Dyshidrotic Eczema (Hand Dermatitis)

  • Unknown

  • Not independent disease = due to other types of eczema
  • Not due to sweat gland dysfunction
  • Aggravating factor: hyperhidrosis
  • Flares: stress and hot climate

  • Symmetric, firm, vesicles of variable size (due to spongiosis of epidermis) 
  • Very pruritic
  • Affects:
    • Palms
    • Lateral/medial fingers 
    • Less often soles and toes
  • Dyshidrosis lamellose sicca (keratolysis exfoliativa)
    • Variant without blisters
    • Small annular collarettes

Associated with 

  • Atopic dermatitis (late-stage)
  • Allergic contact dermatitis/ Nickel and cobalt
  • Irritant contact dermatitis
  • Intravenous immunoglobulin

  • Spongiosis with vesicles within epidermis
  • No involvement of sweat glands

  • Treat underlying cause
  • Systemic corticosteroids
  • Topical corticosteroids
  • Topical calcineurin inhibitors
  • Phototherapy 
  • Bath Psoralen and ultraviolet A > oral Psoralen and ultraviolet A/or ultraviolet B)
  • Oral alitretinoin