4dff ad75 aadf46b5aaa4 PMID 23046099 S2CID 4609200 Vocks E Plotz S G Ring J 1999 01 01 The Dyshidrotic Eczema Area and Severity Index A score developed for the assessment of dyshidrotic eczema Dermatology 198 3 265 269 doi 10 1159 000018127 ISSN 1018 8665 PMID 10393450 S2CID 22978226 eMedicine Dyshidrotic Eczema Article by Camila K Janniger Archived from the original on 2007 07 07 Retrieved 2007 07 10 BIRT AR March 1964 Drugs for Eczema of Children Can Med Assoc J 90 11 693 4 PMC 1922428 PMID 14127384 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 Baron S Moss C February 2003 Caustic burn caused by potassium permanganate Arch Dis Child 88 2 96 doi 10 1136 adc 88 2 96 PMC 1719457 PMID 12538301 Vesicular hand dermatitis Archived from the original on 2010 03 30 Retrieved 2010 04 07 Diepgen Thomas L Agner Tove Aberer Werner Berth Jones John Cambazard Frederic Elsner Peter McFadden John Coenraads Pieter Jan 2007 10 01 Management of chronic hand eczema Contact Dermatitis 57 4 203 210 doi 10 1111 j 1600 0536 2007 01179 x ISSN 1600 0536 PMID 17868211 S2CID 34639884 Ruzicka T Lynde CW Jemec GB Diepgen T Berth Jones J Coenraads PJ et al April 2008 Efficacy and safety of oral alitretinoin 9 cis retinoic acid in patients with severe chronic hand eczema refractory to topical corticosteroids results of a randomized double blind placebo controlled multicentre trial PDF Br J Dermatol 158 4 808 17 doi 10 1111 j 1365 2133 2008 08487 x PMID 18294310 S2CID 205256947 Archived from the original PDF on 2019 02 18 Retrieved 2019 02 05 Bollag W Ott F 1999 Successful treatment of chronic hand eczema with oral 9 cis retinoic acid Dermatology Basel 199 4 308 12 doi 10 1159 000018280 PMID 10640839 S2CID 35358182 Ruzicka T Larsen FG Galewicz D Horvath A Coenraads PJ Thestrup Pedersen K Ortonne JP Zouboulis CC Harsch M Brown TC Zultak M December 2004 Oral alitretinoin 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 Arch Dermatol 140 12 1453 9 doi 10 1001 archderm 140 12 1453 PMID 15611422 ICD 11 Beta Draft External links nbsp Wikimedia Commons has media related to Dyshidrosis Pompholyx at DermNet NZ New Zealand Dermatological Society Incorporated Retrieved from https en wikipedia org w index php title Dyshidrosis amp oldid 1208637963, wikipedia, wiki, book, books, library,

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