Dyshidrotic eczema treatment
Synonyms
- Pompholyx.
- Acute and recurrent vesicular hand dermatitis
Tips
- Dyshidrotic eczema treatment includes topical and systemic treatment options.
- The exact etiology of dyshidrotic eczema is unknown.
- It may occur as a reaction pattern to various endogenous and exogenous factors, including atopy, hyperhidrosis, dermatophytosis, contact allergic dermatitis (to nickel, chromium, balsams and cobalt), irritant dermatitis.
- The clinical course of dyshidrotic eczema can range from self-limited to chronic, severe, or debilitating.
- Attempts to control pompholyx with elimination diets(low-nickel and cobalt diets) may be worth a trial in difficult cases.
- Palmar pompholyx may result as a areaction to adistant fungal infection(tinea pedis).
- Emotional stress and environmental factors (eg, seasonal changes, hot or cold temperatures, humidity) have been reported to exacerbate pompholyx.
- Pompholyx has also been reported to be induced by intravenous immuneglobulin (IVIG) therapy and during the immune reconstitution inflammatory syndrome.
- Punch biopsy for direct immunofluorescence may be needed to exclude bullous pemphigoid.
Medical treatment
- Burrow solution.
- Potassium permanganate 1:10.000 solution.
- Topical corticosteroids
- Mometasone furoate 0.1% ointment : twice daily.
- Clobetasol ointment twice daily.
- Topical calcineurin inhibitors
- Tacrolimus 0.1% ointment twice daily.
- Pimecrolimus 1% cream twice daily with overnight occlusion for 6 weeks.
- Systemic corticosteroids
- Prednisone : 0.5–1.0 mg/kg/day tapered over 2 weeks.
- Triamcinolone acetonide (40–60 mg) Intramuscular.
- Oral antihistamines.
- Oral antibiotics for secondry bacterial infection..
- Emollients.
Resistant cases options
- Alitretinoin: 30 mg daily for 3 to 6 months.
- Methotrexate :15 to 22.5 mg per week for resistant cases.
- Cyclosporine 3 mg/kg/day for 6 weeks.
- Azathioprine 100–150 mg daily.
- Mycophenolate mofetil 1.5 g twice daily for 4 weeks and 12 months of 1 g daily.
- Etanercept 25 mg twice weekly for 6 weeks.
Pompholyx associated with hyperhidrosis
- Oxybutynin : 5 mg of oxybutynin twice a day for the first month and once a day for the second month( Source: Click here).
Physical treatment
- Hand and foot narrowband phototherapy
- Bath PUVA
- Intradermal botulinum A toxin ( source: Click here)