Medicine:Dyshidrosis

From HandWiki

Dyshidrosis is a type of dermatitis, characterized by itchy vesicles of 1–2 mm in size, on the palms of the hands, sides of fingers, or bottoms of the feet.[1] Outbreaks usually conclude within three to four weeks, but often recur.[2][1] Repeated attacks may result in fissures and skin thickening.[3] The cause of the condition is not known.[1]

Symptoms

The characteristics of dyshidrosis are itchiness of the palms or soles, followed by the sudden development of intensely itchy small vesicles on the sides of the fingers, the palms or the feet,[3][4] sometimes described as having a "tapioca pudding" appearance.[5] The vesicles may develop in waves.[2] After a few weeks, the top layer of skin may fall off and inflammation appear around the bases of the vesicles, and there may be peeling, rings of scale, or lichenification. After three to four weeks the vesicles will disappear. While they are present there is a risk of secondary bacterial infection.[2][3][6][7] The locations of the eruption may be symmetrical on the body,[8] and redness is not usually present.[3]

  • Advanced stage of dyshidrosis on the fingers
    Advanced stage of dyshidrosis on the fingers
  • Palmar dyshidrosis
    Palmar dyshidrosis
  • Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin
    Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin
  • Advanced stage of dyshidrosis on the foot
    Advanced stage of dyshidrosis on the foot
  • Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flare
    Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flare

Causes

Whilst the exact causes of the condition are currently unknown,[1] its triggers may include food allergens from a wide range of foods, including tuna, tomato, pineapple, chocolate, coffee, and spices among others,[6] physical or mental stress, frequent hand washing, or metals.[6] A number of studies have implicated balsam of Peru.[6] A 2013 study found that dyshidrosis on the hands increased among those allergic to house dust mites, following inhalation of house dust mite allergen.[9] Id reaction and irritant contact dermatitis are also possible causes.[10]

In 2005, researchers from Anhui Medical University and the Chinese National Human Genome Center, Beijing, theorizing that mutations in single genes could predispose the condition, ran a study of a Chinese family with the condition present across four generations via autosomal dominant inheritance. Their analysis of haplotypes within the family identified a locus for the condition on chromosome 18.[11]

Diagnosis

Dyshidrosis is diagnosed clinically by gathering a patient's history and making observations.[1] Allergy testing and culture may be done to rule out other problems.[1] Severity of symptoms can also be assessed using the dyshidrotic eczema area and severity index (DASI), although it was designed for clinical trials and is not typically used in practice.[12]

Treatment

Avoiding triggers may be useful, as may be the application of a barrier cream or wearing of gloves.[3] Treatment is generally made with steroid cream,[13] although this can be dangerous in the long term due to the side effect of thinning of the skin, which is particularly troublesome in the context of hand dyshidrosis due to the amount of toxins and bacteria the hands typically come in contact with.[1] High strength steroid creams may be required for the first week or two.[3]

In especially acute and severe cases, systemic steroids can be taken orally;[8] the immunosuppressive drug tacrolimus, or PUVA therapy may also be tried.[3][1] Dapsone (diamino-diphenyl sulfone), an antibacterial, has been recommended for the treatment of dyshidrosis in some chronic cases.[14]

Antihistamines such as Fexofenadine may be used to help with the itching.[15][1] Potassium permanganate dilute solution soaks are popular, used to "dry out" the vesicles[16] and kill off superficial Staphylococcus aureus,[17] but they can be very painful and undiluted may cause significant burning.[18]

Alitretinoin (9-cis-retinoic acid) has been approved for prescription in the UK. It is specifically used for chronic hand and foot eczema.[19][20][21] It is made by Basilea of Switzerland (BAL 4079).

Epidemiology

A study of 20,000 randomly-selected individuals in Gothenburg, Sweden in 1988 found 2% of male respondents and 3% of female respondents to have dyshidrosis, and that it comprised 5% of cases of hand eczema of any type.[22] A study of 6300 pediatric patients in Turkey in 2006 found 1% to have dyshidrosis.[23]

History of classification

The condition was named dyshidrosis by the British dermatologist William Tilbury Fox in 1873, in a clinical lecture wherein he presented it as "a disordered condition of the sweat-follicles and the sweat-function... which is, as a rule, diagnosed as eczema, but is a separate and distinct affair... I have termed the disease dysidrosis [sic], because nature seems to have a difficulty in getting rid of the secreted sweat, which remains to distend the follicles, and to macerate the tissues."[24] His theory that the condition was related to sweat was soon observed as unproven in scholarly publication[25] and subsequent research on multiple occasions has shown an absence of relation to the sweat glands.[26]

The condition had already been described clinically in a lecture in 1871 by Sir Jonathan Hutchinson, who had named it cheiro-pompholyx.[lower-alpha 1][27] Hutchinson's work was based on his observations, in 1864, of the same woman patient who Tilbury Fox would later describe in his own lecture. In 1875 Hutchinson published his book Illustrations of Clinical Surgery, describing the condition of "cheiro-pompholyx" without making reference to Tilbury Fox's work.[28] This led to a dispute between the two dermatologists, played out in letters to The Lancet.

Tilbury Fox was aggrieved that his reading of Hutchinson's lecture suggested it to imply Hutchinson had been the first to formally describe the condition. Hutchinson apologised, saying that he had been in too much of a hurry to publish to read Tilbury Fox's work, and being aware that Tilbury Fox had described it as a sweating disorder, he had considered it to be a different condition to the one he was writing about.[29] In the same letter he chastised Tilbury Fox for claiming propriety over describing the vesicles as resembling "a sago grain", a comparison that he had also independently made, and noted that the subject of his lecture in 1871 had been his patient for several years before Tilbury Fox's lecture.[29]

In an editorial for the Chicago Medical Journal and Examiner, Dr. Nathan Smith Davis wryly described the dispute as "not the first occasion upon which two eminent men have contended for the honor of a lady's hand."[30]

After a paper by Dr. A. R. Robinson describing the condition, entitled "Pompholyx" and mentioning the dispute, was published in the Archives of Dermatology the following year,[31] Tilbury Fox responded with a strident critique of Robinson's conclusions and accused him of having misrepresented the facts of the dispute.[32]

See also

  • Dermatitis herpetiformis – a similar condition caused by celiac and often mistaken for dyshidrosis.
  • Epidermolysis bullosa – a genetic disorder that causes similar, albeit more severe, symptoms to those of dyshidrosis.

Notes

  1. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pompholyx

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Colomb-Lippa, D; Klingler, AM (July 2011). "Dyshidrosis". Journal of the American Academy of Physician Assistants 24 (7): 54. PMID 21748961. 
  2. ↑ 2.0 2.1 2.2 Cite error: Invalid <ref> tag; no text was provided for refs named patient
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Cite error: Invalid <ref> tag; no text was provided for refs named Lof2006
  4. ↑ Shelley, W. B. (1953-09-01). "Dysidrosis (pompholyx)". A.M.A. Archives of Dermatology and Syphilology 68 (3): 314–319. doi:10.1001/archderm.1953.01540090076008. ISSN 0096-5979. PMID 13079297. 
  5. ↑ Bielan, Barbara (1996-04-01). "Dyshidrotic eczema" (in en). Dermatology Nursing 8 (2). http://go.galegroup.com/ps/anonymous?id=GALE%7CA19051123&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=10603441&p=AONE&sw=w&authCount=1&isAnonymousEntry=true. 
  6. ↑ 6.0 6.1 6.2 6.3 Veien, Niels K. (2009-07-01). "Acute and recurrent vesicular hand dermatitis". Dermatologic Clinics 27 (3): 337–353, vii. doi:10.1016/j.det.2009.05.013. ISSN 1558-0520. PMID 19580928. 
  7. ↑ Lofgren, Sabra M.; Warshaw, Erin M. (2006-12-01). "Dyshidrosis: epidemiology, clinical characteristics, and therapy". Dermatitis: Contact, Atopic, Occupational, Drug 17 (4): 165–181. doi:10.2310/6620.2006.05021. ISSN 1710-3568. PMID 17150166. 
  8. ↑ 8.0 8.1 Perry, Adam D.; Trafeli, John P. (2009-05-01). "Hand Dermatitis: Review of Etiology, Diagnosis, and Treatment" (in en). The Journal of the American Board of Family Medicine 22 (3): 325–330. doi:10.3122/jabfm.2009.03.080118. ISSN 1557-2625. PMID 19429739. 
  9. ↑ "Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study". Contact Dermatitis 68 (2): 76–85. 2013. doi:10.1111/j.1600-0536.2012.02172.x. PMID 23046099. https://pure.rug.nl/ws/files/6789209/Schuttelaar_2013_Contact_Dermat.pdf. 
  10. ↑ Fitzpatrick, James (2016). "8". Dermatology Secrets Plus. Elsevier. pp. 70–81. ISBN 978-0-323-31029-1. https://books.google.com/books?id=ReqeCgAAQBAJ&pg=PR76. 
  11. ↑ Chen J., Liang Y., Zhou F., Yang S., Wang J., Wang P., Du W., Xu S., Huang W., Zhang X. (February 2006). "The Gene for a Rare Autosomal Dominant Form of Pompholyx Maps to Chromosome 18q22.1–18q22.3". Journal of Investigative Dermatology (Elsevier) 126 (2): 300–304. doi:10.1038/sj.jid.5700103. PMID 16374448. 
  12. ↑ Vocks, E.; Plötz, S. G.; Ring, J. (1999-01-01). "The Dyshidrotic Eczema Area and Severity Index – A score developed for the assessment of dyshidrotic eczema". Dermatology 198 (3): 265–269. doi:10.1159/000018127. ISSN 1018-8665. PMID 10393450. 
  13. ↑ "eMedicine – Dyshidrotic Eczema: Article by Camila K Janniger". http://www.emedicine.com/ped/topic1867.htm. 
  14. ↑ "Vesicular hand dermatitis". http://www.dermnet.org.nz/dermatitis/pompholyx.html. 
  15. ↑ Diepgen, Thomas L.; Agner, Tove; Aberer, Werner; Berth-Jones, John; Cambazard, Frédéric; Elsner, Peter; McFadden, John; Coenraads, Pieter Jan (2007-10-01). "Management of chronic hand eczema" (in en). Contact Dermatitis 57 (4): 203–210. doi:10.1111/j.1600-0536.2007.01179.x. ISSN 1600-0536. PMID 17868211. 
  16. ↑ BIRT AR (March 1964). "Drugs for Eczema of Children". Can Med Assoc J 90 (11): 693–4. PMID 14127384. 
  17. ↑ Stalder JF; Fleury M; Sourisse M et al. (1992). "Comparative effects of two topical antiseptics (chlorhexidine vs KMn04) on bacterial skin flora in atopic dermatitis". Acta Derm Venereol Suppl (Stockh) 176: 132–4. PMID 1476027. 
  18. ↑ "Caustic burn caused by potassium permanganate". Arch. Dis. Child. 88 (2): 96. February 2003. doi:10.1136/adc.88.2.96. PMID 12538301. 
  19. ↑ "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, multicentre trial". Br. J. Dermatol. 158 (4): 808–17. April 2008. doi:10.1111/j.1365-2133.2008.08487.x. PMID 18294310. https://pure.rug.nl/ws/files/6715954/Ruzicka_2008_Br_J_Dermatol.pdf. Retrieved 2019-02-05. 
  20. ↑ "Successful treatment of chronic hand eczema with oral 9-cis-retinoic acid". Dermatology 199 (4): 308–12. 1999. doi:10.1159/000018280. PMID 10640839. 
  21. ↑ "Oral alitretinoin (9-cis-retinoic acid) therapy for chronic hand dermatitis in patients refractory to standard therapy: results of a randomized, double-blind, placebo-controlled, multicenter trial". Arch Dermatol 140 (12): 1453–9. December 2004. doi:10.1001/archderm.140.12.1453. PMID 15611422. 
  22. ↑ "Epidemiology of different types of hand eczema in an industrial city". Acta Dermato-Venereologica 69 (3): 227–233. 17 May 1989. doi:10.2340/0001555569227233. PMID 2566226. https://medicaljournalssweden.se/actadv/article/view/4647. Retrieved 16 May 2024. 
  23. ↑ "Prevalence of skin diseases among pediatric patients in Turkey". Journal of Dermatology 35 (7): 413–418. 10 July 2008. doi:10.1111/j.1346-8138.2008.00495.x. PMID 18705828. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1346-8138.2008.00495.x. Retrieved 16 May 2024. 
  24. ↑ "Clinical Lecture on Dysidrosis: An Undescribed Eruption". British Medical Journal 2 (665): 365–366. 27 September 1873. doi:10.1136/bmj.2.665.365. PMID 20747210. PMC 2294466. https://archive.org/details/sim_british-medical-journal_july-5-december-27-1873_2/page/368. Retrieved 16 May 2024. 
  25. ↑ Robinson, Andrew Rose (1885). A Manual of Dermatology. New York: D. Appleton & Company. p. 252. https://archive.org/details/b21932050/page/252/mode/2up?q=%22sweat+duct+theory%22. Retrieved 16 May 2024. 
  26. ↑ "Acute and recurrent vesicular hand dermatitis not pompholyx or dyshidrosis". JAMA Dermatology 143 (12): 1578–1580. December 2007. doi:10.1001/archderm.143.12.1578. PMID 18087011. 
  27. ↑ "Cheiro-Pompholyx". The Lancet 1 (2748): 630–631. 29 April 1876. https://archive.org/details/sim_the-lancet_1876-04-29_1_2748/page/630/mode/2up. Retrieved 17 May 2024. 
  28. ↑ "Plate X. Cheiro-pompholyx.". Illustrations of Clinical Surgery. J. & A. Churchill. 1875. pp. 49–52. https://archive.org/details/b21515736_0002/page/n5/mode/2up. Retrieved 17 May 2024. 
  29. ↑ 29.0 29.1 "Mr. Hutchinson's "Cheiro-Pompholyx".". The Lancet 1 (2747): 618–619. 22 April 1876. https://archive.org/details/sim_the-lancet_1876-04-22_1_2747/page/618/mode/2up. Retrieved 17 May 2024. 
  30. ↑ "The Controversy Between Mr. Jonathan Hutchinson and Dr. Tilbury Fox". The Chicago Medical Journal and Examiner 33 (9): 816–819. September 1876. https://archive.org/details/sim_chicago-medical-journal-and-examiner_1876-09_33_9/page/816/mode/2up. Retrieved 17 May 2024. 
  31. ↑ Bulkley, Lucius Duncan, ed (July 1877). "Pompholyx". Archives of Dermatology (New York City: G. P. Putnam's Sons) 3: 290–303. https://archive.org/details/archivesofdermat3187unse/page/n303/mode/2up. Retrieved 17 May 2024. 
  32. ↑ Bulkley, Lucius Duncan, ed (January 1878). "A Note on "Dyshidrosis"". Archives of Dermatology (Philadelphia: J. B. Lippincott & Co.) 4: 42–46. https://archive.org/details/archivesofdermat3187unse/page/n303/mode/2up. Retrieved 17 May 2024. 
Classification
External resources


Template:Diseases of the skin and subcutaneous tissue



Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Dyshidrosis&oldid=4017054"