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Dyshidrotic eczema

Monday, 18 February 2008

It is a form of eczema often seen on the hands and feet where tiny blisters of serum form just below the skin’s surface. I refer to these as “tapioca seed vesicles”. The presence of these blisters signals an acute flare that is accompanied by tremendous itching. Deep, painful cracks in the skin and superficial scaling tend to accompany this condition. Dyshidrotic Eczema must be distinguished from an allergic contact dermatitis, and I often patch test patients to see whether they have a contact dermatitis as the primary, or even a secondary etiology of their disease. Dyshidrotic Eczema tends to be a chronic condition that appears periodically throughout adulthood.

Dyshidrotic Eczema is a recurrent disease of the palmar and/ or plantar skin characterised by sudden eruptions of clear, mostly pruritic vesicles. Sweat gland dysfunction or sweat retention do not play the pathogenetic role that has been assigned to them in the past, although some degree of hyperhidrosis exists in many of the affected patients. Etiologic factors for Dyshidrotic Eczema include atopy, contact allergy, constant irritation, primary fungal infections and fungal id-reactions. An idiopathic form is also recognised. Smoking and excessive coffee consumption are believed to play an aggravating role.

The cause of Dyshidrotic Eczema is not known, but it occasionally appears to be seasonal. Small fluid filled blisters called vesicles appear on the hands and feet. They are most common along the edges of the fingers, toes, palms and soles. The vesicles produce intense itching. Scratching leads to skin changes with thickening. Scratching may also lead to secondary infections. Some individuals with Dyshidrotic Eczema are atopic (have an allergic predisposition). Some cases may be triggered by contact with substances causing allergic skin reactions. Dyshidrotic Eczema may occur in both men and women. Its onset occurs usually before the age of 40. Individuals experiencing emotional stress may be more likely to develop flare-ups of this disease.

The diagnosis is based on the patient history, the clinical picture and on the exclusion of other skin diseases. Patch testing is used to exclude underlying contact allergies. Possible etiologic factors such as atopy, contact allergy, irritation and fungal infections have to be ruled out before settling on the diagnosis idiopathic Dyshidrotic Eczema. Pustular psoriasis of the palms and soles, epidermolysis bullosa hereditaria, hand-foot-mouth-disease, acrodermatitis enteropathica and scabies in children are possible differential diagnoses for vesicles on the palms and soles.

Corticosteroid creams and ointments play an important role in the treatment of this disorder. Application of corticosteroid under plastic occlusion may increase their effectiveness. Severe attacks may require the use of oral or intramuscular corticosteroid. Oral antihistamines may help to reduce itching. Antibiotics may be necessary if infection is present.

For More Information And Great Articles About Dyshidrotic Eczema, Please Visit Dyshidrotic Eczema


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