eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Vesicular Palmoplantar Eczema: Differential Diagnoses & Workup

Author: Wingfield Rehmus, MD, MPH,
Coauthor(s): Carol E Cheng, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Oct 30, 2009

Differential Diagnoses

Contact Dermatitis, Allergic
Contact Dermatitis, Irritant
Lichen Planus
Pityriasis Rubra Pilaris
Psoriasis, Pustular
Syphilis

Other Problems to Be Considered

Allergy (eg, benzoisothiazolines)
N -Isopropyl-N -phenyl-4-phenylenediamine (IPPD)
Occult fungal infection
Palmoplantar pustular psoriasis
Pustular bacterid
Keratolysis exfoliativa (focal palmar peelings, desquamation en aires)
Protein contact dermatitis
Chronic acral dermatitis
Pemphigoid/pemphigoid gestationis
Dyshidrosiform bullous pemphigoid9
Epidermolysis bullosa
Autoimmune progesterone dermatitis
Keratoderma climactericum

Workup

Laboratory Studies

  • The diagnosis of palmoplantar eczema is essentially a clinical one, and laboratory tests are not routinely performed. However, laboratory studies may be helpful in excluding other disorders.
  • Elevated serum immunoglobulin E levels or positive results on prick tests may suggest an atopic tendency.
  • Skin scrapings can be used to exclude the presence of a fungus.
  • Skin swabs may exclude bacterial infection.

Other Tests

  • Perform KOH staining of skin scrapings to rule out fungal infection, especially in hyperkeratotic forms of the disease.
  • Swab and culture suspected lesions to exclude secondary bacterial infection.

Procedures

  • Perform patch tests to exclude contact dermatitis or a systemic reaction to contact allergen.
  • Perform biopsy to distinguish eczema from psoriasis or some forms of palmoplantar hyperkeratoses.

Histologic Findings

Histologic features vary according to the stage of the evolution vesicular palmoplantar eczema. Usually, evidence suggests intracellular edema or spongiosis, lymphocytic infiltration of the epidermis, and intraepidermal vesicles or bullae in acutely affected persons. In chronically affected persons, spongiosis is present and often associated with epithelial proliferation and/or hyperkeratosis or psoriasiform epidermal hyperplasia. Dermis is often edematous, with a mixed perivascular inflammatory cell infiltrate.

More on Vesicular Palmoplantar Eczema

Overview: Vesicular Palmoplantar Eczema
Differential Diagnoses & Workup: Vesicular Palmoplantar Eczema
Treatment & Medication: Vesicular Palmoplantar Eczema
Follow-up: Vesicular Palmoplantar Eczema
Multimedia: Vesicular Palmoplantar Eczema
References
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References

  1. Chen JJ, Liang YH, Zhou FS, et al. The gene for a rare autosomal dominant form of pompholyx maps to chromosome 18q22.1-18q22.3. J Invest Dermatol. Feb 2006;126(2):300-4. [Medline].

  2. Edman B. Palmar eczema: a pathogenetic role for acetylsalicylic acid, contraceptives and smoking?. Acta Derm Venereol. 1988;68(5):402-7. [Medline].

  3. Man I, Ibbotson SH, Ferguson J. Photoinduced pompholyx: a report of 5 cases. J Am Acad Dermatol. Jan 2004;50(1):55-60. [Medline].

  4. Man I, Ibbotson SH, Ferguson J. Photoinduced pompholyx: a report of 5 cases. J Am Acad Dermatol. Jan 2004;50(1):55-60. [Medline].

  5. Guillet MH, Wierzbicka E, Guillet S, Dagregorio G, Guillet G. A 3-year causative study of pompholyx in 120 patients. Arch Dermatol. Dec 2007;143(12):1504-8. [Medline].

  6. Uyttendaele H, Obadiah J, Grossman M. Dyshidrotic-like spongiotic dermatitis after intravenous immunoglobulin therapy. J Drugs Dermatol. Jun 2003;2(3):337-41. [Medline].

  7. Colebunders R, Zolfo M, Lynen L. Severe dyshidrosis in two patients with HIV infection shortly after starting highly active antiretroviral treatment. Dermatol Online J. Aug 1 2005;11(2):31. [Medline].

  8. MacConnachie AA, Smith CC. Pompholyx eczema as a manifestation of HIV infection, response to antiretroviral therapy. Acta Derm Venereol. 2007;87(4):378-9. [Medline].

  9. Kim YJ, Kim MY, Kim HO, Park YM. Dyshidrosiform bullous pemphigoid. Acta Derm Venereol. 2004;84(3):253-4. [Medline].

  10. Schnopp C, Remling R, Mohrenschlager M, Weigl L, Ring J, Abeck D. Topical tacrolimus (FK506) and mometasone furoate in treatment of dyshidrotic palmar eczema: a randomized, observer-blinded trial. J Am Acad Dermatol. Jan 2002;46(1):73-7. [Medline].

  11. Schurmeyer-Horst F, Luger TA, Bohm M. Long-term efficacy of occlusive therapy with topical pimecrolimus in severe dyshidrosiform hand and foot eczema. Dermatology. 2007;214(1):99-100. [Medline].

  12. Egawa K. Topical vitamin D3 derivatives in treating hyperkeratotic palmoplantar eczema: a report of five patients. J Dermatol. May 2005;32(5):381-6. [Medline].

  13. Scerri L. Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol. 1999;455:343-8. [Medline].

  14. Egan CA, Rallis TM, Meadows KP, Krueger GG. Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Dermatol. Apr 1999;40(4):612-4. [Medline].

  15. Pickenacker A, Luger TA, Schwarz T. Dyshidrotic eczema treated with mycophenolate mofetil. Arch Dermatol. Mar 1998;134(3):378-9. [Medline].

  16. Ogden S, Clayton TH, Goodfield MJ. Recalcitrant hand pompholyx: variable response to etanercept. Clin Exp Dermatol. Jan 2006;31(1):145-6. [Medline].

  17. Behrens S, von Kobyletzki G, Gruss C, Reuther T, Altmeyer P, Kerscher M. PUVA-bath photochemotherapy (PUVA-soak therapy) of recalcitrant dermatoses of the palms and soles. Photodermatol Photoimmunol Photomed. Apr 1999;15(2):47-51. [Medline].

  18. Petering H, Breuer C, Herbst R, Kapp A, Werfel T. Comparison of localized high-dose UVA1 irradiation versus topical cream psoralen-UVA for treatment of chronic vesicular dyshidrotic eczema. J Am Acad Dermatol. Jan 2004;50(1):68-72. [Medline].

  19. Tzaneva S, Kittler H, Thallinger C, Honigsmann H, Tanew A. Oral vs. bath PUVA using 8-methoxypsoralen for chronic palmoplantar eczema. Photodermatol Photoimmunol Photomed. Apr 2009;25(2):101-5. [Medline].

  20. Robertson L. New and existing therapeutic options for hand eczema. Skin Therapy Lett. Mar 2009;14(3):1-5. [Medline].

  21. Swartling C, Naver H, Lindberg M, Anveden I. Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin. J Am Acad Dermatol. Nov 2002;47(5):667-71. [Medline].

  22. Kontochristopoulos G, Gregoriou S, Agiasofitou E, Nikolakis G, Rigopoulos D, Katsambas A. Letter: regression of relapsing dyshidrotic eczema after treatment of concomitant hyperhidrosis with botulinum toxin-A. Dermatol Surg. Oct 2007;33(10):1289-90. [Medline].

  23. 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. Jan 2002;16(1):40-2. [Medline].

  24. Fairris GM, Jones DH, Mack DP, Rowell NR. Conventional superficial X-ray versus Grenz ray therapy in the treatment of constitutional eczema of the hands. Br J Dermatol. Mar 1985;112(3):339-41. [Medline].

  25. Cartwright PH, Rowell NR. Comparison of Grenz rays versus placebo in the treatment of chronic hand eczema. Br J Dermatol. Jul 1987;117(1):73-6. [Medline].

  26. Lindelof B, Wrangsjo K, Liden S. A double-blind study of Grenz ray therapy in chronic eczema of the hands. Br J Dermatol. Jul 1987;117(1):77-80. [Medline].

  27. Matin A, Bliwise DL, Wellman JJ, Ewing HA, Rasmuson P. Resolution of dyshidrotic dermatitis of the hand after treatment with continuous positive airway pressure for obstructive sleep apnea. South Med J. Feb 2002;95(2):253-4. [Medline].

  28. Stuckert J, Nedorost S. Low-cobalt diet for dyshidrotic eczema patients. Contact Dermatitis. Dec 2008;59(6):361-5. [Medline].

  29. Vocks E, Plotz SG, Ring J. The Dyshidrotic Eczema Area and Severity Index - A score developed for the assessment of dyshidrotic eczema. Dermatology. 1999;198(3):265-9. [Medline].

  30. Burton JL, Holden CA. Morphological types of hand eczema, pompholyx. Eczema, lichenification and prurigo. In: Champion RH, Wilkinson DS, Ebling FJG, eds. Rook, Wilkinson, Ebling Textbook of Dermatology. 6th ed. Blackwell Science: 1998:650-2.

  31. Douwes KE, Karrer S, Abels C, Landthaler M, Szeimies RM. Does smoking influence the efficacy of bath-PUVA therapy in chronic palmoplantar eczema?. Photodermatol Photoimmunol Photomed. Feb 2000;16(1):25-9. [Medline].

  32. Kimball A. Vesicular palmoplantar eczema. In: Fitzpatrick's Dermatology in General Medicine. 2003.

  33. Odia S, Vocks E, Rakoski J, Ring J. Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol. Nov 1996;76(6):472-4. [Medline].

  34. Schmidt T, Abeck D, Boeck K, Mempel M, Ring J. UVA1 irradiation is effective in treatment of chronic vesicular dyshidrotic hand eczema. Acta Derm Venereol. Jul 1998;78(4):318-9. [Medline].

  35. Storrs FJ. Acute and recurrent vesicular hand dermatitis not pompholyx or dyshidrosis. Arch Dermatol. Dec 2007;143(12):1578-80. [Medline].

  36. Sugimura C, Katsuura J, Moriue T, Matsuoka Y, Kubota Y. Dyshidrosiform pemphigoid: report of a case. J Dermatol. Jul 2003;30(7):525-9. [Medline].

  37. Wilkinson JD. Vesicular palmoplantar eczema. In: Freedberg IM, Elsen AZ, Wolff K, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. McGraw-Hill; 1999:1489-94.

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Further Reading

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Keywords

vesicular palmoplantar eczema, pompholyx, dyshidrotic eczema, vesicobullous dermatitis, dyshidrosis, subacute vesiculosquamous eczema, chronic relapsing vesiculosquamous eczema, hand eczema

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Contributor Information and Disclosures

Author

Wingfield Rehmus, MD, MPH, 
Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Carol E Cheng, Boston University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

James J Nordlund, MD, Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine
James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center
Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, 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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