DYSHIDROSIS, is a type of dermatitis , that is characterized by itchy
blisters on the palms of the hands and bottoms of the feet. Blisters
are generally one to two millimeters in size and heal over three
weeks. However, they often recur. Redness is not usually present.
Repeated attacks may result in fissures and skin thickening .
The cause is unknown. Triggers may include allergens, physical or
mental stress , frequent hand washing, or metals. Diagnosis is
typically based on what it looks like and the symptoms. Allergy
testing and culture may be done to rule out other problems. Other
conditions that produce similar symptoms include pustular psoriasis
and scabies .
Avoiding triggers may be useful as may a barrier cream . Treatment
is generally with steroid cream . High strength steroid creams may be
required for the first week or two.
Antihistamines may be used to
help with the itch. If this is not effective steroid pills,
tacrolimus , or psoralen plus ultraviolet A (PUVA) may be tried.
About 1 in 2,000 people are affected in
Sweden . Males and females
appear to be affected equally. The first description was in 1873. The
name comes from the word "dyshidrotic," meaning "difficult sweating,"
as problems with sweating was once believed to be the cause.
* 1 Signs and symptoms
* 2 Causes
* 3 Diagnosis
* 4 Treatment
* 5 Epidemiology
* 6 See also
* 7 References
* 8 External links
SIGNS AND SYMPTOMS
Dyshidrosis has been described as having the following
* Itchiness of the palms or soles, followed the a sudden development
of intensely itchy small blisters on the sides of the fingers, the
palms or the feet.
* These blisters are often described as having a "tapioca pudding "
* After a few weeks, the small blisters eventually disappear as the
top layer of skin falls off.
* These eruptions do not occur elsewhere on the body.
* The eruptions may be symmetrical.
Advanced stage of dyshidrosis on the fingers
Advanced stage of palmar dyshidrosis on the palm showing cracked and
Advanced stage of dyshidrosis on the foot.
Rim of scale on the palmar surface of the thumb from a resolving
The exact causes of dyshidrosis are unknown. In 2013, a randomized,
double-blind, placebo-controlled cross-over study by the University
Medical Center Groningen reported that dyshydrosis outbreaks on the
hands increased significantly among those allergic to house dust mites
, following inhalation of house dust mite allergen.
Food allergens may be involved in certain cases. Cases studies have
implicated a wide range of foods including tuna , tomato , pineapple ,
chocolate , coffee , and spices among others. A number of studies
have implicated balsam of Peru .
Dyshidrosis is diagnosed clinically, by gathering a patient's history
and making careful observations (see signs and symptoms section).
Severity of symptoms can also be assessed using the dyshidrotic eczema
area and severity index (DASI). The DASI has been designed for
clinical trials and is not typically used in practice.
There are many treatments available for dyshidrosis. However, few of
them have been developed or tested specifically on the condition.
* Barriers to moisture and irritants, including barrier creams and
* 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 - also popular, and
used to 'dry out' the vesicles, and kill off superficial
Staphylococcus aureus , but it can also be very painful. Undiluted it
may cause significant burning.
Dapsone (diamino-diphenyl sulfone), an antibacterial , has been
recommended for the treatment of dyshidrosis in some chronic cases.
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 (BAL 4079).
* Systemic steroids can be taken orally to treat especially acute
and severe cases of dyshidrosis.
About 1 in 2,000 people are affected in
Sweden . Males and females
appear to be affected equally.
Epidermolysis bullosa - a genetic disorder that causes similar,
albeit more severe, symptoms to those of dyshidrosis.
Dermatitis herpetiformis - a similar condition caused by celiac
and often mistaken for dyshidrosis.
* ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews'
Diseases of the Skin: Clinical
Dermatology (10th ed.). Saunders. ISBN
* ^ "Pompholyx". Patient. 2014-02-26. Archived from the original on
3 August 2016. Retrieved 11 August 2016.
* ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L.
(2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN
* ^ "Dyshidrosis".
Merriam-Webster . 2014.
Archived from the original on 15 April 2014. Retrieved 14 April 2014.
* ^ A B "What Is Atopic Dermatitis? Fast Facts". NIAMS. November
2014. Archived from the original on 27 July 2016. Retrieved 11 August
* ^ A B C D E F G H I J K L M N O P Lofgren, SM; Warshaw, EM
(December 2006). "Dyshidrosis: epidemiology, clinical characteristics,
Dermatitis : contact, atopic, occupational, drug. 17
(4): 165–81. PMID 17150166 .
* ^ A B C D E F G H I J K L Colomb-Lippa, D; Klingler, AM (July
2011). "Dyshidrosis.". JAAPA : official journal of the American
Academy of Physician Assistants. 24 (7): 54. PMID 21748961 .
* ^ Shelley, W. B. (1953-09-01). "Dysidrosis (pompholyx)". A.M.A.
Dermatology and Syphilology. 68 (3): 314–319. ISSN
0096-5979 . PMID 13079297 . Archived from the original on 2017-04-03.
* ^ Bielan, Barbara (1996-04-01). "Dyshidrotic eczema". Dermatology
Nursing. 8 (2). Archived from the original on 2017-04-02.
* ^ Veien, Niels K. (2009-07-01). "Acute and recurrent vesicular
hand dermatitis". Dermatologic Clinics. 27 (3): 337–353, vii. ISSN
1558-0520 . PMID 19580928 . doi :10.1016/j.det.2009.05.013 . Archived
from the original on 2016-10-24.
* ^ Lofgren, Sabra M.; Warshaw, Erin M. (2006-12-01). "Dyshidrosis:
epidemiology, clinical characteristics, and therapy". Dermatitis:
Contact, Atopic, Occupational, Drug. 17 (4): 165–181. ISSN 1710-3568
. PMID 17150166 . Archived from the original on 2017-04-03.
* ^ A B C Perry, Adam D.; Trafeli, John P. (2009-05-01). "Hand
Dermatitis: Review of Etiology, Diagnosis, and Treatment". The Journal
of the American Board of Family Medicine. 22 (3): 325–330. ISSN
1557-2625 . PMID 19429739 . doi :10.3122/jabfm.2009.03.080118 .
Archived from the original on 2017-09-08.
* ^ Schuttelaar ML, Coenraads PJ, Huizinga J, De Monchy JG,
Vermeulen KM (2013). "Increase in vesicular hand eczema after house
dust mite inhalation provocation: a double-blind, placebo-controlled,
cross-over study". Contact Dermatitis. 68 (2): 76–85. PMID 23046099
. doi :10.1111/j.1600-0536.2012.02172.x .
* ^ A B C Veien, Niels K. (2009-07-01). "Acute and recurrent
vesicular hand dermatitis". Dermatologic Clinics. 27 (3): 337–353,
vii. ISSN 1558-0520 . PMID 19580928 . doi :10.1016/j.det.2009.05.013 .
* ^ Vocks, E.; Plötz, S. G.; Ring, J. (1999-01-01). "The
Eczema Area and Severity Index - A score developed for the
assessment of dyshidrotic eczema".
Dermatology (Basel, Switzerland).
198 (3): 265–269. ISSN 1018-8665 . PMID 10393450 . doi
:10.1159/000018127 . Archived from the original on 2017-04-03.
* ^ "eMedicine - Dyshidrotic
Eczema : Article by Camila K
Janniger". Archived from the original on 2007-07-07. Retrieved
* ^ BIRT AR (March 1964). "Drugs for
Eczema of Children" . Can Med
Assoc J. 90 (11): 693–4. PMC 1922428 . PMID 14127384 .
* ^ Stalder JF, Fleury M, Sourisse M, et al. (1992). "Comparative
effects of two topical antiseptics (chlorhexidine vs KMn04) on
bacterial skin flora in atopic dermatitis". Acta Derm Venereol Suppl
(Stockh). 176: 132–4. PMID 1476027 .
* ^ Baron S, Moss C (February 2003). "Caustic burn caused by
potassium permanganate". Arch. Dis. Child. 88 (2): 96. PMC 1719457
. PMID 12538301 . doi :10.1136/adc.88.2.96 .
* ^ "Archived copy". Archived from the original on 2010-03-30.
* ^ Diepgen, Thomas L.; Agner, Tove; Aberer, Werner; Berth-Jones,
John; Cambazard, Frédéric; Elsner, Peter; McFadden, John; Coenraads,
Pieter Jan (2007-10-01). "Management of chronic hand eczema". Contact
Dermatitis. 57 (4): 203–210. ISSN 1600-0536 . doi
:10.1111/j.1600-0536.2007.01179.x . Archived from the original on
* ^ Ruzicka T, Lynde C, Jemec G et al. Efficacy and safety of oral
alitretinoin in patients with severe chronic hand eczema refractory to
topical corticosteroids: results of a randomised, double-blind,
placebo-controlled, multicentre trial. British Journal of Dermatology
April 2008; 158(4): 808-817.
Dermatology 1999;199:308-312 doi :10.1159/000018280
* ^ Vol. 140 No. 12, December 2004 Archives of
Al1itretinoin (9-cis-Retinoic Acid) Therapy for Chronic Hand
Dermatitis in Patients Refractory to Standard Therapy Results of a
Randomized, Double-blind, Placebo-Controlled, Multicenter Trial Thomas
Ruzicka, MD; Frederik Grønhøj Larsen, MD, PhD; Dorota Galewicz, MD;
Attila Horváth, MD; Peter Jan Coenraads, MD; Kristian
Thestrup-Pedersen, MD; Jean Paul Ortonne, MD; Christos C. Zouboulis,
MD; Martin Harsch, PhD; Thomas C. Brown, PhD; Maurice Zultak