Clinical Notes : Dermatology

121. Vesicular Hand Dermatitis

Vesicular Hand Dermatitis

 

Definition

 

Vesicular hand dermatitis is a form of hand/foot eczema characterised by vesicles or bullae (blisters).

It is also called vesicular endogenous eczema, dyshidrotic eczema and pompholyx.

Pompholyx is sometimes subclassified as cheiropompholyx (hands) and pedopompholyx (feet).

Presentation

It is :

  • more common in females than males.

 

Often associated with :

  • Palmoplantar hyperhidrosis (flares often occur during hot weather, humid conditions)

  • Emotional stress

  • A personal or family history of atopic eczema (in 50% of cases)

  • Genetics

  • Contact with irritants such as water, detergents, solvents and friction

  • Contact allergy to nickel and other allergens

  • Inflammatory dermatophyte (tinea) infections 

  • Adverse reaction to drugs (most often immunoglobulin therapy)

 

Diagnosis

Presents as :

  • recurrent crops of deep-seated blisters on the palms and soles

  • intense itch and/or a burning sensation

  • the blisters peel off and the skin then appears red, dry and has painful fissures (cracks)

  • When involving the distal finger adjacent or proximal to the nail fold, it can result in paronychia (nail fold swelling) and nail dystrophy with irregular pitting and ridges

  • Secondary bacterial infection with Staphylococcus aureus and/or Streptococcus pyogenes is common, and results in pain, swelling and pustules on the hands and/or feet

  • After a few weeks, the small blisters eventually disappear as the top layer of skin falls off

Special investigations :

  • If suspicious of a fungal infection (tinea pedis), skin scrapings should be taken for KOH stain

  • Patch testing is indicated in chronic or atypical cases

  • Skin biopsy is rarely necessary (It shows spongiotic eczema)

 

Management

 

Challenging to treat because of the thick horny layer of skin of palms and soles.

General measures :

  • Wet dressings to dry up blisters, using dilute potassium permanganate, aluminium acetate or acetic acid

  • Cold packs

  • Soothing emollient lotions and creams

  • Potent antiperspirants applied to palms and soles at night

  • Protective nitrile gloves lined with cotton to minimise sweating, should be worn when doing wet or dirty work

  • Well-fitting footwear, with 2 pairs of socks to absorb sweat and reduce friction

 

Prescription medicines

 

Other options

What is the outlook for vesicular hand/foot dermatitis

Vesicular hand/foot dermatitis generally gradually subsides and resolves spontaneously.

It may recur in hot weather or after a period of stress, and in some patients is recalcitrant.

 
 
 

Amanda Oakley

DermNet NZ

July 2014

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