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Diseases

Dyshidrotic dermatitis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Dyshidrotic dermatitis is a chronic, relapsing-remitting vesicular eruption of the palms and soles; classically pruritic; also known as dyshidrotic eczema.

  • The common exacerbating factor is irritation, as seen in frequent hand washing, hyperhidrosis, and stress. However, the underlying etiology is unknown.

  • Diagnosis is based on characteristic history and physical examination.

  • The foremost objective in treatment is identification and avoidance of exacerbating factors.

  • First-line therapy is topical corticosteroids or immunomodulators.

Dyshidrotic eczema
Dyshidrotic eczema
Photograph courtesy of Dr Spencer Holmes, MD; used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

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      • Diagnostics Tests

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        • Treatment Options

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          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Dyshidrotic eczema

            Dyshidrotic eczema

          • Dyshidrotic eczema

            Dyshidrotic eczema

          • Dyshidrotic eczema

            Dyshidrotic eczema

          Citations

            Key Articles

            • Agner T, Elsner P. Hand eczema: epidemiology, prognosis and prevention. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:4-12.[Abstract][Full Text]

            • Elsner P, Agner T. Hand eczema: treatment. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:13-21.[Abstract][Full Text]

            • Jacob PT, Marie LAS, Jose HA, et al. Guidelines for diagnosis, prevention and treatment of hand eczema. Contact Dermatitis. 2022 May;86(5):357-78.[Abstract]

            • Christoffers WA, Coenraads PJ, Svensson Å, et al. Interventions for hand eczema. Cochrane Database Syst Rev. 2019 Apr 26;4(4):CD004055.[Abstract][Full Text]

            Referenced Articles

            • 1. Agner T, Elsner P. Hand eczema: epidemiology, prognosis and prevention. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:4-12.[Abstract][Full Text]

            • 2. Fowler JF Jr, Storrs FJ. Nickel allergy and dyshidrotic eczema: are they related? Am J Contact Dermatol. 2001;12:119-121.[Abstract]

            • 3. Agrup G. Hand eczema and other hand dermatoses in south Sweden. Acta Derm Venereol (Stockh). 1969;49(Suppl 61):5-91.

            • 4. Magina S, Barros MA, Ferreira JA, et al. Atopy, nickel sensitivity, occupation, and clinical patterns in different types of hand dermatitis. Am J Contact Dermat. 2003;14:63-68.[Abstract]

            • 5. Gladys TE, Maczuga S, Flamm A. Characterizing demographics and cost of care for dyshidrotic eczema. Contact Dermatitis. 2022 Feb;86(2):107-12.[Abstract][Full Text]

            • 6. Lodi A, Betti R, Chiarelli G, et al. Epidemiological, clinical and allergological observations on pompholyx. Contact Dermatitis. 1992;26:17-21.[Abstract]

            • 7. Edman B. Palmar eczema: a pathogenic role for acetylsalicyclic acid, contraceptives and smoking? Acta Derm Venereol. 1988;68:402-407.[Abstract]

            • 8. Lehucher-Michel MP, Koeppel MC, Lanteaume A, et al. Dyshidrotic eczema and occupation: a descriptive study. Contact Dermatitis. 2000;43:200-205.[Abstract]

            • 9. Bryld LE, Agner T, Menne T. Relationship between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy. Acta Derm Venereol. 2003;83:186-188.[Abstract]

            • 10. Prystupa K, Rudzki E. Oral tolerance of nickel in patients with dyshidrosis. Contact Dermatitis. 2000;42:276-277.[Abstract]

            • 11. Veien NK, Hattel T, Justesen O, et al. Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema. Contact Dermatitis. 1983;9:402-406.[Abstract]

            • 12. Crosti C, Lodi A. Pompholyx: A still unresolved kind of eczema. Dermatol. 1993;186:241-242.[Abstract]

            • 13. Yokozeki H, Katayama I, Nishioka K, et al. The role of metal allergy and local hyperhidrosis in the pathogenesis of pompholyx. J Dermatol. 1992;19:964-967.[Abstract]

            • 14. Wollina U, Abdel Naser MB. Pharmacotherapy of pompholyx. Expert Opin Pharmacother. 2004;5:1517-1522.[Abstract]

            • 15. Elsner P, Agner T. Hand eczema: treatment. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:13-21.[Abstract][Full Text]

            • 16. Shenefelt PD. Psychodermatological disorders: recognition and treatment. Int J Dermatol. 2011;50:1309-22.[Abstract]

            • 17. Kutzner H, Wurzel R, Wolff H. Are acrosyringia involved in the pathogenesis of "dyshidrosis"? Am J Dermatopathol. 1986;8:109-116.[Abstract]

            • 18. de Boer EM, Bruynzeel DP, van Ketel WG. Dyshidrotic eczema as an occupational dermatitis in metal workers. Contact Dermatitis. 1988;19:184-188.[Abstract]

            • 19. Thelin I, Agrup G. Pompholyx - a one year series. Acta Derm Venereol. 1985;65:214-217.[Abstract]

            • 20. Guillet MH, Wierzbicka E, Guillet S, et al. A 3-year causative study of pompholyx in 120 patients. Arch Dermatol. 2007;143:1504-1508.[Abstract]

            • 21. Vocks E, Plötz SG, Ring J. The Dyshidrotic Eczema and Severity Index - a score developed for the assessment of dyshidrotic eczema. Dermatol. 1999;198:265-269.[Abstract]

            • 22. Jacob PT, Marie LAS, Jose HA, et al. Guidelines for diagnosis, prevention and treatment of hand eczema. Contact Dermatitis. 2022 May;86(5):357-78.[Abstract]

            • 23. Warshaw E. Therapeutic options for chronic hand dermatitis. Dermatol Ther. 2004;17:240-250.[Abstract]

            • 24. Swartling C, Naver H, Lindberg M, et al. Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin. J Am Acad Dermatol. 2002;47:667-671.[Abstract]

            • 25. Odia S, Vocks E, Rakoski J, et al. Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol. 1996;76:472-474.[Abstract]

            • 26. Wollina U, Karamfilov T. Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left-right comparison. J Eur Acad Dermatol Venereol. 2002;16:40-42.[Abstract]

            • 27. Veien NK, Kaaber K. Nickel, cobalt and chromium sensitivity in patients with pompholyx (dyshidrotic eczema). Contact Dermatitis. 1979;5:371-374.[Abstract]

            • 28. Veien NK, Hattel T, Justesen O, et al. Dietary restrictions in the treatment of adult patients with eczema. Contact Dermatitis. 1987;17:223-228.[Abstract]

            • 29. Veien NK, Hattel T, Justesen O, et al. Dietary treatment of nickel dermatitis. Acta Derm Venereol. 1985;65:138-142.[Abstract]

            • 30. Kaaber K, Menné T, Veien N, et al. Treatment of nickel dermatitis with Antabuse; a double blind study. Contact Dermatitis. 1983;9:297-299.[Abstract]

            • 31. Pigatto PD, Gibelli E, Fumagalli M, et al. Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx. Contact Dermatitis. 1990;22:27-31.[Abstract]

            • 32. Santucci B, Cristaudo A, Cannistraci C, et al. Nickel sensitivity: effects of prolonged oral intake of the element. Contact Dermatitis. 1988;19:202-205.[Abstract]

            • 33. Sharma AD. Low nickel diet in dermatology. Indian J Dermatol. 2013 May;58(3):240.[Abstract][Full Text]

            • 34. Veien NK, Olhom Larsen P, Thestrup-Pedersen K, et al. Long-term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol. 1999;140:882-886.[Abstract]

            • 35. Volden G. Successful treatment of chronic skin diseases with clobetasol propionate and a hydrocolloid occlusive dressing. Acta Derm Venereol. 1992;72(1):69-71.[Abstract]

            • 36. Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023 Jul;89(1):e1-20.[Abstract][Full Text]

            • 37. Schnopp C, Remling R, Möhrenschlager M, et al. Topical tacrolimus (FK 506) and mometasone furoate in the treatment of dyshidrotic palmar eczema: A randomized, observer-blinded trial. J Am Acad Dermatol. 2002;46:73-77.[Abstract]

            • 38. Belsito DV, Fowler JF Jr, Marks JG Jr, et al. Pimecrolimus cream 1%: a potential new treatment for chronic hand dermatitis. Cutis. 2004;73:31-38.[Abstract]

            • 39. Christoffers WA, Coenraads PJ, Svensson Å, et al. Interventions for hand eczema. Cochrane Database Syst Rev. 2019 Apr 26;4(4):CD004055.[Abstract][Full Text]

            • 40. Davis MD, McEvoy M, el-Azhary RA. Topical psoralen-ultraviolet A therapy for palmoplantar dermatoses: experience with 35 consecutive patients. Mayo Clin Proc. 1998;73:407-411.[Abstract]

            • 41. Schempp CM, Müller H, Czech W, et al. Treatment of chronic palmoplantar eczema with local bath-PUVA therapy. J Am Acad Dermatol. 1997;36:733-737.[Abstract]

            • 42. Behrens S, von Kobyletzki G, Gruss C, et al. PUVA-bath photochemotherapy (PUVA-soak therapy) of recalcitrant dermatoses of the palms and soles. Photodermatol Photoimmunol Photomed. 1999;15:47-51.[Abstract]

            • 43. Egan CA, Rallis TM, Meadows KP, et al. Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Derm. 1999;40:612-614.[Abstract]

            • 44. Scerri L. Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol. 1999;455:343-348.[Abstract]

            • 45. Granlund H, Erkko P, Eriksson E, et al. Comparison of cyclosporine and topical betamethasone-17, 21-dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol. 1996;76:371-376.[Abstract]

            • 46. Pickenäcker A, Luger TA, Schwartz T. Dyshidrotic eczema treated with mycophenolate mofetil. Arch Dermatol. 1998;134:378-379.[Abstract]

            • 47. Lowe NJ, Weingarten D, Bourget T, et al. PUVA therapy for psoriasis: comparison of oral and bath-water delivery of 8-methoxypsoralen. J Am Acad Dermatol. 1986;14:754-60.[Abstract]

            • 48. LeVine MJ, Parrish JA, Fitzpatrick TB. Oral methoxsalen photochemotherapy (PUVA) of dyshidrotic eczema. Acta Derm Venereol. 1981;61:570-71.[Abstract]

            • 49. Polderman MC, Govaert JC, le Cessie S, et al. A double-blind placebo-controlled trial of UVA-1 in the treatment of dyshidrotic eczema. Clin Exp Dermatol. 2003;28:584-87.[Abstract]

            • 50. Rivard J, Lim HW. The use of 308-nm excimer laser for dermatoses: experience with 34 patients. J Drugs Dermatol. 2006;5:550-54.[Abstract]

            • 51. Wollina U. Pompholyx: what's new? Expert Opin Investig Drugs. 2008;17:897-904.[Abstract]

            • 52. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of Dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016 Dec 15;375(24):2335-48.[Abstract][Full Text]

            • 53. Ho JSS, Molin S. A review of existing and new treatments for the management of hand eczema. J Cutan Med Surg. 2023 Jul 27;:12034754231188325.[Abstract][Full Text]

            • 54. Voorberg AN, Romeijn GLE, de Bruin-Weller MS, et al. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis-52 week results from the Dutch BioDay Registry. Contact Dermatitis. 2022 Aug;87(2):185-91.[Abstract][Full Text]

            • 55. Voorberg AN, Kamphuis E, Christoffers WA, et al. Efficacy and safety of dupilumab in patients with severe chronic hand eczema with inadequate response or intolerance to alitretinoin: a randomized, double-blind, placebo-controlled phase IIb proof-of-concept study. Br J Dermatol. 2023 Sep 15;189(4):400-9.[Abstract][Full Text]

            • 56. Oosterhaven JAF, Romeijn GLE, Schuttelaar MLA. Dupilumab treatment of very severe refractory atopic hand eczema. JAMA Dermatol. 2018 Aug 1;154(8):969-70.[Abstract][Full Text]

            • 57. Cheng J, Facheris P, Ungar B, et al. Current emerging and investigational drugs for the treatment of chronic hand eczema. Expert Opin Investig Drugs. 2022 Aug;31(8):843-53.[Abstract][Full Text]

            • 58. Deng L, Luo Y, An B, et al. Recalcitrant palmar-plantar atopic dermatitis successfully treated with dupilumab: a case series. Clin Cosmet Investig Dermatol. 2022;15:2421-26.[Abstract][Full Text]

            • 59. Bissonnette R, Papp KA, Poulin Y, et al. Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial. Br J Dermatol. 2016 Nov;175(5):902-11.[Abstract][Full Text]

            • 60. Nakagawa H, Nemoto O, Igarashi A, et al. Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: a phase 3, randomized, double-blind, vehicle-controlled study and an open-label, long-term extension study. J Am Acad Dermatol. 2020 Apr;82(4):823-31.[Abstract][Full Text]

            • 61. Papp K, Szepietowski JC, Kircik L, et al. Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol. 2021 Oct;85(4):863-72.[Abstract][Full Text]

            • 62. Reich K, Thyssen JP, Blauvelt A, et al. Efficacy and safety of abrocitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis: a randomised, double-blind, multicentre phase 3 trial. Lancet. 2022 Jul 23;400(10348):273-82.[Abstract][Full Text]

            • 63. Bieber T, Simpson EL, Silverberg JI, et al. Abrocitinib versus placebo or dupilumab for atopic dermatitis. N Engl J Med. 2021 Mar 25;384(12):1101-12.[Abstract][Full Text]

            • 64. Shi VY, Bhutani T, Fonacier L, et al. Phase 3 efficacy and safety of abrocitinib in adults with moderate-to-severe atopic dermatitis after switching from dupilumab (JADE EXTEND). J Am Acad Dermatol. 2022 Aug;87(2):351-58.[Abstract][Full Text]

            • 65. Simpson EL, Sinclair R, Forman S, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020 Jul 25;396(10246):255-66.[Abstract][Full Text]

            • 66. Silverberg JI, Simpson EL, Thyssen JP, et al. Efficacy and safety of abrocitinib in patients with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2020 Aug 1;156(8):863-73.[Abstract][Full Text]

            • 67. Guttman-Yassky E, Silverberg JI, Nemoto O, et al. Baricitinib in adult patients with moderate-to-severe atopic dermatitis: a phase 2 parallel, double-blinded, randomized placebo-controlled multiple-dose study. J Am Acad Dermatol. 2019 Apr;80(4):913-21.e9.[Abstract][Full Text]

            • 68. Bieber T, Reich K, Paul C, et al. Efficacy and safety of baricitinib in combination with topical corticosteroids in patients with moderate-to-severe atopic dermatitis with inadequate response, intolerance or contraindication to ciclosporin: results from a randomized, placebo-controlled, phase III clinical trial (BREEZE-AD4). Br J Dermatol. 2022 Sep;187(3):338-52.[Abstract][Full Text]

            • 69. Guttman-Yassky E, Teixeira HD, Simpson EL, et al. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet. 2021 Jun 5;397(10290):2151-68.[Abstract][Full Text]

            • 70. Reich K, Teixeira HD, de Bruin-Weller M, et al. Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2021 Jun 5;397(10290):2169-81.[Abstract][Full Text]

            • 71. Kiszla BM, Orlowski TJ, Kole LCS. Efficacy and tolerance of upadacitinib in the treatment of dyshidrotic eczema. JAAD Case Rep. 2023 Aug;38:141-43.[Abstract][Full Text]

            • 72. Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep;75(3):494-503.e6.[Abstract][Full Text]

            • 73. Chu DK, Chu AWL, Rayner DG, et al. Topical treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials. J Allergy Clin Immunol. 2023 Sep 5.[Abstract][Full Text]

            • 74. Kahn JS, Grossman-Kranseler JS, Zancanaro P, et al. Topical crisaborole in the treatment of atopic hand dermatitis: a retrospective chart review. Dermatitis. 2021 Nov-Dec 01;32(6):e141-43.[Abstract][Full Text]

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