Dehidrosis or Dehydrotic Eczema

What is?

It is an erythematous eczema, located on the palms of the hand and the soles of the feet, whose main characteristic is the appearance of small vesicles, which are intensely itchy. Men suffer from it more frequently, with a ratio of 3 to 1. The highest incidence is found among young people between 20 and 40 years of age, although it can occur in children and adults, mainly in times of heat and humidity.

How does it seem?

The triggering cause is unclear and may be multifactorial. An allergic component is found in 50% of patients, as a consequence of an alteration of the immune system called atopy. (It is a hypersensitivity reaction subject to hereditary influence).

Other factors such as the role played by the sweat glands (hyperhidrosis), as well as allergy to nickel sulfate, are also evaluated.

Personal circumstances are another factor of particular relevance in this disease, such as greater emotional tension, stress.

Clinical manifestations

Clinically it is characterized by a sudden eruption of hard vesicles like “millet grains”, which produce intense itching on the palms of the hands and soles of the feet. They are located preferably on the lateral sides of the fingers of both extremities (especially the third and fourth), and they worsen with heat and humidity. They present outbreaks of several weeks duration and their distribution is generally bilateral and symmetrical.

At first, the vesicles may be imperceptible or appear in the form of millet or tapioca seeds, which can be felt above the skin. The content of the vesicles is light in color, although on some occasions it may be hematic. The confluence of several vesicles can give rise to large blisters that evolve into lesions with a dry appearance, erythemo-scaling and lichenification. Repeated outbreaks can end up causing, in the affected areas, nail dystrophy, with striations, thickening and discoloration of the nails. Superinfection with the formation of pustules that can cause lymphangitis and lymphadenopathy is frequent.

Diagnosis

It is done through a good history and clinical examination.

The definitive diagnosis will be given by histopathology. Microscopically, spongiotic vesicles are observed in the epidermis accompanied by a perivascular lymphocytic infiltrate in the papillary and reticular dermis.

Differential diagnosis

From the clinical point of view, it will have to be done with: palmar-plantar pustular psoriasis, ringworm of the hands and feet, bullous dermatosis, and other eczema.

Treatment

Eliminate the causal effect if known.

In the acute phase, zinc sulfate-based fomentation (1/1,000), Burow's solution, is recommended. Corticosteroid creams or ointments or 2% erythromycin lotions may also be prescribed.

In stubborn cases, they should be associated with topical treatment with macrolide antibiotics (erythromycin) for variable periods, depending on the intensity of the outbreak.