Dyshidrotic 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.
Dyshidrotic dermatitis in Adult
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Synopsis
Codes
ICD10CM:
L30.1 – Dyshidrosis [pompholyx]
SNOMEDCT:
201201000 – Podopompholyx
402222007 – Vesicular hand eczema
L30.1 – Dyshidrosis [pompholyx]
SNOMEDCT:
201201000 – Podopompholyx
402222007 – Vesicular hand eczema
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Diagnostic Pearls
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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
- Scabies
- In immunocompromised patients, also consider crusted scabies.
- Epidermolysis bullosa simplex
- Porphyria cutanea tarda
- Hand-foot-and-mouth disease
- Zoster
- An unusual acral form of bullous pemphigoid resembles dyshidrotic eczema.
- Dyshidrotic cutaneous T-cell lymphoma
- Erythema multiforme
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below 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.
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References
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Last Reviewed:12/16/2020
Last Updated:12/16/2020
Last Updated:12/16/2020
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Dyshidrotic dermatitis in Adult