eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Dyshidrotic Eczema: Differential Diagnoses & Workup

Author: Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Contributor Information and Disclosures

Updated: Apr 9, 2009

Differential Diagnoses

Other Problems to Be Considered

  • Id reaction (ie, autoeczematization)
  • Pustular psoriasis
  • Primary fungal infection
  • Recurrent focal palmar peeling (previously termed keratolysis exfoliativa)
  • Dyshidrosiform bullous pemphigoid that may have vesicles (vesicular pemphigoid) or may be evident as erythema and swelling with bullae on the palmoplantar areas8

Workup

Histologic Findings

The vesicles in patients with dyshidrotic eczema are intraepidermal and spongiotic.

More on Dyshidrotic Eczema

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

References

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

  2. 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].

  3. 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].

  4. Tamer E, Ilhan MN, Polat M, Lenk N, Alli N. Prevalence of skin diseases among pediatric patients in Turkey. J Dermatol. Jul 2008;35(7):413-8. [Medline].

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

  6. Iannaccone S, Sferrazza B, Quattrini A, Smirne S, Ferini-Strambi L. Pompholyx (vesicular eczema) after i.v. immunoglobulin therapy for neurologic disease. Neurology. Sep 22 1999;53(5):1154-5. [Medline].

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

  8. Yasuda M, Miyachi Y, Utani A. Two cases of dyshidrosiform pemphigoid with different presentations. Clin Exp Dermatol. Jan 23 2009;[Medline].

  9. National Institute for Clinical Excellence. Frequency of application of topical corticosteroids for atopic eczema. London, England: National Institute for Clinical Excellence (NICE); 2004. 34.

  10. Wollina U, Abdel Naser MB. Pharmacotherapy of pompholyx. Expert Opin Pharmacother. Jul 2004;5(7):1517-22. [Medline].

  11. Capella GL. Topical khellin and natural sunlight in the outpatient treatment of recalcitrant palmoplantar pompholyx: report of an open pilot study. Dermatology. 2005;211(4):381-3. [Medline].

  12. [Best Evidence] Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML. Probiotics for treating eczema. Cochrane Database Syst Rev. Oct 8 2008;CD006135. [Medline].

  13. 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].

  14. Wollina U. Pompholyx: what's new?. Expert Opin Investig Drugs. Jun 2008;17(6):897-904. [Medline].

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

  16. 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].

  17. Grange-Prunier A, Bezier M, Perceau G, Bernard P. [Tobacco contact dermatitis caused by sensitivity to sorbic acid.]. Ann Dermatol Venereol. Feb 2008;135(2):135-138. [Medline].

  18. Jain VK, Aggarwal K, Passi S, Gupta S. Role of contact allergens in pompholyx. J Dermatol. Mar 2004;31(3):188-93. [Medline].

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

  20. Klein AW. Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin. J Am Acad Dermatol. Jan 2004;50(1):153-4; author reply 154. [Medline].

  21. Landow K. Hand dermatitis. The perennial scourge. Postgrad Med. Jan 1998;103(1):141-2, 145-8, 151-2. [Medline].

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

  23. 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].

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

  25. Pitche P, Boukari M, Tchangai-Walla K. [Factors associated with palmoplantar or plantar pompholyx: a case-control study]. Ann Dermatol Venereol. Feb 2006;133(2):139-43. [Medline].

Further Reading

Keywords

dyshidrotic eczema, rash, pompholyx, dyshidrosis, cheiropompholyx, chiropompholyx, dyshidria, palmoplantar hyperhidrosis, dermatitis, pruritic vesicular eruption, acute and recurrent vesicular hand dermatitis, skin rash, treatment, diagnosis, outbreak, skin condition, metal hypersensitivity, contact dermatitis

Contributor Information and Disclosures

Author

Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

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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