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13-31: Dyshidrotic Eczema

J. Matthew Hardin

Clinical Summary

Dyshidrotic eczema (also called pompholyx or acute vesiculobullous hand eczema) is the abrupt appearance of deep-seated, 1- to 2-mm vesicles on the sides of the fingers, palms, and soles. The vesicles are extremely pruritic, may coalesce into larger bullae, and may rupture to become dry or fissured. The outbreak usually resolves over a few weeks unless secondary infection develops. The differential includes bullous tinea, id reaction, scabies infestation, or allergic contact dermatitis.

Management and Disposition

Treatment includes a high-potency topical steroid and prevention of secondary infection. Refer to a dermatologist for long-term treatment; this is often chronic with the potential for significant disability.

Pearls

  1. The initial lesions resemble tapioca pudding.

  2. These lesions wax and wane and are often exacerbated by stressful life events.

FIGURE 13.86

Dyshidrotic Eczema. In most cases dyshidrotic eczematous dermatitis starts with tapioca-like vesicles on the lateral aspects of the fingers. (Photo contributor: Richard P. Usatine, MD. Used with permission. From Usatine RP, Smith MA, Mayeaux EJ, Chumley HS. The Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw Hill; 2013: Fig. 147-7.)

In a patient with dyshidrotic eczema there are multiple, small, raised, fluid-filled lesions with diffuse margins over the lateral aspect of the hand and fingers.
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FIGURE 13.87

Dyshidrotic Eczema. The vesicles show confluence and spread to the palm, but also to the wrist and dorsal aspect of the hand when the eruption progresses. (Used with permission from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. 5th ed. New York, NY: McGraw Hill; 2005: 45.)

In a patient with dyshidrotic eczema there are multiple, small, raised, fluid-filled lesions with diffuse margins over the inside of the wrist and palm.
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