| Diagnostic Hallmarks | | | | into one that is chronically troublesome. New crops of |
| Distribution - sides and tips of the digits, palms and | | | | vesicles continue to appear on the skin that is already |
| soles | | | | eczematized; this triggers new bouts of scratching and |
| | | | further skin damage. Moreover, mild irritation from |
| Clinical Presentation | | | | exposure to soap and water, which might have been |
| Dyshidrosis is a disease of noninflammatory vesiculatio. | | | | insufficient to harm normal skin, tends to aggravate the |
| Eczematization of dyshidrosis develops under two | | | | condition further. Essentially, a single disease, |
| conditions. The first occurs when itching leads to | | | | dyshidrosis, becomes a multifactorial process with |
| uncontrolled scratching. This superimposition of the | | | | additional elements of atopic dermatitis and irritant |
| itch-scratch cycle leads to vesicle roof disruption and | | | | contact dermatitis. |
| causes excoriations in surrounding, previously normal | | | | Pathogenesis |
| skin. Weeping and crusting are present because of the | | | | The development of dyshidrotic eczema occurs in only |
| broken epithelium. The second condition occurs when | | | | about 10% of patients with dyshidrosis. In some |
| closely set vesicles appear fast enough to form fragile | | | | instances, dyshidrotic eczema is simply an extension in |
| multilocular bullae. These break easily, leading to | | | | severity of dyshidrosis. New vesicles appear more |
| profuse weeping and crusting. New vesicles develop | | | | rapidly than old ones heal. In most instances, however, |
| before reepithelialization has occurred, and the process | | | | the eczematous appearance occurs as a result of the |
| continues indefinitely even without superimposition of | | | | superim position of the itch-scratch cycle (atopic |
| the itch-scratch cycle. | | | | dermatitis) directly over the noninflammatory |
| In either set of circumstances, eczematous lesions | | | | vesiculation of dyshidrosis. Not surprisingly, dyshidrotic |
| may spread onto the previously uninvolved dorsal | | | | eczema (as opposed to dyshidrosis itself) preferentially |
| surface of the fingers and hands through the process | | | | occurs in those who are genetically atopic. |
| known as autoeczematization. Moreover, the | | | | Therapy |
| eczematization obscures the noninflammatory nature | | | | In general, the approach to treatment of dyshidrotic |
| of the original underlying vesicles. Because of these | | | | eczema is similar to that for dyshidrosis and atopic |
| two changes, the clinician may miss the correct | | | | dermatitis. Soaks, sedatives, and application of mid- to |
| diagnosis unless information is obtained about the very | | | | high-potency topical steroids may clear mild cases of |
| first lesions noted by the patient. | | | | dyshidrotic eczema. Patients with more severe |
| The diagnosis of dyshidrotic eczema is made on a | | | | disease will require a "burst" of systemic steroids. |
| clinical basis. Biopsy is usually not helpful. The | | | | PUVA therapy, usually topical rather than systemic can |
| differential diagnoses of hand and foot eczema are | | | | be used effectively in cases resistant to more |
| considered in greater detail in. | | | | conventional theory. Because of the importance of |
| Course and Prognosis | | | | psychologic factors in both dyshidrosis and dyshidrotic |
| Either the superim position of the itch-scratch cycle or | | | | eczema, it is sometimes necessary to consider |
| the development of closely set repeated episodes of | | | | counseling, behavior modification, and the use of |
| dyshidrosis converts an intermittently active process | | | | psychotropic medication. |