Dyshidrosis

Classification according to ICD-10
L30.1	Dyshidrosis (Pompholyx)
ICD-10 online (WHO version 2019)

Typical findings in dyshidrosis on the hand

histological section

Flaking after the vesicles have healed

The Dyshidrosis (syn. Dyshidrosis , dyshidrotic eczema , dyshidrotic eczema , pompholyx or atopic Palmoplantarekzem ) is a disease of the skin . It manifests itself in the form of small, almost always itchy blisters on the sides of the fingers, palms and soles of the feet (podopompholyx). The name has historical reasons. Contrary to previous assumptions, however, there is no connection between these skin changes and the function of the sweat glands (Greek δυσ-, dys- = "bad, bad, evil"; Greek ἱδρώς (hidrós) = "sweat").

Cause and development of the disease

A clear cause of the development of dyshidrotic eczema has not yet been identified. However, dyshidrosis occurs very frequently in atopic people and in connection with contact allergies or intolerance to drugs as well as fungal infections . In addition, chronic skin damage caused by alkaline soaps or cleaning agents, for example, can lead to dyshidrotic eczema. Skin exposure to heavy metal salts (e.g. chromium , nickel and cobalt salts ) can also be a trigger. Stressful situations are discussed as a cofactor . Dyshidrosis can also occur as an undesirable side effect of antihypertensive agents such as ACE inhibitors.

Clinical manifestations

The symptoms occur predominantly on the palms of the hands, the sides of the fingers and the soles of the feet. Small, water-clear and usually very itchy blisters are found on the affected skin areas . A histological examination of the tissue reveals spongy ( cancellous ) vesicles within the upper skin ( epidermis ). The affected skin is usually reddened. The skin changes can occur in phases or drag on over a long period of time. The blisters can burst and then begin to ooze, which can lead to infections . The skin flakes off as it heals. If the disease lasts for a long time, the affected areas of the skin keratinize and bleeding cracks ( fissures ) form.

variants

Dyshidrosis lamellosa sicca

If the skin changes only slightly, the blisters dry up quickly without any signs of inflammation. This creates characteristic, circular and dry cavities in the horny layer, which then flake off like a frill. This variant often occurs when there is atopy .

Cheiropompholyx and Podopompholyx

On the palm (Cheiropompholyx) or foot (Podopompholyx) blisters up to the size of a cherry stone appear , which unite with one another. Bacterial and mycotic secondary infections can occur as complications .

treatment

Treatment should be based on the cause of the skin change. Treatment of the underlying disease may therefore be necessary. Short-term topical treatment with glucocorticoids as a lotion or cream over a few days is usually most effective. Optionally, additionally a zinc - shake mixture are used for covering. External tanning agents (e.g. as a bath additive) can be helpful for drying out the blisters . A more recent approach to treatment is the oral administration of the vitamin A derivative alitretinoin (9-cis- retinoic acid ). Appropriate medications can be an alternative, especially for patients who do not respond to local treatment with highly effective corticosteroids. Frequent (e.g. job-related) washing or disinfection of hands should be avoided. It is also contraindicated to wear gloves (for example, tight-fitting work gloves, latex or non-latex, rubber, PVC gloves). Relapses can lead to incapacity for work.

• PUVA therapy
• an antihistamine for the itching

literature

• Otto Braun-Falco , Gerd Plewig , Helmut H. Wolff: Dermatology and Venereology . Springer, Berlin 2005, ISBN 3-540-43556-5 , pp. 396-398 .
• Peter Fritsch: Dermatology & Venereology, Basics, Clinic, Atlas. 2nd Edition. Springer Verlag, Berlin 2004, ISBN 3-540-00332-0 .
• Hans Joachim Schwanitz: The atopic palmoplantar eczema. Springer Verlag, Berlin / Heidelberg 1986, ISBN 3-540-15899-5 .

Individual evidence

1. ↑ Mayo Clinic: Dyshidrosis risk factors
2. ↑ T. Ruzicka, CW Lynde, GB Jemec, T. Diepgen, J. Berth-Jones, PJ Coenraads, A. Kaszuba, R. Bissonnette, E. Varjonen, P. Holló, F. Cambazard, M. Lahfa, P. Elsner, F. Nyberg, A. Svensson, TC Brown, M. Harsch, J. Maares: Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized , double-blind, placebo-controlled, multicenter trial. In: Br J Dermatol . 158 (4), 2008 Apr, pp. 808-817. Epub 2008 Feb 21
3. ↑ W. Bollag, F. Ott: Successful treatment of chronic hand eczema with oral 9-cis-retinoic acid. In: Dermatology. 199 (4), 1999, pp. 308-312.

Web links

Commons : Dyshidrosis  - collection of images, videos and audio files

• Patient information sheet: what is dyshidrotic eczema? Clinic for Dermatology, Venereology and Allergology at the Ruhr University Bochum
• Information about the disease in DermIS
• Eczema, dyshidrotic in HONselect
• Dyshidrosis at Mayo Clinic (Engl.)

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !