Dyshidrotic dermatitis in Child
Alerts and Notices
SynopsisDyshidrotic dermatitis (dyshidrotic eczema, pompholyx) is generally defined as a recurrent vesicular eruption limited to the hands (most often the sides of the digits) and sometimes the feet. The lesions are extremely pruritic. The etiology is unknown; no causal relationship with sweating has been shown. There is no sex predilection.
Dyshidrotic dermatitis is rare in younger children. When arising in the pediatric population, it is generally seen after the age of 10. The condition often presents episodically, more commonly in warm weather.
Dyshidrotic eczema has been associated with atopic dermatitis, contact irritants and allergens, dermatophyte and bacterial infections, hyperhidrosis, hot weather, diet, and emotional stress. Administration of intravenous immunoglobulin (IVIG) has been associated with severe dyshidrotic dermatitis. There have also been a few reports of dyshidrotic dermatitis in adults treated with secukinumab.
Some cases spontaneously resolve. Treatment is aimed at symptomatic relief and control of vesiculation.
L30.1 – Dyshidrosis [pompholyx]
201201000 – Podopompholyx
402222007 – Vesicular hand eczema
Differential Diagnosis & Pitfalls
- Allergic contact dermatitis – Distinguishing idiopathic dyshidrotic dermatitis from allergic contact dermatitis can be difficult, although contact dermatitis often involves the dorsum of the hand. An extensive history of environmental exposure should be gathered when a vesicular hand rash is present.
- Palmoplantar pustulosis
- Dermatophyte infection (eg, tinea pedis and/or manuum)
- Herpetic whitlow
- Pustular psoriasis
- Bullous impetigo
- Infantile acropustulosis
- Scabies is associated with superficial vesicles, pustules, and burrows; often has coexistent lesions on the wrists, waist, and axillae; and is diffusely pruritic.
- In immunocompromised patients, also consider crusted scabies.
- Epidermolysis bullosa simplex
- Hand-foot-and-mouth disease – Causes oval, palmoplantar vesicles as well as concomitant oral mucosal vesicles or erosions.
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patient Information for Dyshidrotic dermatitis in Child
OverviewDyshidrotic eczema (dyshidrotic dermatitis) is an itchy rash that occurs on the hands (usually the palms and sides of the fingers) and/or the feet. Dyshidrotic eczema manifests as small, itchy, fluid-filled blisters. Sometimes the blisters are very small, like pinpoints, and sometimes they are larger, covering almost the whole palm or foot. The fluid inside the blister can be clear or white to yellow. It is not known what causes this condition, but it is more common in people with eczema. Even in people without sensitive skin, it seems to be triggered by the same things that trigger eczema: cold, dry air or contact with irritants that bother the skin. In other people, a warm, moist climate may be the trigger.
Who’s At RiskDyshidrotic eczema is rare in younger children. When children do get the condition, it usually occurs after age 10 years.
Signs & Symptoms
- The most common location of dyshidrotic eczema is on the hands, and it is sometimes also seen on the feet.
- Small, firm, fluid-filled blisters (vesicles) appear on the surfaces of both palms and both soles and on the sides of the fingers and toes.
- These blisters can appear deep in the skin due to the thickness of the skin on the palms.
- In severe cases, the small blisters can join and form bullae (blisters that are larger than a thumbnail).
- The blisters may break open, ooze, and form a scaly crust.
Self-Care GuidelinesYour child should avoid anything that irritates the skin in the affected areas. Handwashing with mild soaps or cleansers and frequent application of thick emollient creams (eg, Eucerin, Aquaphor, and CeraVe) and petroleum jelly (eg, Vaseline) may be beneficial. Do not pop the blisters of dyshidrotic eczema because of the risk of infection.
When to Seek Medical CareSee your child's medical professional for evaluation if they have a rash on the hands and/or feet that does not improve with self-care measures.
TreatmentsTo manage dyshidrotic eczema, your child's medical professional may recommend:
- A topical steroid cream, lotion, or ointment.
- Ultraviolet light therapy in more severe or recurrent cases.
Dyshidrotic dermatitis in Child