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Vesicular Palmoplantar Eczema Workup

  • Author: Elaine Dupuis, MD, MBA; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 21, 2016
 

Laboratory Studies

The diagnosis of palmoplantar eczema is essentially a clinical one; however, studies may be helpful in excluding other disorders. Consider the following:

  • KOH staining of skin scrapings to rule out fungal infection, especially in hyperkeratotic forms of the disease
  • Swab and culture of suspected lesions to exclude secondary bacterial infection if infection is suspected
  • A biopsy to distinguish eczema from psoriasis or some forms of palmoplantar hyperkeratoses
  • Patch testing to exclude contact dermatitis or a systemic reaction to contact allergen
  • Allergy testing may suggest an atopic tendency
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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.

Distinguishing between palmoplantar pustulosis and pompholyx can be challenging, as they share similar histological features. Recent studies have looked at differentiating the two entities and found thinning of rete ridges, foci of parakeratosis, and irregular epidermal hyperplasia to be more often associated with pompholyx.[26] Further, a comparison of inflammatory mediator expression between pompholyx and palmoplantar pustulosis found increased mRNA expression of granzyme B in pompholyx. In contrast, interleukin (IL)–8, and IL-17α were increased in palmoplantar pustulosis.[27] These may serve as immunologic markers in distinguishing palmoplantar pustulosis from pompholyx.

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Contributor Information and Disclosures
Author

Elaine Dupuis, MD, MBA Resident Physician, Section of Dermatology, Department of Medicine, University of Calgary Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Wingfield Rehmus, MD, MPH Dermatologist, BC Children's Hospital, Vancouver, British Columbia

Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Valeant Canada<br/> Received honoraria from Valeant Canada for advisory board; Received honoraria from Pierre Fabre for advisory board; Received honoraria from Mustella for advisory board; Received honoraria from Abbvie for advisory board.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Carol E Cheng, MD Attending Physician, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference 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.

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