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Background: It is unclear whether the respiratory tract is involved in eliciting or aggravating eczematous lesions in patients with vesicular hand eczema. Objectives. To investigate the effect of inhalation of house dust mite (HDM) on vesicular hand eczema., Methods: Eighteen patients with vesicular hand eczema and HDM allergy received inhalation challenges with four concentrations of HDM in a randomized, double-blind, placebo-controlled, cross-over study. Early asthmatic reactions and late asthmatic reactions were defined as a placebo-corrected fall of 15% or more from baseline of forced expiratory volume in 1 second. Hand eczema was scored according to the Dyshidrotic Eczema Area and Severity Index (DASI) at baseline, and 1, 6, 24 and 48 hr., Results: The median DASI increased significantly as compared with baseline at 6 and 48 hr after HDM inhalation. This increase was significantly different between the provocations at 6 hr. The median vesicles score increased significantly from baseline at 24 and 48 hr. Patients with a placebo-corrected increase in the number of vesicles at 24 hr and 48 hr had significantly more often late asthmatic reactions than those without an increase in the number of vesicles. Patients with a placebo-corrected increase of the DASI score at 24 hours had as a group a higher mean total IgE level than those without an increase of the DASI score., Conclusion: Hand eczema increased significantly more after HDM provocation than after placebo provocation. An increase in the number of vesicles was preceded by late asthmatic reactions. The group patients with an increase of hand eczema tended to have a higher mean total IgE level., (© 2012 John Wiley & Sons A/S.)

We report a case of adult-onset acquired zinc deficiency after bariatric surgery. Zinc deficiency may be inherited in the form of acrodermatitis enteropathica or acquired by low nutritional intake, malabsorption, excessive loss of zinc, or a combination of these factors.

Background: Pompholyx-like reactions may develop for aggressive atopic dermatitis treatments in the incipient phase despite of improvement of other skin symptoms., Methods: Eighty-nine patients admitted to National Center for Child Health and Development for treatment of atopic dermatitis between April 2007 and March 2009 were recruited., Results: Pompholyx-like reactions were seen in thirteen out of eighty-nine patients between 4 and 32 (mean 16.7±10.4) days following admission. The mean age of patients with these reactions was 6.2±6.1 years (range of 3 months to 23 years). At the time of admission, practical issues of scoring atopic dermatitis: the SCORAD was assessed. The values of SCORAD index with pompholyx were ranging from 16-91 (mean 50.8±17.9), and the index except under one-year old were significantly higher than unaffected patients. These patients were evaluated into their medical record, for evidence of Pompholyx-like lesions: a bilateral vesicular eruption confined to the skin of the palms, soles, or sides of the fingers. Topical corticosteroids are used to treat Pompholyx-like reactions, all them achieved remission between 4 and 50 days (mean 18.5±12.0). In general, pompholyx is more common in summer. However, it seems that there were no significant differences in the pompholyx-like reactions incidence between in summer and in winter., Conclusion: The factor for the occurrence of pompholyx-like lesions remains unexplained. Although the original symptoms of eczema were improved, pompholyx-like eczema breakout, therefore, patients often feel uneasy. We should be aware of this clinical condition.

Pompholyx is a vesicobullous disorder of the palms and soles. The condition is hard to treat because of the peculiarities of the affected skin, namely the thick horny layer and richness of the sweat glands. In this article, we review the available therapies, and score the treatments according to the level of evidence. The cornerstones of topical therapy are corticosteroids, although calcineurin inhibitors also seem to be effective. Topical photochemotherapy with methoxsalen (8-methoxypsoralen) is as effective as systemic photochemotherapy or high-dose UVA-1 irradiation. Systemic therapy is often necessary in bullous pompholyx. Corticosteroids are commonly used although no controlled study has been published to date. For recalcitrant cases, corticosteroids are combined with immunosuppressants. Alitretinoin has efficacy in chronic hand dermatitis including pompholyx. Another evolving treatment seems to be the intradermal injection of botulinum toxin. Radiotherapy might be an option for selected patients not responding to conventional treatment. In practice, patients benefit most from a combination of treatments.

Background: Dyshidrotic eczema is a type of chronic intermittent dermatitis characterized by vesicles, dystrophic fingernail changes, and rarely bullae that affects the hands and feet. Many exogenous factors may trigger a flare including dermatophyte infections, contact irritants, and metal hypersensitivity. Although metal hypersensitivity does not play a role in all cases of dyshidrotic eczema, high oral ingestion of nickel and/or cobalt should be considered, regardless of patch test results., Objective: We updated and simplified existing published guidelines for low-cobalt diets. A recent review of the literature showed that dietary cobalt restriction, a safe yet burdensome treatment option for dyshidrosis, is referenced to dated sources., Methods: We have analysed current data for the cobalt content in common food items., Conclusion: We propose a revised, point-based diet that will eliminate much of the dietary cobalt (and nickel) and reduce dyshidrotic eczema flares.

Objective: To assess the relative frequency of the different causes of pompholyx evoked in the literature., Design: Prospective survey., Setting: Clinical outpatient setting., Patients: A total of 120 consecutive patients with pompholyx referred to our department from 2000 through 2003., Main Outcome Measures: Systematic investigation of different causes of pompholyx: fungal intertrigo, hyperhidrosis, atopy, contact eczema, and internal reactions with systematic provocation tests to metals, balsam of Peru, and food allergen when suspected., Results: The present study found the following causes of pompholyx in the 120 patients: mycosis (10.0%); allergic contact pompholyx (67.5%), with cosmetic and hygiene products as the main factor (31.7%), followed by metals (16.7%); and internal reactivation from drug, food, or haptenic (nickel) origin (6.7%). The remaining 15.0% of patients were classified as idiopathic patients, but all were atopic. (Percentages do not total 100 because of rounding.), Conclusions: Our data confirm the existence of reactional pompholyx to interdigital-plantar intertrigos and endogenous reactions to metals or other allergens, but they mainly point at the unexpected importance of a so-called contact pompholyx in which cosmetic and hygiene products play a preponderant role compared with metals. The great frequency of atopic conditions, even if idiopathic pompholyx is not inferred as an equivalent of atopy, should lead to further causative investigations before undertaking more expensive or extensive treatments of refractory pompholyx.

A seven month-old boy had been suffering from recalcitrant pompholyx of both soles in spite of the treatment with corticosteroid ointment for three months. Because patch test of chromium was positive at 48 and 96 hr reading, we advised to his mother that the infant must avoid to touch and to take the chromium-containing goods. His lactating mother had been taking high amounts of chocolate and cocoa every day, both of which contain considerable amounts of chromium. The pompholyx disappeared within 2 weeks, after his mother stopped eating chocolate and cocoa. Oral provocation test with chocolate and cocoa to the patient's lactating mother resulted in the development of pompholyx in the baby within two days. We diagnosed the infant as systemic metal allergy to chromium which was possibly transferred from his mother's milk. This is the first report of systemic metal allergy which is provoked by mother's milk which is from the person who takes a lot of metal-containing foods.

Background: Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis., Patients and Methods: This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo., Results: One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls., Discussion: The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.

We describe 5 patients whose histories and investigation findings point toward a diagnosis of photo-induced hand pompholyx, a previously unreported condition. Several factors have been associated with the exacerbation of pompholyx, but no direct relationship with sunlight exposure has been reported.

The use of intravenous immunoglobulin (IVIG) has become an accepted treatment for patients with Guillain-Barré syndrome. Few patients develop adverse reactions to IVIG such as flushing, urticaria, eczema, chest tightness, wheezing, diaphoresis and hypotension. We report three patients who each received a five day course of IVIG at the standard dose of 0.4 g/kg/day. Two patients had Guillain-Barré syndrome, and the other had Miller Fisher syndrome. All developed eczematous reactions after 4 days from the start day of therapy to 5 days from the last day of therapy. One patient with GBS had widespread eczematous eruption with severe pompholyx lesions on the palms, fingers and soles, and spread over a period of 2 to 3 weeks to become generalized. That persisted for 4 weeks but gradually settled with desquamation by the use of topical steroids. None of our patients subsequently developed long-term or chronic eczema after the resolution of the initial cutaneous reaction. Eczematous reactions of our patients were similar to those reported in the literature and clinically typical as pompholyx. Although pompholyx has been recognized as a clinical entity, its cause remains obscure. Cutaneous reactions after IVIG infusion are recognized to be rare, but actually they may occur more frequently than our recognition, and its knowledge is essential to make the right clinical decision.

A 63-year-old woman presented simultaneously with two rare forms of bullous pemphigoid. Initially she had a dyshidrotic palmoplantar eczema. Repeated epicutaneous patch tests ruled out a type IV allergic reaction to common allergens. Six months later the patient developed disseminated pruritic nodules. After 4.5 years she then demonstrated scattered bullae within erythematous plaques indicative of bullous pemphigoid. A skin biopsy showed linear IgG and IgM as well as C3 deposits at the dermo-epidermal junction and circulating autoantibodies against the basement membrane could be found in serum. Accordingly, the diagnosis of bullous pemphigoid was made. In retrospect, the vesicular palmoplantar eczema and pruritic nodules could be interpreted in this case as early manifestations of bullous pemphigoid. We recommend that in patients with persistent pruritic skin lesions, which are resistant to standard therapy, bullous pemphigoid should be excluded by adequate immunological examinations.

Dyshidrotic eczema (DE) is a chronic and/or recurrent vesicular eczema of the palmar sides of the hands and sometimes the soles of the feet. The major aetiologies to be considered are atopic DE, contact DE, systemic contact DE and DE due to fungal or microbial allergy. To clarify the role of occupational contact allergens, 59 workers with DE were examined to determine whether they had atopy, environmental contact sensitization and/or contact allergy coupled with work activity. For all, patch testing was carried out using the European standard series and the material brought in by the patients. No significant difference was found between the rate (42.4%) of history of atopy among the 59 workers with DE and that (30.6%) observed among 160 workers with other forms of hand eczema (HE). Positive patch test reactions were found in 72.8% of dyshidrotic patients. A relationship to occupational activity was strong for 18 (30.5%) of them but this rate was significantly lower than that (55%) observed among the 160 with other types of eczema. Results of the present study showed that contact sensitization is as much involved in workers with DE as in workers with other form of HE, even though the relationship to work is significantly less frequent for DE. It also suggests that atopic histories are no more involved in DE than in other forms of HE.

Dyshidrosis is a vesicular, non inflammatory and recurrent disease of the palms and soles related to eczema. Sometimes hyperhidrosis can induce inflammatory reactions. The diagnosis becomes obvious when a period of ferocious pruritus, vesicle develop on the sides of the fingers and the palms. These vesicles are imbedded in the epidermis below the thick stratum corneum. They are strongly distended and painful when they grow in size. They dry up and disappear within three weeks. Relapses are frequent in patients with a topy, sweat gland disorders or neurovegetative disturbances. Several clinical aspects are observed: bullous dyshidrosis, superinfection, psoriasiform keratodermia. Dyshidrosis in infectious, fungal or allergic origin can be cured by suppressing the causative agent, but complex or idiopathic lesions follow their own course and persist.

Hand eczema continues to bedevil both patients and physicians. While appropriate and judicious intervention minimizes aggravation, discomfort, and inconvenience, recurrences are frequent. Treatment with corticosteroids is often effective for irritant dermatitis. Efforts to avoid the irritant, protect the hands, and use emollients are vital in preventing recurrence. Protection and avoidance are also the key techniques to teach patients with allergic dermatitis. In the case of pompholyx, experts now believe the condition is caused by stress or emotional turmoil, so the most helpful intervention may be patient education about stress management. Recognizing the role of irritants encountered at work, at home, and in the recreational setting offers physicians the opportunity to intervene preemptively. When patients avoid unnecessary exposure and protect the skin against climatic instability, the toll exacted by hand eczema can be dramatically reduced.

Post-cast hypertrichosis and dyshidrotic dermatitis are not uncommon separately. Yet, the simultaneous occurrence of both conditions in an individual is rare. A patient with both localized hypertrichosis and ipsilateral dyshidrotic dermatitis following multiple fractures and cast application is reported. The clinical presentation, management, spontaneous resolution, and/or response to therapy of post-cast hypertrichosis and dyshidrotic dermatitis that occurred concurrently in an individual were similar to that described when these conditions occur independently. The acquired conditions that may be associated with localized hypertrichosis are summarized and the postulated mechanisms of pathogenesis for dyshidrotic dermatitis are reviewed. The diagnosis of post-cast hypertrichosis in this patient was suspected based upon the distribution and temporal association of the hypertrichosis to the location and placement of his cast, and confirmed by excluding other causes of acquired localized hypertrichosis. Also, the possibility that in this individual either the trauma to his bones, the cast on his arm, or both had an etiologic role in promoting the development of dyshidrotic dermatitis is suggested.

The aim of this study was to compile a register of all the employees of a University Hospital Centre who complained of dermatosis of the hands due to latex. Recruitment was made by their spontaneous presentation in the service of the Workers Doctor (Médecine de Travail). The prevalence of clinical signs of contact eczema or professional urticaria is 2.3% for all personnel. 2.7% for nurses, 4.4% for care assistants or ancillary staff of the hospital service. In this population, 73% of subjects have shown previous atopy. The positive predictive value of the allergy tests was 51.3%, 2.32% of ASH-ASI, 1.75% of AS, 1.47% of IDE were allergic to latex, about 1.06% of the total personnel. 80% had atopy and 36.66% had a crossed allergy (banana, kiwi, avocat, pollen). Prevalence was zero amongst the administrative officers, but not systematic enquiry was made in the professional category. The orthoergical dermatoses were more frequent amongst the ASH-ASI, though the positive predictive value of tests was less. The considerable exposure to a number of caustic substances, as well as absence of precautions such as rinsing and drying of hands may explain this. All employees with allergy to latex have been declared to have a professional illness a card that mentions this allergy has been given to them.

Pompholyx (Dyshidrosis) is a disease of unknown etiology presenting as symmetrical, vesicular hand and foot dermatitis. To clarify the pathogenetic role of sweat and metal allergy, twenty five patients with pompholyx were examined with respect to their perspiration volume using equipment that continuously recorded the local perspiration volume. Patients were also examined for metal allergy by patch testing and oral challenge tests. The perspiration volumes were measured using recently developed equipment for continuous recording of local perspiration volume (Kenz-Perspiro oss-100). The perspiration volume of pompholyx patients was found to be 2.5 times higher than that of age-matched normal controls. Twenty percent of the patients showed sensitivity to chromate, 16% to cobalt, and 28% to nickel on patch testing. Six patients with positive results were challenged orally in a controlled trial with 2.5 mg nickel, 1 mg cobalt, or 2.5 mg chromium. Four of them (67%) showed vesicular reactions on their hands with challenge testing. These results indicated a sensitivity to metal compounds which, in combination with local hyperhidrosis, may contribute to the development of vesicular lesions in pompholyx.

We have studied a group of 104 patients with pompholyx, to investigate the relationship between allergological factors and its etiopathogenesis. The following examinations were performed: blood sampling (routine tests and IgE levels), allergological tests (patch, prick, intradermal, and oral provovation tests with nickel sulphate), skin biopsy to exclude pemphigus vulgaris or bullous pemphigoid. An accurate history of familial and personal allergic diathesis was enquired for and various possible aggravating factors (season, microclimate, perspiration and emotional stress) were considered. The results were age and sex-matched with a healthy control group (208 subjects). We found familial and personal atopic diathesis in 50% of patients versus 11.5% of controls (p less than 0.001); 39 patients (37.49%) also had high levels of IgE. Nickel sulphate was the allergen with the highest positivity on patch testing: 20.19% versus 6.25% of the control group (p less than 0.001). The % of patients allergic to nickel reached 26%, including those (6 patients) reacting to the oral provocation test. Season (43 patients) and hyperhidrosis (38) were the aggravating factors most commonly claimed. We detected no correlation between age, sex, grading of pompholyx and the allergological parameters investigated. Though several different allergological findings have previously been reported in dyshidrosis, their role in its pathogenesis has not yet been fully explained. We think that different haptens or antigens can produce the same clinical and histological picture of pompholyx in predisposed subjects.

During one year 68 patients with pompholyx attending the outpatient clinic at the Department of Dermatology, Lund, were examined with special regard to occupational disability. Owing to pompholyx 56 patients had sick-leave, and in 48 sick-leave lasted more than 1 month. No patient needed change of occupation because of pompholyx, and no disability pension was granted because of the disease.

The purpose of a pilot study with 20 patients, suffering from dyshidrotic exzema of the hands, was to investigate the relevance of a psychosomatic approach for its etiology and therapy. A set of psychological and allergological tests revealed the following results. - 10 patients suffered from a contact allergy (epicutaneous test), 6 of them were allergic to nickel - the patients were less aggressive and more permissive (Freiburger Personality Inventory; FPI) as compared to a standard population. They reported more somatic complaints (HHM) as healthy subjects. - the results of a semistructured interview support the hypothesis, that the dyshidrotic exzema often has an expressive function: the patients present their dependency conflict in a symbolic manner by means of their hands. They try to take their life in their own hands; autonomous actions however are hampered by their own dependency needs. The development of the dyshidrotic symptoms corresponds to the autonomy, which has been achieved with regard to the individual conflict of ambivalence. According to our findings the contact with nickel is not predominant, neither causative nor triggering, factor. Following the psychosomatic concept of Engel and Schmale, the authors discuss the pathogenesis of dyshidrosis with the meaning of a complication of (pregenital) conversion, with the hands as the part affected.

The common manifestation of pompholyx is easily recognized by the clinician. Morphologic variants are known in which the predominant lesions are pustules or desquamation with or without erythema. A patient is described herein whose eruption was composed mainly of arciform, annular, and target-like vesicles. Pompholyx (bubble) is a preferred term because "dyshidrosis" denotes a dysfunction of sweating, which does not occur in this condition. The causes of this eruption have not been determined, but it is likely that a certain genetic predisposition and multiple environmental factors are responsible. Pompholyx should be considered in the differential diagnosis of eruptions with annular pattern.

Contact sensitivity to medicaments and other chemical allergens has been observed in about 30% of 364 patients with pompholyx. Pompholyx is a recurrent vesicular eruption which increases the incidence of contact sensitivity. The majority of patients tested by means of intradermal and cultural tests did not show any relevant finding on the microbial nature, allergic or not, of pompholyx.