eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Dyshidrotic Eczema: Follow-up

Author: Sadegh Amini, MD, Senior Clinical Research Fellow, Skin Research Group, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami
Coauthor(s): Anne E Burdick, MD, MPH, Professor of Dermatology, Director of Leprosy Program, Associate Dean for TeleHealth and Clinical Outreach, University of Miami Miller School of Medicine
Contributor Information and Disclosures

Updated: Aug 17, 2009

Follow-up

Further Outpatient Care

  • Schedule follow-up and check blood pressure 1 week after initiating prednisone.

Deterrence/Prevention

  • Advise dyshidrotic eczema patients to avoid known contact irritants or allergens.
  • Advise dyshidrotic eczema patients to reduce stress (may help some patients).
  • Advise dyshidrotic eczema patients to follow a hand care regimen.
  • Advise regular prophylactic use of emollients.

Complications

  • Secondary bacterial infection of dyshidrotic eczema vesicles or bullae can result in cellulitis, lymphangitis, and septicemia (rare).
  • Dystrophic nail changes may develop with transverse ridging, thickening, discoloration, and pitting of nails.

Prognosis

  • Dyshidrotic eczema follows a chronic intermittent course. Fewer episodes occur after middle age.

Patient Education

  • Instruct dyshidrotic eczema patients to avoid contact with certain allergens or irritants (eg, nickel).
  • Instruct dyshidrotic eczema patients to follow a hand care routine that avoids irritants.
  • Instruct dyshidrotic eczema patients to use emollients regularly.
  • For excellent patient education resources, visit eMedicine's Skin, Hair and, Nails Center. Also, see eMedicine's patient education article Eczema.

Miscellaneous

Medicolegal Pitfalls

  • Failure to guard against or inform dyshidrotic eczema patients of the potential development of adverse systemic effect with prolonged use of systemic steroids (eg, hypertension, diabetes mellitus, weight gain, cataracts, osteoporosis)
  • Failure to acquire an adequate history of exposure to potential allergic and irritant contactants (contactants at patient's work may be a contributing factor or cause recurrent episodes)
  • Failure to consider other possible diagnoses

Special Concerns

  • Substances used to systemically challenge patients with possible ingested allergens may trigger exacerbations. Vasculitis or erythema multiforme may develop during this testing.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Ivan D. Camacho, MD, in the development and writing of this article.



More on Dyshidrotic Eczema

Overview: Dyshidrotic Eczema
Differential Diagnoses & Workup: Dyshidrotic Eczema
Treatment & Medication: Dyshidrotic Eczema
Follow-up: Dyshidrotic Eczema
Multimedia: Dyshidrotic Eczema
References
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Further Reading

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Keywords

dyshidrotic eczema, pompholyx, vesicular palmoplantar eczema, atopic dermatitis, contact dermatitis, hand eczema, atopic diathesis, asthma, hay fever, allergic sinusitis, contact allergens, intravenous immunoglobulin therapy, interdigital maceration, desquamation of interdigital spaces

cellulitis, lymphangitis, Dyshidrotic Eczema Area and Severity Index, allergy to ingested metals, dermatophyte infection, emotional stress, nickel sensitivity, id reaction, tinea pedis infection, pompholyx dermatophytid, palmar pompholyx reaction, implanted metals.

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Contributor Information and Disclosures

Author

Sadegh Amini, MD, Senior Clinical Research Fellow, Skin Research Group, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami
Sadegh Amini, MD is a member of the following medical societies: American Society for Dermatologic Surgery, International Society for Dermatologic Surgery, and International Society of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Anne E Burdick, MD, MPH, Professor of Dermatology, Director of Leprosy Program, Associate Dean for TeleHealth and Clinical Outreach, University of Miami Miller School of Medicine
Anne E Burdick, MD, MPH is a member of the following medical societies: Washington State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

John D Wilkinson, MD, MBBS, MRCS, FRCP, Chairman, Clinical Director, Department of Dermatology, Amersham Hospital and High Wycombe Hospital, UK
John D Wilkinson, MD, MBBS, MRCS, FRCP is a member of the following medical societies: American Academy of Dermatology and Royal College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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