eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Vesicular Palmoplantar Eczema: Follow-up

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

Updated: Oct 30, 2009

Follow-up

Deterrence/Prevention

  • Elimination of known exacerbating factors, although often difficult to accomplish, is crucial in preventing relapses of vesicular palmoplantar eczema.

Prognosis

  • Acute vesicular eczema (pompholyx) in both major and minor forms tends to occur intermittently or sporadically and becomes less common as patients age. Episodes are less frequent from middle age onward.
  • The prognosis is less satisfactory for subacute and chronic forms of vesicular and hyperkeratotic eczema, which often persist for years, than for other forms.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to investigate for other possible diagnoses, such as contact dermatitis, palmoplantar pustular psoriasis, and pustular bacterid, is a pitfall.
  • Failure to inform patients about the potential atrophy of the skin and/or increased risk of secondary infection that occurs with prolonged application of potent topical steroids is another pitfall. Consider potential systemic adverse effects, such as hyperglycemia, osteoporosis, and weight gain in patients receiving long-term treatment with systemic steroids.
  • Failure to monitor and inform patients with recurrent episodes of the possible long-term effects of immunosuppressive drugs (eg, liver and kidney damage, increased risks of neoplasia) is another pitfall.

Special Concerns

  • Vesicular and hyperkeratotic eczema is a major cause of disability and may result in long periods of occupational limitations.
  • Provide emotional support and psychological counseling to patients, with particular sensitivity to the concerns and needs of patients and their families in view of the chronic nature of the disease.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, (1) Spiros Gramvussakis, MD; (2) John D Wilkinson, MBBS, MRCS, FRCP; and (3) Raeesa W Mirza, MD, MBBS, to the development and writing of this article.



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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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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