Dyshidrosis

The characteristics of dyshidrosis are itchiness of the palms or soles, followed by the sudden development of intensely itchy small vesicles on the sides of the fingers, the palms or the feet,

{{Cite journal

| last = Shelley

| first = W. B.

| date = 1953-09-01

| title = Dysidrosis (pompholyx)

| journal = A.M.A. Archives of Dermatology and Syphilology

| volume = 68

| issue = 3

| pages = 314–319

| issn = 0096-5979

| pmid = 13079297

| doi = 10.1001/archderm.1953.01540090076008}}

sometimes described as having a "tapioca pudding" appearance.

{{Cite journal

| last = Bielan

| first = Barbara

| date = 1996-04-01

| title = Dyshidrotic eczema

| url = http://go.galegroup.com/ps/anonymous?id=GALE%7CA19051123&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=10603441&p=AONE&sw=w&authCount=1&isAnonymousEntry=true

| journal = Dermatology Nursing

| language = en

| volume = 8

| issue = 2

| url-status = live

| archive-url = https://web.archive.org/web/20170402082024/http://go.galegroup.com/ps/anonymous?id=GALE%7CA19051123&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=10603441&p=AONE&sw=w&authCount=1&isAnonymousEntry=true

| archive-date = 2017-04-02}}

The vesicles may develop in waves. After a few weeks, the top layer of skin may fall off and inflammation appear around the bases of the vesicles, and there may be peeling, rings of scale, or lichenification. After three to four weeks the vesicles will disappear. While they are present there is a risk of secondary bacterial infection.

{{Cite journal

| last1 = Lofgren

| first1 = Sabra M.

| last2 = Warshaw

| first2 = Erin M.

| date = 2006-12-01

| title = Dyshidrosis: epidemiology, clinical characteristics, and therapy

| journal = Dermatitis: Contact, Atopic, Occupational, Drug

| volume = 17

| issue = 4

| pages = 165–181

| issn = 1710-3568

| pmid = 17150166

| doi = 10.2310/6620.2006.05021}}

The locations of the eruption may be symmetrical on the body,

{{Cite journal

| last1 = Perry

| first1 = Adam D.

| last2 = Trafeli

| first2 = John P.

| date = 2009-05-01

| title = Hand Dermatitis: Review of Etiology, Diagnosis, and Treatment

| journal = The Journal of the American Board of Family Medicine

| language = en

| volume = 22

| issue = 3

| pages = 325–330

| doi = 10.3122/jabfm.2009.03.080118

| issn = 1557-2625

| pmid = 19429739

| doi-access = free}}

and redness is not usually present.

File:DyshidroticDermatitisOnHandsLateStage.jpg|Advanced stage of dyshidrosis on the fingers

File:Dyshidrosis.JPG|Palmar dyshidrosis

File:Palmar dyshidrosis peeling stage.JPG|Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin

File:Dyshidrosis late stage.jpg|Advanced stage of dyshidrosis on the foot

File:Rim of scale on plantar surface of thumb.jpg|Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flare

Whilst the exact causes of the condition are currently unknown, its triggers may include food allergens from a wide range of foods, including tuna, tomato, pineapple, chocolate, coffee, and spices among others, physical or mental stress, frequent hand washing, or metals.

{{Cite journal

| last = Veien

| first = Niels K.

| date = 2009-07-01

| title = Acute and recurrent vesicular hand dermatitis

| journal = Dermatologic Clinics

| volume = 27

| issue = 3

| pages = 337–353, vii

| doi = 10.1016/j.det.2009.05.013

| issn = 1558-0520

| pmid = 19580928}}

A number of studies have implicated balsam of Peru. A 2013 study found that dyshidrosis on the hands increased among those allergic to house dust mites, following inhalation of house dust mite allergen.

{{cite journal

| vauthors = Schuttelaar ML, Coenraads PJ, Huizinga J, De Monchy JG, Vermeulen KM

| title = Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study

| journal = Contact Dermatitis

| volume = 68

| issue = 2

| pages = 76–85

| year = 2013

| pmid = 23046099

| doi = 10.1111/j.1600-0536.2012.02172.x

| s2cid = 4609200

| url = https://pure.rug.nl/ws/files/6789209/Schuttelaar_2013_Contact_Dermat.pdf

| hdl = 11370/69c0f80d-e6f3-4dff-ad75-aadf46b5aaa4

| hdl-access = free}}

Id reaction and irritant contact dermatitis are also possible causes.

{{cite book

| title = Dermatology Secrets Plus

| last = Fitzpatrick

| first = James

| publisher = Elsevier

| year = 2016

| isbn = 978-0-323-31029-1

| pages = 70–81

| chapter = 8

| chapter-url = https://books.google.com/books?id=ReqeCgAAQBAJ&pg=PR76}}

In 2005, researchers from Anhui Medical University and the Chinese National Human Genome Center, Beijing, theorizing that mutations in single genes could predispose the condition, ran a study of a Chinese family with the condition present across four generations via autosomal dominant inheritance. Their analysis of haplotypes within the family identified a locus for the condition on chromosome 18.

{{cite journal

| title = The Gene for a Rare Autosomal Dominant Form of Pompholyx Maps to Chromosome 18q22.1–18q22.3

| author = Chen J., Liang Y., Zhou F., Yang S., Wang J., Wang P., Du W., Xu S., Huang W., Zhang X.

| journal = Journal of Investigative Dermatology

| volume = 126

| issue = 2

| date = February 2006

| pages = 300–304

| publisher = Elsevier

| doi = 10.1038/sj.jid.5700103

| pmid = 16374448

| doi-access = free

}}

Dyshidrosis is diagnosed clinically by gathering a patient's history and making observations. Allergy testing and culture may be done to rule out other problems. Severity of symptoms can also be assessed using the dyshidrotic eczema area and severity index (DASI), although it was designed for clinical trials and is not typically used in practice.

{{Cite journal

| last1 = Vocks

| first1 = E.

| last2 = Plötz

| first2 = S. G.

| last3 = Ring

| first3 = J.

| date = 1999-01-01

| title = The Dyshidrotic Eczema Area and Severity Index – A score developed for the assessment of dyshidrotic eczema

| journal = Dermatology

| volume = 198

| issue = 3

| pages = 265–269

| doi = 10.1159/000018127

| issn = 1018-8665

| pmid = 10393450

| s2cid = 22978226}}

Avoiding triggers may be useful, as may be the application of a barrier cream or wearing of gloves. Treatment is generally made with steroid cream,

{{cite web

| url = http://www.emedicine.com/ped/topic1867.htm

| title = eMedicine – Dyshidrotic Eczema: Article by Camila K Janniger

| access-date = 2007-07-10

| url-status = live

| archive-url = https://web.archive.org/web/20070707015519/http://www.emedicine.com/ped/topic1867.htm

| archive-date = 2007-07-07}}

although this can be dangerous in the long term due to the side effect of thinning of the skin, which is particularly troublesome in the context of hand dyshidrosis due to the amount of toxins and bacteria the hands typically come in contact with. High strength steroid creams may be required for the first week or two.

In especially acute and severe cases, systemic steroids can be taken orally; the immunosuppressive drug tacrolimus, or PUVA therapy may also be tried. Dapsone (diamino-diphenyl sulfone), an antibacterial, has been recommended for the treatment of dyshidrosis in some chronic cases.

{{cite web

| url = http://www.dermnet.org.nz/dermatitis/pompholyx.html

| title = Vesicular hand dermatitis

| access-date = 2010-04-07

| url-status = live

| archive-url = https://web.archive.org/web/20100330150735/http://www.dermnet.org.nz/dermatitis/pompholyx.html

| archive-date = 2010-03-30}}

Antihistamines such as Fexofenadine may be used to help with the itching.

{{Cite journal

| last1 = Diepgen

| first1 = Thomas L.

| last2 = Agner

| first2 = Tove

| last3 = Aberer

| first3 = Werner

| last4 = Berth-Jones

| first4 = John

| last5 = Cambazard

| first5 = Frédéric

| last6 = Elsner

| first6 = Peter

| last7 = McFadden

| first7 = John

| last8 = Coenraads

| first8 = Pieter Jan

| date = 2007-10-01

| title = Management of chronic hand eczema

| journal = Contact Dermatitis

| language = en

| volume = 57

| issue = 4

| pages = 203–210

| doi = 10.1111/j.1600-0536.2007.01179.x

| pmid = 17868211

| s2cid = 34639884

| issn = 1600-0536

| doi-access = free}}

Potassium permanganate dilute solution soaks are popular, used to "dry out" the vesicles

{{cite journal

| author = BIRT AR

| title = Drugs for Eczema of Children

| journal = Can Med Assoc J

| volume = 90

| issue = 11

| pages = 693–4

| date = March 1964

| pmid = 14127384

| pmc = 1922428}}

and kill off superficial Staphylococcus aureus,

{{cite journal

| author = Stalder JF

| title = Comparative effects of two topical antiseptics (chlorhexidine vs KMn04) on bacterial skin flora in atopic dermatitis

| journal = Acta Derm Venereol Suppl (Stockh)

| volume = 176

| pages = 132–4

| year = 1992

| pmid = 1476027

| name-list-style = vanc

| author2 = Fleury M

| author3 = Sourisse M

| display-authors = 3

| last4 = Allavoine

| first4 = T

| last5 = Chalamet

| first5 = C

| last6 = Brosset

| first6 = P

| last7 = Litoux

| first7 = P}}

but they can be very painful and undiluted may cause significant burning.

{{cite journal

| vauthors = Baron S, Moss C

| title = Caustic burn caused by potassium permanganate

| journal = Arch. Dis. Child.

| volume = 88

| issue = 2

| pages = 96

| date = February 2003

| pmid = 12538301

| doi= 10.1136/adc.88.2.96

| pmc = 1719457}}

Alitretinoin (9-cis-retinoic acid) has been approved for prescription in the UK. It is specifically used for chronic hand and foot eczema.

{{cite journal

| vauthors = Ruzicka T, Lynde CW, Jemec GB, Diepgen T, Berth-Jones J, Coenraads PJ, Kaszuba A, Bissonnette R, Varjonen E, Holló P, Cambazard F, Lahfa M, Elsner P, Nyberg F, Svensson A, Brown TC, Harsch M, Maares J

| display-authors = 6

| title = Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial

| journal = Br. J. Dermatol.

| volume = 158

| issue = 4

| pages = 808–17

| date = April 2008

| pmid = 18294310

| doi = 10.1111/j.1365-2133.2008.08487.x

| s2cid = 205256947

| url = https://pure.rug.nl/ws/files/6715954/Ruzicka_2008_Br_J_Dermatol.pdf

| access-date = 2019-02-05

| archive-date = 2019-02-18

| archive-url = https://web.archive.org/web/20190218111529/https://pure.rug.nl/ws/files/6715954/Ruzicka_2008_Br_J_Dermatol.pdf

| url-status = dead}}

{{cite journal

| vauthors = Bollag W, Ott F

| title = Successful treatment of chronic hand eczema with oral 9-cis-retinoic acid

| journal = Dermatology

| volume = 199

| issue = 4

| pages = 308–12

| date = 1999

| pmid = 10640839

| doi = 10.1159/000018280

| s2cid = 35358182}}{{cite journal

| vauthors = Ruzicka T, Larsen FG, Galewicz D, Horváth A, Coenraads PJ, Thestrup-Pedersen K, Ortonne JP, Zouboulis CC, Harsch M, Brown TC, Zultak M

| title = Oral alitretinoin (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

| journal = Arch Dermatol

| volume = 140

| issue = 12

| pages = 1453–9

| date = December 2004

| pmid = 15611422

| doi = 10.1001/archderm.140.12.1453

| doi-access = free}}

It is made by Basilea of Switzerland (BAL 4079).

A study of 20,000 randomly-selected individuals in Gothenburg, Sweden in 1988 found 2% of male respondents and 3% of female respondents to have dyshidrosis, and that it comprised 5% of cases of hand eczema of any type.

{{cite journal

| url = https://medicaljournalssweden.se/actadv/article/view/4647

| title = Epidemiology of different types of hand eczema in an industrial city

| journal = Acta Dermato-Venereologica

| volume = 69

| issue = 3

| pages = 227–233

| date = 17 May 1989

| author1-last = Meding

| author1-first = B.

| author2-last = Swanbeck

| author2-first = G.

| doi = 10.2340/0001555569227233

| doi-broken-date = 1 November 2024

| pmid = 2566226

| access-date = 16 May 2024

}}

A study of 6300 pediatric patients in Turkey in 2006 found 1% to have dyshidrosis.

{{cite journal

| url = https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1346-8138.2008.00495.x

| title = Prevalence of skin diseases among pediatric patients in Turkey

| journal = Journal of Dermatology

| volume = 35

| pages = 413–418

| date = 10 July 2008

| author1-last = Tamer

| author1-first = Emine

| author2-last = Ilhan

| author2-first = Mustafa N.

| author3-last= Polat

| author3-first = Muhterem

| author4-last = Lenk

| author4-first = Nurdan

| author5-last = Alli

| author5-first = Nuran

| issue = 7

| doi = 10.1111/j.1346-8138.2008.00495.x

| pmid = 18705828

| access-date = 16 May 2024

| url-access = subscription

}}

The condition was named dyshidrosis by the British dermatologist William Tilbury Fox in 1873, in a clinical lecture wherein he presented it as "a disordered condition of the sweat-follicles and the sweat-function... which is, as a rule, diagnosed as eczema, but is a separate and distinct affair... I have termed the disease {{sic|dysidrosis}}, because nature seems to have a difficulty in getting rid of the secreted sweat, which remains to distend the follicles, and to macerate the tissues."

{{cite journal

| url = https://archive.org/details/sim_british-medical-journal_july-5-december-27-1873_2/page/368

| title = Clinical Lecture on Dysidrosis: An Undescribed Eruption

| journal = British Medical Journal

| date = 27 September 1873

| volume = 2

| issue = 665

| pages = 365–366

| doi = 10.1136/bmj.2.665.365

| pmc = 2294466

| pmid = 20747210

| author-last = Tilbury Fox

| author-first = William

| author-link = William Tilbury Fox

| access-date = 16 May 2024

}} His theory that the condition was related to sweat was soon observed as unproven in scholarly publication{{cite book

| url = https://archive.org/details/b21932050/page/252/mode/2up?q=%22sweat+duct+theory%22

| title = A Manual of Dermatology

| year = 1885

| page = 252

| publisher = D. Appleton & Company

| location = New York

| last = Robinson

| first = Andrew Rose

| access-date = 16 May 2024}} and subsequent research on multiple occasions has shown an absence of relation to the sweat glands.{{cite journal

| url = https://pubmed.ncbi.nlm.nih.gov/18087011/

| title = Acute and recurrent vesicular hand dermatitis not pompholyx or dyshidrosis

| journal = JAMA Dermatology

| doi = 10.1001/archderm.143.12.1578

| pmid = 18087011

| date = December 2007

| volume = 143

| issue = 12

| author-last = Storrs

| author-first = Frances J

| pages = 1578–1580

| access-date = 16 May 2024}}

The condition had already been described clinically in a lecture in 1871 by Sir Jonathan Hutchinson, who had named it cheiro-pompholyx.{{efn|name=pompholyx}}

{{cite journal

| url = https://archive.org/details/sim_the-lancet_1876-04-29_1_2748/page/630/mode/2up

| title = Cheiro-Pompholyx

| journal = The Lancet

| date = 29 April 1876

| volume = 1

| issue = 2748

| pages = 630–631

| author-last = Hutchinson

| author-first = Sir Jonathan

| author-link = Jonathan Hutchinson

| orig-date = lecture given in April 1871

| access-date = 17 May 2024}}

Hutchinson's work was based on his observations, in 1864, of the same woman patient who Tilbury Fox would later describe in his own lecture. In 1875 Hutchinson published his book Illustrations of Clinical Surgery, describing the condition of "cheiro-pompholyx" without making reference to Tilbury Fox's work.

{{cite book

| url = https://archive.org/details/b21515736_0002/page/n5/mode/2up

| title = Illustrations of Clinical Surgery

| chapter = Plate X. Cheiro-pompholyx.

| pages = 49–52

| year = 1875

| publisher = J. & A. Churchill

| author-last = Hutchinson

| author-first = Sir Jonathan

| author-link = Jonathan Hutchinson

| access-date = 17 May 2024}}

This led to a dispute between the two dermatologists, played out in letters to The Lancet.

Tilbury Fox was aggrieved that his reading of Hutchinson's lecture suggested it to imply Hutchinson had been the first to formally describe the condition. Hutchinson apologised, saying that he had been in too much of a hurry to publish to read Tilbury Fox's work, and being aware that Tilbury Fox had described it as a sweating disorder, he had considered it to be a different condition to the one he was writing about.

{{cite journal

| url = https://archive.org/details/sim_the-lancet_1876-04-22_1_2747/page/618/mode/2up

| title = Mr. Hutchinson's "Cheiro-Pompholyx".

| journal = The Lancet

| date = 22 April 1876

| volume = 1

| issue = 2747

| pages = 618–619

| author-last = Hutchinson

| author-first = Sir Jonathan

| author-link = Jonathan Hutchinson

| access-date = 17 May 2024}}

In the same letter he chastised Tilbury Fox for claiming propriety over describing the vesicles as resembling "a sago grain", a comparison that he had also independently made, and noted that the subject of his lecture in 1871 had been his patient for several years before Tilbury Fox's lecture.

In an editorial for the Chicago Medical Journal and Examiner, Dr. Nathan Smith Davis wryly described the dispute as "not the first occasion upon which two eminent men have contended for the honor of a lady's hand."

{{cite journal

| url = https://archive.org/details/sim_chicago-medical-journal-and-examiner_1876-09_33_9/page/816/mode/2up

| title = The Controversy Between Mr. Jonathan Hutchinson and Dr. Tilbury Fox

| journal = The Chicago Medical Journal and Examiner

| date = September 1876

| volume = 33

| issue = 9

| pages = 816–819

| author-last = Davis

| author-first = Dr. Nathan Smith

| author-link = Nathan Smith Davis

| access-date = 17 May 2024}}

After a paper by Dr. A. R. Robinson describing the condition, entitled "Pompholyx" and mentioning the dispute, was published in the Archives of Dermatology the following year,

{{cite journal

| url = https://archive.org/details/archivesofdermat3187unse/page/n303/mode/2up

| title = Pompholyx

| journal = Archives of Dermatology

| date = July 1877

| volume = 3

| pages = 290–303

| author-last = Robinson

| author-first = A. R.

| editor-last = Bulkley

| editor-first = Lucius Duncan

| editor-link = Lucius Duncan Bulkley

| publisher = G. P. Putnam's Sons

| location = New York City

| access-date = 17 May 2024}}

Tilbury Fox responded with a strident critique of Robinson's conclusions and accused him of having misrepresented the facts of the dispute.

{{cite journal

| url = https://archive.org/details/archivesofdermat3187unse/page/n303/mode/2up

| title = A Note on "Dyshidrosis"

| journal = Archives of Dermatology

| date = January 1878

| volume = 4

| pages = 42–46

| author-last = Tilbury Fox

| author-first = William

| author-link = William Tilbury Fox

| editor-last = Bulkley

| editor-first = Lucius Duncan

| editor-link = Lucius Duncan Bulkley

| publisher = J. B. Lippincott & Co.

| location = Philadelphia

| access-date = 17 May 2024}}

• Dermatitis herpetiformis – a similar condition caused by celiac and often mistaken for dyshidrosis.
• Epidermolysis bullosa – a genetic disorder that causes similar, albeit more severe, symptoms to those of dyshidrosis.

{{Notelist}}

{{Reflist}}

{{Medical resources

| DiseasesDB = 10373

| ICD11 = {{ICD11|EA85.0}}

| ICD10 = {{ICD10|L|30|1|L|20}}

| ICD9 = {{ICD9|705.81}}

| ICDO =

| OMIM =

| MedlinePlus = 000832

| eMedicineSubj = derm

| eMedicineTopic = 110

| eMedicine_mult = {{eMedicine2|ped|1867}}

| MeshID = D011146

}}

{{Commons category|Dyshidrosis}}

{{Diseases of the skin and subcutaneous tissue}}

{{Disorders of skin appendages}}

Category:Eczema

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate

Category:Chronic blistering cutaneous conditions