Dyshidrotic dermatitis in Adult
Alerts and Notices
SynopsisDyshidrotic dermatitis (dyshidrotic eczema, pompholyx) is generally defined as a recurrent vesicular eruption limited to the hands (most often the sides of the digits) and sometimes the feet. The etiology is unknown; no causal relationship with sweating has been shown. There is no sex predilection. The lesions are extremely pruritic.
Dyshidrotic eczema can be associated with atopic dermatitis, contact irritants and allergens, dermatophyte and bacterial infections, hyperhidrosis, hot weather, high dietary intake of nickel or cobalt, and emotional stress. Administration of intravenous immunoglobulin (IVIG) has been associated with severe dyshidrotic dermatitis. There have also been a few reports of dyshidrotic dermatitis in patients treated with secukinumab.
Some cases spontaneously resolve. Treatment is aimed at symptomatic relief and control of vesiculation.
L30.1 – Dyshidrosis [pompholyx]
201201000 – Podopompholyx
402222007 – Vesicular hand eczema
Differential Diagnosis & Pitfalls
- Allergic contact dermatitis – Distinguishing idiopathic dyshidrotic dermatitis from allergic contact dermatitis can be difficult, although contact dermatitis often involves the dorsum of the hand. An extensive history of environmental exposure should be gathered when a vesicular hand rash is present.
- Palmoplantar pustulosis
- Dermatophyte infection (eg, tinea pedis and/or manuum)
- Herpetic whitlow
- Pustular psoriasis
- Bullous impetigo
- In immunocompromised patients, also consider crusted scabies.
- Epidermolysis bullosa simplex
- Porphyria cutanea tarda
- Hand-foot-and-mouth disease
- An unusual acral form of bullous pemphigoid resembles dyshidrotic eczema.
- Dyshidrotic cutaneous T-cell lymphoma
- Erythema multiforme
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patient Information for Dyshidrotic dermatitis in Adult
OverviewDyshidrotic eczema (dyshidrotic dermatitis) is an itchy rash that occurs on the hands (usually the palms and sides of the fingers) and/or the feet. Dyshidrotic eczema manifests as small, itchy, fluid-filled blisters.
Sometimes the blisters are very small, like pinpoints, and sometimes they are larger, covering almost the whole palm or foot. The fluid inside the blister can be clear or white to yellow. It is not known what causes this condition, but it is more common in people with eczema. Even in people without sensitive skin, it seems to be triggered by the same things that trigger eczema: cold, dry air, or contact with irritants that bother the skin. In other people, a warm, moist climate may be the trigger.
Who’s At RiskDyshidrotic eczema may occur in people of all ages but usually occurs after age 10 years.
Signs & SymptomsThe most common location of dyshidrotic eczema is on the hands and, less commonly, the feet. It appears as:
- Small, fluid-filled blisters (vesicles) on the surfaces of the palms and soles and the sides of the fingers and toes.
- The blisters can appear deep in the skin due to the thickness of the skin on the palms and soles. In severe cases, the small blisters can merge and form bullae (large blisters larger than a thumbnail).
- The blisters may break open, ooze, and form a scaly crust.
Self-Care GuidelinesAvoid anything that irritates the skin in the affected areas. Handwashing with mild soaps or cleansers and frequent application of thick emollient creams (eg, Eucerin, Aquaphor, and CeraVe) and petroleum jelly (eg, Vaseline) may be beneficial. Do not pop the blisters of dyshidrotic eczema because of the risk of infection.
When to Seek Medical CareSeek medical evaluation for a rash on the hands and/or feet that is unresponsive to self-care measures.
TreatmentsTo manage dyshidrotic eczema, your medical professional may recommend:
- A topical steroid cream, lotion, or ointment.
- A short course of an oral steroid (prednisone [eg, Rayos]) can be very effective and fast in controlling symptoms and is reserved for severe cases.
- Chronic, severe disease can be treated with a form of ultraviolet light therapy called PUVA (psoralen and ultraviolet A) or narrow-band UVB (ultraviolet B) phototherapy administered at a dermatologist's office.
Dyshidrotic dermatitis in Adult