What is dyshidrotic eczema?

What is Dyshidrotic Eczema?

Dyshidrotic eczema (also called pompholyx or acute palmoplantar eczema) is a recurrent vesicular eruption characterized by intensely pruritic, small tense vesicles primarily affecting the palms, soles, and lateral/ventral surfaces of the fingers. 1, 2

Clinical Presentation

The condition presents with distinctive features that aid in diagnosis:

• Vesicles appear as "tapioca pudding" on physical examination, which is the characteristic clinical hallmark of this disorder 2
• Vesicles are embedded deep in the epidermis below the thick stratum corneum, appearing strongly distended and painful as they enlarge 3
• Lesions typically develop suddenly after a period of ferocious pruritus 3
• The eruption is symmetrical and affects the palms, soles, and/or lateral aspects of fingers 4
• Individual vesicles dry up and disappear within approximately three weeks, though relapses are frequent 3

Epidemiology and Demographics

• The condition is more common in young adults 2
• It affects men and women equally 2
• Relapses occur more frequently in patients with atopy, sweat gland disorders, or neurovegetative disturbances 3

Pathophysiology and Etiology

While the exact etiology remains unknown, several factors are implicated:

• Histologic examination reveals an eczematous reaction around sweat ducts, though this is not associated with structural abnormalities of the sweat ducts themselves 1
• The condition often occurs in individuals with hyperhidrosis, suggesting a relationship to sweating 1
• Seasonal variation exists, with flares commonly occurring during spring allergy season 1
• Metal allergy (particularly nickel and cobalt) is regarded as one of the important potential etiologic factors, given the presence of metal allergy in affected patients and improvement when metal allergens are removed 1, 5

Clinical Variants and Complications

Several clinical presentations may occur:

• Bullous dyshidrotic eczema 3
• Secondary bacterial superinfection 3
• Psoriasiform keratodermia 3
• Dystrophic fingernail changes 5

Nomenclature

The term "acute and recurrent vesicular hand dermatitis" has been proposed more recently to better reflect the clinical features of this condition 1

Triggering Factors

Multiple exogenous factors may precipitate flares:

• Dermatophyte infections 5
• Contact irritants 5
• Metal hypersensitivity (nickel and cobalt) 5
• High oral ingestion of nickel and/or cobalt, regardless of patch test results 5
• Intravenous immunoglobulin therapy (rare drug-related side effect) 4