Dyshidrosis

BASICS

DESCRIPTION

  • Common, chronic or recurrent dermatitis involving the palms and soles. The precise definition is not well-settled, with many terms used interchangeably.
  • Nonerythematous; symmetric, fluid filled, deep vesicular eruption primarily of the palms, soles, and interdigital areas
  • Associated with burning, itching, and pain
  • System(s) affected: dermatologic, exocrine, immunologic
  • Synonym(s): dyshidrotic eczema, pompholyx (from Greek “bubble”), lamellar dyshidrosis, acute palmoplantar eczema, cheiropompholyx, keratolysis exfoliativa, vesicular palmoplantar eczema, desquamation of interdigital spaces pompholyx, acute and recurrent vesicular hand dermatitis, recurrent vesicular palmoplantar dermatitis

EPIDEMIOLOGY

Incidence

  • Mean age of onset is ≤40 years.
  • Male < female
  • Comprises 5–20% of hand eczema cases

Prevalence

20 cases/100,000 people

ETIOLOGY AND PATHOPHYSIOLOGY

  • Exact mechanism is unknown; thought to be multifactorial (allergies, genetics, and dermatophyte infection implicated)
  • Dermatopathology: intraepidermal spongiosis without effect on eccrine sweat glands
  • Vesicles remain intact due to thickness of stratum corneum of palmar/plantar skin (1).
  • Immunologic reaction: theorized that rapid rise in immunoglobulin levels may precipitate vesicle formation

Genetics

  • Atopy: 50% of patients with dyshidrotic eczema have atopic dermatitis (1). Transcriptome analysis results in a large overlap between vesicular hand eczema and atopic dermatitis.
  • Hypothesized that overexpression of 2 water/glycerol channel proteins (aquaporin-3 and aquaporin-10) may alter the function of the epidermal water permeability barrier.
  • Rare autosomal dominant form of pompholyx found in Chinese population maps to chromosome 18q22.1–18q22.3 (2)

RISK FACTORS

  • Many risk factors and aggravating factors are disputed in the literature, with none being consistently associated.
  • Atopy
  • Other dermatologic conditions
    • Atopic dermatitis (early in life)
    • Contact dermatitis (later in life)
    • Dermatophytosis (present in 10% of patients with the condition) (2)
    • Hyperhidrosis (present in 40% of patients with the condition)
    • Contact sensitivity present in 30–67% patients (2)
  • Sensitivity to
    • Foods
    • Drugs: neomycin, quinolones, acetaminophen, oral contraceptives, and IV immunoglobulin therapy
    • Metals: nickel (more common in young women), cobalt, and chromate (more common in men) sensitivity which may include implanted orthopedic or orthodontic metals (1)
    • Smoking
    • Detergents/solvents
    • Increased water exposure (e.g., florists, hair stylists, health care workers)
    • Cement exposure (construction/industrial workers)
    • Climate: hot/cold weather; humidity
    • Stress
    • Prolonged wear of occlusive gloves
    • Sunlight/UVA radiation

GENERAL PREVENTION

  • Control emotional stress.
  • Avoid excessive sweating.
  • Avoid exposure to irritants.
  • Avoid diet high in metal salts (chromium, cobalt, nickel).
  • Avoid smoking.

COMMONLY ASSOCIATED CONDITIONS

  • Atopic dermatitis
  • Allergic contact dermatitis
  • Parkinson disease
  • HIV (2)

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