Author: Amanda Oakley, Dermatologist, Hamilton New Zealand, 1997. Updated July 2014.
Vesicular hand dermatitis is a form of hand/foot eczema characterised by vesicles or bullae (blisters). It is also called vesicular endogenous eczema, dyshidrotic eczema and pompholyx. Pompholyx is sometimes subclassified as cheiropompholyx (hands) and pedopompholyx (feet).
Vesicular hand dermatitis most often affects young adults.
Vesicular hand dermatitis is multifactorial. In many cases it appears to be related to sweating, as flares often occur during hot weather, humid conditions, or following emotional upset. Other contributing factors include:
Vesicular hand dermatitis presents as recurrent crops of deep-seated blisters on the palms and soles. They cause intense itch and/or a burning sensation. The blisters peel off and the skin then appears red, dry and has painful fissures (cracks).
The clinical presentation is typical.
As in other forms of hand dermatitis, vesicular hand dermatitis is aggravated by contact with irritants such as water, detergents and solvents. Contact with them must be avoided as much as possible and protective gloves worn to prevent additional irritant contact dermatitis.
People with vesicular hand dermatitis that are found to be allergic to nickel must try to avoid touching nickel items.
Vesicular hand dermatitis is challenging to treat. Topical therapy is relatively ineffective because of the thick horny layer of skin of palms and soles.
Vesicular hand dermatitis generally gradually subsides and resolves spontaneously. It may recur in hot weather or after a period of stress, and in some patients is recalcitrant.
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