Dyshidrosis

Description

• A common chronic dermatitis often involving the palms and soles. The precise definition is frequently debated, with many terms being used interchangeably. Efforts are being made to more specifically define dyshidrosis, and literature supports the presence of several different classes within the family “dyshidrosis.”
• Dyshidrotic eczema
  • Common, chronic, or recurrent; nonerythematous; symmetric vesicular eruption primarily of the palms, soles, and interdigital areas
  • Associated with burning, itching, and pain
• Pompholyx (from Greek “bubble”)
  • Rare condition characterized by abrupt onset of large bullae
  • Often used interchangeably with dyshidrotic eczema (small vesicles); however, may be a distinct entity
• Lamellar dyshidrosis
  • Fine, spreading, exfoliation of the superficial epidermis in the same distribution as described above
• System(s) affected: dermatologic, exocrine, immunologic
• Synonym(s): cheiropompholyx, keratolysis exfoliativa, vesicular palmoplantar eczema, desquamation of interdigital spaces pompholyx, acute and recurrent vesicular hand dermatitis, recurrent vesicular palmoplantar dermatitis

Epidemiology

• Mean age of onset is 40 years and younger.
• Male = female
• Comprises 5–20% of hand eczema cases

Prevalence
20 cases per 100,000 people

Etiology and Pathophysiology

• Exact mechanism 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
• Aggravating factors (debated)
  • Hyperhidrosis (in 40% of patients with the condition)
  • Detergents/solvents
  • Increased water exposure (e.g., florists, hair stylists, health care workers)
  • Climate: hot/cold weather; humidity
  • Contact sensitivity (in 30–67% of patients with the condition) (2)
  • Metals: nickel, cobalt, and chromate sensitivity (may include implanted orthopedic or orthodontic metals) (1)
  • Stress
  • Dermatophyte infection (present in 10% of patients with the condition) (2)
  • Prolonged wear of occlusive gloves
  • Cement workers
  • IV immunoglobulin therapy
  • Smoking
  • Sunlight/UVA radiation

• Atopy: 50% of patients with dyshidrotic eczema have atopic dermatitis (1).
• Rare autosomal dominant form of pompholyx found in Chinese population maps to chromosome 18q22.1–18q22.3 (2)

Risk Factors

• Many risk 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
• Sensitivity to
  • Foods
  • Drugs: neomycin, quinolones, acetaminophen, and oral contraceptives
  • Contact and dietary: nickel (more common in young women), chromate (more common in men), and cobalt (1)
  • Smoking

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)