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Dyshidrosis is a type of
dermatitis Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened ...
, characterized by
itch An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...
y
vesicles Vesicle may refer to: ; In cellular biology or chemistry * Vesicle (biology and chemistry), a supramolecular assembly of lipid molecules, like a cell membrane * Synaptic vesicle In a neuron, synaptic vesicles (or neurotransmitter vesicles) s ...
of in size, on the palms of the hands, sides of fingers, or bottoms of the feet. Outbreaks usually conclude within three to four weeks, but often recur. Repeated attacks may result in fissures and skin thickening. The cause of the condition is not known.


Symptoms

The characteristics of dyshidrosis are itchiness of the palms or soles, followed by the sudden development of intensely itchy small vesicles on the sides of the fingers, the palms or the feet, sometimes described as having a "
tapioca pudding Tapioca pudding is a sweet pudding made with tapioca and either milk or cream. Coconut milk is also used in cases in which the flavor is preferred or in areas in which it is a commonplace ingredient for cooking. It is made in many cultures with ...
" appearance. The vesicles may develop in waves. After a few weeks, the top layer of skin may fall off and inflammation appear around the bases of the vesicles, and there may be peeling, rings of scale, or
lichenification Lichenification is a cutaneous condition caused by consistent irritation of the skin, such as scratching or rubbing, but can also be caused by friction from clothing or chemical irritants. Lichenification can develop from scratching existing skin ...
. After three to four weeks the vesicles will disappear. While they are present there is a risk of secondary bacterial infection. The locations of the eruption may be symmetrical on the body, and redness is not usually present. File:DyshidroticDermatitisOnHandsLateStage.jpg, Advanced stage of dyshidrosis on the fingers File:Dyshidrosis.JPG, Palmar dyshidrosis File:Palmar dyshidrosis peeling stage.JPG, Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin File:Dyshidrosis late stage.jpg, Advanced stage of dyshidrosis on the foot File:Rim of scale on plantar surface of thumb.jpg, Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flare


Causes

Whilst the exact causes of the condition are currently unknown, its triggers may include food allergens from a wide range of foods, including
tuna A tuna (: tunas or tuna) is a saltwater fish that belongs to the tribe Thunnini, a subgrouping of the Scombridae ( mackerel) family. The Thunnini comprise 15 species across five genera, the sizes of which vary greatly, ranging from the bul ...
,
tomato The tomato (, ), ''Solanum lycopersicum'', is a plant whose fruit is an edible Berry (botany), berry that is eaten as a vegetable. The tomato is a member of the nightshade family that includes tobacco, potato, and chili peppers. It originate ...
,
pineapple The pineapple (''Ananas comosus'') is a Tropical vegetation, tropical plant with an edible fruit; it is the most economically significant plant in the family Bromeliaceae. The pineapple is indigenous to South America, where it has been culti ...
,
chocolate Chocolate is a food made from roasted and ground cocoa beans that can be a liquid, solid, or paste, either by itself or to flavoring, flavor other foods. Cocoa beans are the processed seeds of the cacao tree (''Theobroma cacao''); unprocesse ...
,
coffee Coffee is a beverage brewed from roasted, ground coffee beans. Darkly colored, bitter, and slightly acidic, coffee has a stimulating effect on humans, primarily due to its caffeine content, but decaffeinated coffee is also commercially a ...
, and
spices In the culinary arts, a spice is any seed, fruit, root, Bark (botany), bark, or other plant substance in a form primarily used for flavoring or coloring food. Spices are distinguished from herbs, which are the leaves, flowers, or stems of pl ...
among others, physical or mental stress, frequent hand washing, or metals. A number of studies have implicated
balsam of Peru Balsam is the resinous exudate (or sap) which forms on certain kinds of trees and shrubs. Balsam (from Latin ''balsamum'' "gum of the balsam tree," ultimately from a Semitic source such as ) owes its name to the biblical Balm of Gilead. Chem ...
. A 2013 study found that dyshidrosis on the hands increased among those allergic to
house dust mites A house is a single-unit residential building. It may range in complexity from a rudimentary hut to a complex structure of wood, masonry, concrete or other material, outfitted with plumbing, electrical, and heating, ventilation, and air condi ...
, following inhalation of house dust mite allergen.
Id reaction ID or its variants may refer to: * Identity document, a document used to verify a person's identity * Identifier, a symbol which uniquely identifies an object or record People * I. D. Ffraid (1814–1875), Welsh poet and Calvinistic Methodist mi ...
and
irritant contact dermatitis Irritant contact dermatitis is a form of contact dermatitis that can be divided into forms caused by chemical irritants and those caused by physical irritants. Chemical Chemical irritant contact dermatitis is either acute or chronic, which i ...
are also possible causes. In 2005, researchers from Anhui Medical University and the Chinese National Human Genome Center, Beijing, theorizing that
mutation In biology, a mutation is an alteration in the nucleic acid sequence of the genome of an organism, virus, or extrachromosomal DNA. Viral genomes contain either DNA or RNA. Mutations result from errors during DNA or viral replication, ...
s in single
gene In biology, the word gene has two meanings. The Mendelian gene is a basic unit of heredity. The molecular gene is a sequence of nucleotides in DNA that is transcribed to produce a functional RNA. There are two types of molecular genes: protei ...
s could predispose the condition, ran a study of a Chinese family with the condition present across four generations via autosomal dominant inheritance. Their analysis of
haplotypes A haplotype (haploid genotype) is a group of alleles in an organism that are inherited together from a single parent. Many organisms contain genetic material (DNA) which is inherited from two parents. Normally these organisms have their DNA orga ...
within the family identified a locus for the condition on
chromosome 18 Chromosome 18 is one of the 23 pairs of chromosomes in humans. People normally have two copies of this chromosome. Chromosome 18 spans about 80 million base pairs (the building material of DNA) and represents about 2.5 percent of the total DNA in ...
.


Diagnosis

Dyshidrosis is diagnosed clinically by gathering a patient's history and making observations. Allergy testing and
culture Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...
may be done to rule out other problems. Severity of symptoms can also be assessed using the dyshidrotic eczema area and severity index (DASI), although it was designed for clinical trials and is not typically used in practice.


Treatment

Avoiding triggers may be useful, as may be the application of a
barrier cream A barrier cream is a Topical medication, topical formulation used in industrial applications and as a cosmetic to place a physical barrier between the skin and contaminants that may irritate the skin (contact dermatitis or occupational dermatitis ...
or wearing of gloves. Treatment is generally made with steroid cream, although this can be dangerous in the long term due to the side effect of thinning of the skin, which is particularly troublesome in the context of hand dyshidrosis due to the amount of toxins and bacteria the hands typically come in contact with. High strength steroid creams may be required for the first week or two. In especially acute and severe cases, systemic steroids can be taken orally; the
immunosuppressive drug Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent the activity of the immune system. Classification Immunosuppressive drugs can be classifie ...
tacrolimus Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After Allotransplantation, allogenic organ transplant, the risk of organ Transplant rejection, rejection is moderate. To lower the risk of organ rejectio ...
, or
PUVA therapy PUVA (psoralen and UVA) is an ultraviolet light therapy treatment for skin diseases: vitiligo, eczema, psoriasis, graft-versus-host disease, mycosis fungoides, large plaque parapsoriasis, and cutaneous T-cell lymphoma, using the sensitizing effec ...
may also be tried.
Dapsone Dapsone, also known as 4,4'-sulfonyldianiline (SDA) or diaminodiphenyl sulfone (DDS), is an antibiotic commonly used in combination with rifampicin and clofazimine for the treatment of leprosy. It is a second-line medication for the treatment an ...
(diamino-diphenyl sulfone), an
antibacterial An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention ...
, has been recommended for the treatment of dyshidrosis in some chronic cases.
Antihistamines Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides r ...
such as
Fexofenadine Fexofenadine, sold under the brand name Allegra among others, is an antihistamine medication used in the treatment of allergy symptoms such as allergic rhinitis and urticaria. Therapeutically, fexofenadine is a selective peripheral H1 blocke ...
may be used to help with the itching.
Potassium permanganate Potassium permanganate is an inorganic compound with the chemical formula KMnO4. It is a purplish-black crystalline salt, which dissolves in water as K+ and ions to give an intensely pink to purple solution. Potassium permanganate is widely us ...
dilute solution soaks are popular, used to "dry out" the vesicles and kill off superficial ''
Staphylococcus aureus ''Staphylococcus aureus'' is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often posi ...
'', but they can be very painful and undiluted may cause significant burning.
Alitretinoin Alitretinoin, or 9-cis-retinoic acid, is a form of vitamin A. It is also used in medicine as an antineoplastic (anti-cancer) agent developed by Ligand Pharmaceuticals. It is a first generation retinoid. Ligand gained Food and Drug Administratio ...
(9-cis-retinoic acid) has been approved for prescription in the UK. It is specifically used for chronic hand and foot eczema. It is made by Basilea of Switzerland (BAL 4079).


Epidemiology

A study of 20,000 randomly-selected individuals in
Gothenburg Gothenburg ( ; ) is the List of urban areas in Sweden by population, second-largest city in Sweden, after the capital Stockholm, and the fifth-largest in the Nordic countries. Situated by the Kattegat on the west coast of Sweden, it is the gub ...
, Sweden in 1988 found 2% of male respondents and 3% of female respondents to have dyshidrosis, and that it comprised 5% of cases of hand eczema of any type. A study of 6300
pediatric Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth ...
patients in Turkey in 2006 found 1% to have dyshidrosis.


History of classification

The condition was named ''dyshidrosis'' by the British dermatologist
William Tilbury Fox William Tilbury Fox (1836 – 7 June 1879) was an English dermatology, dermatologist. He was born in Broughton, Hampshire the son of physician Luther Owen Fox and Mary (née Tilbury) Fox, and the brother of Thomas Fox (dermatologist), Tho ...
in 1873, in a clinical lecture wherein he presented it as "a disordered condition of the sweat-follicles and the sweat-function... which is, as a rule, diagnosed as eczema, but is a separate and distinct affair... I have termed the disease , because nature seems to have a difficulty in getting rid of the secreted sweat, which remains to distend the follicles, and to macerate the tissues." His theory that the condition was related to sweat was soon observed as unproven in scholarly publication and subsequent research on multiple occasions has shown an absence of relation to the sweat glands. The condition had already been described clinically in a lecture in 1871 by Sir Jonathan Hutchinson, who had named it ''cheiro-pompholyx''. Hutchinson's work was based on his observations, in 1864, of the same woman patient who Tilbury Fox would later describe in his own lecture. In 1875 Hutchinson published his book ''Illustrations of Clinical Surgery'', describing the condition of "cheiro-pompholyx" without making reference to Tilbury Fox's work. This led to a dispute between the two dermatologists, played out in letters to ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...
''. Tilbury Fox was aggrieved that his reading of Hutchinson's lecture suggested it to imply Hutchinson had been the first to formally describe the condition. Hutchinson apologised, saying that he had been in too much of a hurry to publish to read Tilbury Fox's work, and being aware that Tilbury Fox had described it as a sweating disorder, he had considered it to be a different condition to the one he was writing about. In the same letter he chastised Tilbury Fox for claiming propriety over describing the vesicles as resembling "a
sago Sago () is a starch extracted from the pith, or spongy core tissue, of various tropical palm stems, especially those of ''Metroxylon sagu''. It is a major staple food for the lowland peoples of New Guinea and the Maluku Islands, where it is c ...
grain", a comparison that he had also independently made, and noted that the subject of his lecture in 1871 had been his patient for several years before Tilbury Fox's lecture. In an editorial for the Chicago Medical Journal and Examiner, Dr. Nathan Smith Davis wryly described the dispute as "not the first occasion upon which two eminent men have contended for the honor of a lady's hand." After a paper by Dr. A. R. Robinson describing the condition, entitled "Pompholyx" and mentioning the dispute, was published in the Archives of Dermatology the following year, Tilbury Fox responded with a strident critique of Robinson's conclusions and accused him of having misrepresented the facts of the dispute.


See also

*
Dermatitis herpetiformis Dermatitis herpetiformis (DH) is a chronic autoimmune blistering skin condition, characterised by intensely itchy blisters filled with a watery fluid. DH is a cutaneous manifestation of coeliac disease, although the exact causal mechanism is not ...
– a similar condition caused by celiac and often mistaken for dyshidrosis. * Epidermolysis bullosa – a genetic disorder that causes similar, albeit more severe, symptoms to those of dyshidrosis.


Notes


References


External links

{{Disorders of skin appendages Eczema Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate Chronic blistering cutaneous conditions