Acute palmoplantar eczema (dyshidrotic eczema)
- David R Adams, MD, PharmD
David R Adams, MD, PharmD
- Associate Professor of Dermatology
- Penn State Hershey Med Center
- James G Marks, Jr, MD
James G Marks, Jr, MD
- Professor and Chair, Department of Dermatology
- Penn State Milton S. Hershey Medical Center
Acute palmoplantar eczema (more popularly known as dyshidrotic eczema or pompholyx) is an intensely pruritic, vesicular eruption affecting the palms, soles, or both [1,2]. It is characterized by deep-seated lesions ranging from small vesicles to large tense bullae clinically and by spongiotic vesicles histologically. Recurrence is common and patients typically experience frequent episodes for months or years.
This topic will discuss the pathogenesis, clinical presentation, diagnosis, and management of dyshidrotic eczema. Other forms of eczema involving the hands, including irritant and allergic contact dermatitis and atopic dermatitis, are discussed separately. (See "Irritant contact dermatitis in adults" and "Clinical features and diagnosis of allergic contact dermatitis" and "Management of allergic contact dermatitis" and "Pathogenesis, clinical manifestations, and diagnosis of atopic dermatitis (eczema)" and "Treatment of atopic dermatitis (eczema)".)
The terminology for acute palmoplantar eczema is confusing. The term “dyshidrosis” was coined in 1873 to describe a blistering disease of the palms and soles that was believed to be a disorder of the sweat glands . It is now accepted that the sweat glands are not involved in the pathogenesis [4,5]. However, the term “dyshidrotic eczema” continues to be used.
Other terms for acute palmoplantar eczema include pompholyx, dyshidrosis, vesicular palmoplantar eczema, acute and recurrent vesicular hand dermatitis, cheiropompholyx (affecting the hands), or podopompholyx (affecting the feet). These terms do not represent a specific diagnosis, but rather a morphologic pattern of hand/foot eczema that can occur with irritant contact, allergic contact, or endogenous eczema.
The prevalence of dyshidrotic eczema, including mild and severe forms of dyshidrotic eczema, in the general population is unknown. In occupational or clinical settings, dyshidrotic eczema accounts for 5 to 20 percent of all cases of hand dermatitis . It occurs most commonly in young adults and equally among males and females. Risk factors for dyshidrotic eczema include history of atopic dermatitis and exposure to contact allergens or irritants [7-9]. A rare autosomal dominant form of dyshidrotic eczema has been described .
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL PRESENTATION
- Clinical diagnosis
- Patch testing
- DIFFERENTIAL DIAGNOSIS
- CLINICAL COURSE
- Assessment of severity
- General measures
- Mild to moderate disease
- - Topical corticosteroids
- - Topical calcineurin inhibitors
- Severe disease
- - Systemic corticosteroids
- - Topical corticosteroids
- Treatment response
- Refractory disease
- - Evaluation
- - Treatment
- SUMMARY AND RECOMMENDATIONS