Palmar dehidrosis
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- Local. Mãos
- Lesão eritematosa? Lesão não eritematosa
- Tempo de evolução. Crónico: superior a 2 semanas, Recidiva/recorrente
- Tipo de lesão. Com fluído: vesicula, bolha ou pústula
- Textura da superfície. Crosta/ulceração/escoriação
- Tipo de bordos. Mal definidos
- Cor.
- Distribuição das lesões. Lesões múltiplas agrupadas
- Sintomas associados. Prurido
- Informação complementar.
Summary information
- Acute palmoplantar eczema (commonly called dyshidrotic eczema or deshidrosis) corresponds to an intensely itchy, often symmetrical, vesicular eruption that affects the palms of the hands, the lateral and dorsal region of the fingers and/or the soles of the feet.
- It manifests itself in the form of a sudden eruption of intensely itchy vesicles on the hands and feet, particularly on the lateral and dorsal surfaces of the fingers.
- The vesicles are deep and may be multilocular with a characteristic “tapioca pudding” appearance and may coalesce into blisters.
- In around 70 to 80% of cases, only the hands are affected.
- It occurs more frequently in females and young adults.
- Episodes (de novo or recurrences) tend to occur more frequently during the warmer months.
- Secondary infection of the lesions may occur.
- The diagnosis is essentially clinical.
- A skin biopsy is rarely necessary and is usually indicated when there is no improvement with treatment.
- It can be classified as:
- Mild to moderate dyshidrotic eczema
- injuries that do not involve the entire palmar or plantar surface;
- have few clusters of vesicles;
- mild erythema;
- pruritus that is not disabling;
- no significant pain or discomfort.
- Severe dyshidrotic eczema:
- injuries involving the entire palmar or plantar surface;
- they present with large disabling vesicles or blisters (which interfere with walking or the use of their hands);
- if intensely painful or itchy, regardless of the size of the lesions.
- Mild to moderate dyshidrotic eczema
- Although in most cases it is not possible to identify a predisposing factor, its cause is likely multifactorial, and factors that have been
- associated with its development include:
- history of atopic dermatitis;
- topical or systemic exposure to contact allergens, notably metals, metalworking fluids, ingestion of nickel or cobalt;
- hyperhidrosis;
- exposure to tobacco smoke;
- exposure to ultraviolet radiation;
- stress.
Differential diagnosis
- Palms
- Lateral and dorsal region of the fingers and/or soles of the feet.
Treatment and guidance
- General measures designed to reduce irritation and restore the skin barrier. They should be used at all stages of the disease. Include:
- wash your hands with warm water and mild synthetic detergents (no soap);
- dry your hands well after washing;
- apply emollients after drying your hands and as often as possible;
- remove accessories before contact with moisture;
- wear gloves during the cold months;
- wear suitable gloves when carrying out work with friction (such as gardening or carpentry);
- and avoid exposing the skin to irritating agents such as harsh detergents, solvents and hair dyes.
- Therapeutic options depend on the degree of eczema:
- Mild to moderate dyshidrotic eczema
- topical corticosteroids (1st line)
- of high or very high potency, preferably in an ointment formulation, applied every 12/12 hours for 2 to 4 weeks.
- Long-term use is limited by its side effects, which include skin atrophy, striae, and telangiectasias.
- topical corticosteroids (1st line)
- topical calcineurin inhibitor
- tacrolimus 0.1%, every 12 hours, until resolution;
- consider as an alternative, especially if you want to avoid prolonged use of topical corticosteroids.
- has an anti-inflammatory effect equivalent to a medium-potency topical corticosteroid.
- Severe dyshidrotic eczema:
- oral corticosteroid
- prednisone 40-60 mg, once a day for 1 week, with a halving of the dose in the following week and a subsequent weaning schedule in the following 2 weeks.
- oral corticosteroid
- Mild to moderate dyshidrotic eczema
- Consider a refractory case when there is no improvement or resolution of the clinical condition after 2 to 4 weeks of adequate treatment:
- consider further assessment/referral and reconsideration of differential diagnosis.