Dyshidrotic Eczema

Dyshidrotic eczema, also known as pompholyx, vesicular dermatitis, or vesicular hand and foot dermatitis, is a type of dermatitis which presents as small 1-2 mm fluid-filled vesicles on the palms, along the fingers and on the soles of the feet (1). It usually resolves after two to three weeks with scaling and peeling, and is typically extremely itchy, chronic, recurrent and often symmetric (2).

It is unclear what causes dyshidrotic eczema, but it is associated with atopic dermatitis and the occurrence does not seem to correlate with any specific age or gender (2). The condition may be precipitated by acute inflammatory tinea, or molluscum contagiosum. Other aggravating factors include overheating, irritants, stress, immunoglobulin therapy, hyperhidrosis, smoking, and taking the oral contraceptive pill or aspirin (1,2).

Early treatment is important as dyshidrotic eczema is often difficult to treat and specialist involvement is usually required (1). Secondary infections may occur and a bacterial swab should be taken if clinical signs of infection are present. The condition may also lead to inflammation of the skin around the finger or toenail as well as nail dystrophy (2).

First line treatment for dyshidrotic eczema includes potent corticosteroids, such as betamethasone dipropionate 0.05% cream or ointment, or betamethasone valerate 0.1% cream or ointment, or mometasone furoate 0.1% cream or ointment (1). The cream or ointment should be applied once or twice daily until the skin is clear and with or without a modified dressing (1).

For recurrent episodes of acute dyshidrotic eczema, betamethasone dipropionate 0.05% ointment in an optimised vehicle should be used once or twice daily until the skin is clear or for up to two weeks, with or without a modified dressing (1).

Oral corticosteroids such as prednisolone or prednisone may be required for dyshidrotic eczema where significant blistering and extreme itching occurs (1). The recommended dose is 15-25mg orally once daily for 3 to 4 days, then tapered over 1-2 weeks to minimise rebound flares (1).

General measures to treat dyshidrotic eczema include avoiding aggravating factors where possible, and using potassium permanganate soaks during the acute phase, which helps to dry exudative lesions (2). Regular use of emollients and moisturisers and antihistamines for itching may also be helpful (2). Dermatologists may also use phototherapy with ultraviolet light A, as well as second-line agents such as methotrexate, depending on the severity and behaviour of the disease (2).