Dyshidrotic eczema (pompholyx)
Dyshidrotic eczema (pompholyx) is a recurrent, intensely pruritic eczematous dermatitis of the palms, soles, and sides of the digits that produces small, deep-seated, tapioca-like vesicles which desquamate into erosions and fissures. It is a clinical diagnosis and one of the causes of hand dermatitis; treatment is trigger avoidance, hand protection, petrolatum, and a potent topical glucocorticoid during flares, with KOH prep, mineral-oil prep, and patch testing used to exclude tinea, scabies, and contact allergy.
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What this article covers
- Overview
Definition: dyshidrotic eczema (dyshidrosis, pompholyx) is a form of hand dermatitis characterized by recurrent, intensely pruritic, small vesicles on the palms and sides of the fingers; it is also common on the soles and sides of the toes.
- Epidemiology
Hand dermatitis is most common in people whose jobs involve prolonged exposure to water, chemicals, and occlusive gloves, including health care, house cleaning, food preparation, and hairstyling.
- Risk factors
Wet work and irritant exposure, chiefly water and detergents, which exacerbate dyshidrosis and also cause chronic irritant hand dermatitis.
- Pathophysiology
Barrier disruption comes first: water, detergents, and solvents damage keratinocytes, increasing epidermal permeability and water loss and triggering a nonspecific inflammatory response at the exposed site.
- Clinical features
Hallmark (required for the diagnosis): multiple small, deep-seated, tapioca-like vesicles on the palmar or plantar skin, especially along the lateral aspects of the fingers and toes.
- Differential diagnosis
Tinea manuum (dermatophyte infection): annular, scaly plaques on the dorsal hand or palmar hyperkeratosis that is typically unilateral, often with both feet involved ("two feet, one hand"); KOH prep of the scale shows hyphae.
- Diagnosis
Dyshidrotic eczema is a clinical diagnosis with no formal criteria score or confirmatory test.
- Management
First, for every patient, remove triggers and protect the hands: identify and avoid irritants (water, detergents, solvents) and any suspected allergen, and wear white cotton glove liners inside…
- Complications
Secondary bacterial infection with Staphylococcus aureus, signaled by yellow crusts on eroded skin, the most common complication and a frequent cause of apparent treatment failure.
- Prognosis
Chronic and recurrent: dyshidrotic eczema is diagnosed by its repeated episodes, and flares recur with renewed exposure to water, detergents, and irritants.
- Prevention
Wear white cotton glove liners inside rubber gloves for every episode of wet work or chemical handling, the specific protective measure for dyshidrotic and other hand dermatitis.
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