Dyshidrosis also known as acute vesiculobullous hand eczema, cheiropompholyx, dyshidrotic eczema, pompholyx and podopompholyx) is a skin condition that is characterized by small blisters on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic, clear vesicles, later, scaling, fissures and lichenification occur. Many eczema cases which are diagnosed are garden-variety atopic eczema. This condition do not spread to others, but the compromised integument can increase susceptibility to infection, and the accompanying itching can be a source of psychological distress. The blisters associated with dyshidrosis occur most commonly on the sides of the fingers and the palms, although the soles of the feet also can be affected. The blisters are usually small like the width of a standard pencil lead and found in cluster appearance which is similar to tapioca. The small blisters may merge together to form larger blisters in fatal cases. Skin affected by dyshidrosis is very itchy and more painful when scratched. The underlying skin may be red and tender once the blisters dry and flake off in about three weeks. Dyshidrosis tends to reoccur regularly for months or years.
Recurrence is common and for many can be chronic. Incidence/prevalence is said to be 1/5,000 in the United States. Dyshidrotic eczema occurs in 5-20% of patients with hand eczema and more commonly develops in warmer climates and during spring and summer months (seasonal or summer pompholyx). The male-to-female ratio for dyshidrotic eczema has variably been reported as 1:1 and 1:2. Dyshidrotic eczema affects individuals aged 4-76 years; the mean age is 38 years. The peak incidence of the condition occurs in patients aged 20-40 years. After middle age, the frequency of dyshidrotic eczema episodes tends to decrease. Dyshidrotic eczema accounted for 1% of initial consultations in a 1-year Swedish study. In a study of 107,206 Swedish individuals, 51 (0.05%) were diagnosed with dyshidrosis. Hand dermatitis cases in that population, 3% had dyshidrosis. A retrospective study recorded out of 714 Portuguese patients during a 6-year period, Magina et al found dyshidrotic eczema to be the third most common type of hand dermatitis (20.3%). There are many treatments available for dyshidrosis. However, few of them have been developed or tested specifically on the condition. Topical steroids - while useful, can be dangerous long-term due to the skin-thinning side-effects, which are particularly troublesome in the context of hand dyshidrosis, due to the amount of toxins and bacteria the hands typically come in contact with. Potassium permanganate dilute solution soaks and used to 'dry out' the vesicles and kill off superficial Staphylococcus aureus, but it can also be very painful. Undiluted may cause significant burning. Tropical Calcineurin inhibitors and Botulism toxin A may also be effective in chronic hand dermatitis. Corticosteroids are cornerstones of topical therapy.
The use of oxybutynin in two patients gave excellent results with coexistent hyperhidrosis and dyshidrotic eczema. Advanced studies are needed before recommending this treatment modality. The potential agents used for the pompholyx treatment are topical bexarotene, systemic alitretinoin, leukotriene receptor antagonists, leukotriene synthesis inhibitors, phosphodiesterase-4 inhibitors, and monoclonal antibodies which have found to be effective for the treatment of chronic hand dermatitis and other inflammatory conditions like atopic dermatitis. Controlled studies need to be conducted to establish their efficacy and safety for the treatment of dyshidrotic eczema (pompholyx). Dapsone (diamino-diphenyl sulfone) is an antibacterial sulfonamide. It has been recommended for the treatment of dyshidrosis in some chronic cases. Antihistamines: Fexofenadine up to 180 mg per day. Alitretinoin (9-cis-retinoic acid) has been approved for prescription in the UK. It is specifically used for chronic hand and foot eczema. It is made by Basilea of Switzerland. In the case of a nickel allergy or sensitivity a low nickel diet may lead to improvement. This includes avoiding high nickel foods like oatmeal and chocolate, canned foods (especially acidic foods like pineapple and tomato that leach metal from the can), and using vitamins that do not contain nickel. In this situation avoiding excessive exposure to environmental nickel may also be helpful, such as not using stainless steel pots and silverware. Successful biofeedback therapy is done for treating stress reduction in some individuals.