Chapter 2. Dyshidrotic Eczema
This term refers to a recurrent eczematous disorder of the hands and feet commonly seen in older children and adults; it is often seen in association with hyperhidrosis. Patients have multiple small, intensely pruritic vesicles on the lateral aspects of the hands, soles or digits (PICTURE A and PICTURE B). Maceration and secondary infection are common due to severe pruritis. Patients may also have nail findings including onycholysis, yellowing and pitting of the nails due to inflammation of the paronychial area. A subset of patients with dyshidrotic eczema also have atopy and it is unclear whether this represents an isolated disorder or rather a variant of atopic dermatitis. Dyshidrotic eczema may be confused with allergic contact dermatitis, although the latter tends to affect the dorsal rather than the volar aspects of the hands. Treatment is similar to that for acute atopic dermatitis: topical corticosteroids and lubricants, but the dermatitis may be persistent even with good therapy.