Dehidrosis

Specialty: Skin.

• pompholyx
• dehidrotic eczema
• pruritic palmoplantar vesicles

Why it occurs

• Eczematous reaction of idiopathic or multifactorial origin characterized by the sudden appearance of deep-seated vesicles on the lateral surfaces of the fingers, palms of the hands and soles of the feet
• Allergic or irritative contact dermatitis (occupational exposure to metals such as nickel, chromium or cobalt)
• Remote ide ("dermatophytide") reaction secondary to an active untreated fungal infection (commonly tinea pedis or "athlete's foot")
• Intense acute emotional stress or underlying chronic fatigue
• Concomitant palmoplantar hyperhidrosis that favors maceration of the stratum corneum.

Initial workup

Clinical examination of "millet grain" vesicles. Direct skin scraping with 20% KOH of marginal scaling and soles/feet to rule out primary fungal infection requiring targeted management. Epidermal patch tests to identify contact allergens if the condition is chronic or recurrent.

Standard management

• Clobetasol propionate 0.05% cream or ointment — very high potency corticosteroid essential in the acute vesicular phase to stop the eczematous inflammatory process
• Hydroxyzine — first generation H1 antihistamine with sedative effect for the management of the intense pruritic phase, dose of 25 mg orally at night
• Baths or compresses moistened with a 1:1000 zinc sulfate solution — astringent and drying agents applied for 10-15 minutes on moist vesicles before corticosteroids
• Alitretinoin (oral retinoid indicated for refractory chronic hand eczema of severe intensity, under strict medical and reproductive control).