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Dyshidrosis

Dyshidrosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

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 but no general consensus.
  • 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

Epidemiology

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

Prevalence
20 cases/100,000 populations

Etiology and Pathophysiology

  • Exact mechanism unknown; thought to be multifactorial
  • Dermatopathology: intraepidermal spongiosis without effect on eccrine sweat glands
  • Vesicles remain intact due to thickness of stratum corneum of palmar/plantar skin (1).
  • Exact cause not known; although the following have been implicated: allergies, genetics, and dermatophyte infection
  • Aggravating factors (debated)
    • Hyperhidrosis (in 40% of patients with the condition)
    • Detergents/solvents
    • Increased water exposure
    • Climate: hot/cold weather; humidity
    • Contact sensitivity (in 30–67% of patients with the condition) (2)
    • 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
    • IV immunoglobulin therapy
    • Smoking
    • UVA radiation

Genetics
  • 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)

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Citation

Stephens, Mark B., et al., editors. "Dyshidrosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116195/all/Dyshidrosis.
Dyshidrosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116195/all/Dyshidrosis. Accessed March 24, 2019.
Dyshidrosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116195/all/Dyshidrosis
Dyshidrosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116195/all/Dyshidrosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dyshidrosis ID - 116195 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116195/all/Dyshidrosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -