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Dyshidrotic eczema
Last reviewed: 23.04.2024
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Dyshidrotic eczema is also called "dyshidrosis" and "pompholyx". In 20-25% of cases of eczema of the palms, a dyshidrotic eczema is noted.
This form of eczema is a characteristic chronic recurrent eczematous dermatitis of unknown etiology. Dyshidrotic eczema is characterized by sudden rashes of usually highly itchy, symmetrical vesicles on the palms, side surfaces of the fingers and / or soles.
[The causes of dyshidrotic eczema
In the anamnesis, patients usually have atopy (in a personal or family history - asthma, hay fever or atopic eczema). Moderate or severe itching typically precedes an outbreak or recurrence of the disease. Hyperhidrosis (excessive sweating) often accompanies this condition or worsens it. Peak diseases in women occur at the beginning of the 2nd decade of life, and in men in the middle of the fourth decade.
Symptoms of dyshidrotic eczema
Symptoms of dyshidrotic eczema are characterized by the appearance of vesicles with a diameter of 1-5 mm, which are monomorphic, deeply located rashes, filled with a clear liquid and resembling croup. Vesicles appear suddenly and symmetrically on the palms and the side surface of the fingers or on the soles. Rings of scales and flaking replace vesicles as the itching decreases. Depending on the phase of the disease, the clinician can only observe brown spots. When the acute process ends, the skin peels off and a red cracked base opens with brown spots. Brown spots are places of former vesiculation. Vesicles are slowly resolved within 1-3 weeks. After this, chronic eczematous changes with erythema, desquamation and lichenification can follow. Uncertainty can often occur undulating relapses with the appearance of symmetrically located vesicles. For unknown reasons, chronic recurrent rashes sometimes go away with time.
Differential diagnosis of dyshidrotic eczema
Pustular psoriasis of the palms and soles (the main complaint of patients is more often for pain than for itching). "Id" is a reaction (as a result of a distant source of a fungal infection). Inflammatory fungal infection (positive test with KOH for the presence of fungi). Acute allergic contact dermatitis. Bullous pemphigoid (can be hemorrhagic). Cutaneous T-cell lymphoma (rarely).
Treatment of dyshidrotic eczema
Treatment of dyshidrotic eczema begins with the use of cool moist compresses, either with tap water or with Burov's solution, followed by an application of steroid cream of medium or high pharmacological efficacy (groups I or III). Prescribe prednisone 0.5-1 mg / kg / day with a gradual dose reduction for 1-2 weeks. Some relief can be given by the use of ointment with tacrolimus (Protopic 0.1%), which alternates with a daily two-time application of an external corticosteroid of moderate strength (group I-III) in several cycles of 3-4 weeks. Corticosteroids should not be used repeatedly or for the treatment of a chronic form of the disease. Systemic antihistamines can relieve itching. Psoralen externally on the palm plus ultraviolet A - a treatment option for frequent torpid rashes. The use of disulfiram ("Antabuse" 200 mg / day for 8 weeks) can help nickel-sensitive patients with dyshidrosis palms eczema. If a distant source of fungal infection is identified and the result of the study with KOH is positive, the focus of the fungal infection should be treated with an aggressive external antifungal agent (Econazol or Terbinafine daily for 3 weeks) or with a short course of systemic antifungal agents (Terbinafine or Itraconazole "), selecting the dosage and duration of treatment corresponding to the focus of the infection. Containment or elimination of stress can help in the treatment, there are separate reports on the cure of some patients in such cases.
If the elimination of contact with allergens detected during patch testing does not improve and the condition remains severe, other options for treating disgidrotic eczema may include electrophoresis with tap water, intradermal administration of botulinum toxin (100-160 IU), weekly low doses of methotrexate, azathioprine (100-150 mg / day to achieve control, then maintenance doses of 50-100 mg / day) and low doses of external radiation therapy.