Dyshidrotic eczema, also known as dyshidrosis or palmoplantar eczema, is a condition of atopic dermatitis specific to the palms and soles. The cause of dyshidrosis is not completely understood. Most cases are found to be multifactorial in cause. Some possible associations can include hyperhidrosis, occupational or environmental exposures, history of atopic disease, dermatophyte infection, treatment with IVIG or Coseyntx, smoking, and/or exposure to ultraviolet radiation.
Specific triggers are not always identified. Patients often complain about hyperhidrosis, erythema, crusting, scaling, pruritis, small papules that later blister and pop, and draining clear liquid on palms and soles.
Skin examination findings can include erythema, vesicles that coalesce into larger bullae, and scaling on palms, dorsal fingers, and soles. Bullae will then desiccate and resolves with desquamation. Treatment options can initially include generous amounts of thick emollients applied over medium-to-high strength topical steroids 1-2 times daily for a limited amount of time. Patch allergy testing to evaluate for causative factors can be helpful in some cases, and for avoidance of allergens. Decreasing handwashing or changing hand soaps may also be helpful. Complications can include secondary bacterial infections.
This condition is of a chronic intermittent course. Regular follow-up with a dermatologist is important to evaluate and treat any possible causes. Treatment of this potentially chronic intermittent eczema is important to decrease the risk of effects on the nail beds, secondary infection, and to ensure quality of life is not affected.
Written by Laura Badami, APRN
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