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Dyshidrotic eczema
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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.
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Clinical picture: Clear, mostly severly itching vesicles appear suddenly on the affected areas. Rarely, bullae may develop. They are followed by scaling, erosions and painful fissures. The skin shows a moderate or intense erythema.
Distribution: The palms, soles, palmar and lateral surfaces of the fingers/ toes and the periungual area may be affected.
Diagnosis: 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.
Differential diagnoses: 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.
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