Dyshidrotic eczema, also known as dyshidrotic dermatitis or pompholyx, is characterized by pruritic, tense, deep-seated vesicles mainly on the palms and lateral surfaces of the fingers. In the chronic phase, scaling, desquamation, fissuring, and, sometimes, lichenification may be seen. The peak age of onset is between 20 and 30 years of age. The sex incidence is approximately equal. Most cases are idiopathic. Predisposing factors include atopy, contact allergens, contact irritants, dermatophyte infection, allergy to ingested metal, hyperhidrosis, prolonged use of protective gloves, intravenous immunoglobulin, psychological stress, and smoking. Although the disease is benign, it tends to run a chronic and relapsing course. Successful treatment requires a systemic multipronged approach that consists of avoidance of triggering factors, optimal skin care, pharmacotherapy during acute exacerbations, and education of patients/caregivers. Ultrapotent topical corticosteroids are the mainstay of pharmacotherapy.
Author(s): Alexander K. C. Leung, Benjamin Barankin, and Kam Lun Hon