Materiały źródłowe

• #1 Dyshidrotic Eczema (Pompholyx): Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1122527-overview

  Dyshidrotic eczema is a type of eczema (dermatitis) that is characterized by a pruritic vesicular eruption (bullae, or blisters) on the fingers, palms, and soles; typically these intensely itchy blisters develop on the edges of the fingers, toes, palms, and soles of the feet. […] The etiology of dyshidrotic eczema is unresolved and is believed to be multifactorial. Dyshidrotic eczema is considered to be a reaction pattern caused by various endogenous conditions and exogenous factors. […] The hypothesis of sweat gland dysfunction as the cause of dyshidrotic eczema was refuted on the grounds that vesicles have not been shown to be associated with sweat ducts. A 2009 case report provided clear histopathologic evidence that sweat glands do not play a role in dyshidrosis. […] However, hyperhidrosis is an aggravating factor in 40% of patients with dyshidrotic eczema.

• #2 Dyshidrotic Eczema: A Common Cause of Palmar Dermatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7647841/

  Dyshidrotic eczema (DE) or acute palmoplantar eczema is a common cause of hand and foot dermatitis in adults. […] It is an intraepidermal spongiosis of the thick epidermis in which accumulation of edema causes the formation of small, tense, clear, fluid-filled vesicles on the lateral aspects of the fingers that can become large and form bullae. […] The exact cause of DE has not been established, but there are several risk factors for its occurrence, including atopic dermatitis, exposure to contact allergens and/or irritants, hyperhidrosis, smoking, exposure to ultraviolet light, and intravenous immunoglobulin use. […] The diagnosis of DE is mainly clinical. […] Spongiosis is the main pathologic finding.

• #3 Decoding the mystery of dyshidrotic eczema | National Eczema Association

  https://nationaleczema.org/blog/decoding-dyshidrotic-eczema/

  Dyshidrotic eczema is the least understood of the conditions many subtypes. […] The term dyshidrotic means disordered sweat. It was first coined in the late 19th century, reflecting the belief that a malfunction of the sweat glands in the hands caused this type of eczema. […] Some doctors believe that an allergy to nickel is the principal cause of dyshidrotic eczema, Siegfried said, given the high levels of nickel in sweat and the concentration of sweat glands in the palms and soles of the feet. […] Dyshidrotic eczema is also strongly linked to seasonal allergies, especially to changes in humidity. […] Dyshidrotic eczema can mimic contact dermatitis and even palmoplantar pustulosis, a type of psoriasis appearing on the hands and feet, said Siegfried. […] Without a definitive diagnosis, patients could receive suboptimal treatment.

• #4

  https://journals.lww.com/amjdermatopathology/abstract/1986/04000/are_acrosyringia_involved_in_the_pathogenesis_of.4.aspx

  Investigations of dyshidrotic eruptions of various causes were done by conventional and electron microscopy. In all cases, the histological patterns were identical. The dyshidrotic vesicle is an intraepidermal, spongiotic lesion. The intraepidermal part of the eccrine sweat duct (acrosyringium) is not altered even by spongiosis. As the acrosyringium does not take part in formation of a dyshidrotic vesicle, the term dyshidrosis has to be regarded as a misnomer. […] Dyshidrosis is nothing but spongiotic dermatitis modified by the distinctive characteristics of palmar and plantar skin.

• #5 Pompholyx: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pompholyx-pro

  The term dyshidrosis indicates a sweating abnormality but histology reveals no evidence of eccrine (sweat) gland involvement. Histologically, the vesicles are intra-epidermal with little or no inflammatory change. Hyperhidrosis is, however, an associated condition in 40% of patients and this could account for the confusion. […] One study proposed that the aetiology involved a complex immunological process which involved complement, myeloperoxidase (a lysosomal protein stored in azurophilic granules of the neutrophil) and T cells. […] There is an association with atopy and tinea pedis but both pompholyx and tinea pedis are likely to occur with sweaty feet and causation is not proved. A genetic form has been identified. […] HIV infection and treatment of HIV-infected individuals with antiretroviral therapy (ART) have both been associated, as has intravenous immunoglobulin therapy.

• #6 Dyshidrotic Eczema: Difficulty of Etiological Diagnosis and Therapeutic Management

  https://clinmedjournals.org/articles/cmil/cmil-7-176.php?jid=cmil

  Dyshidrotic Eczema (DE) or acute palmoplantar eczema is a common cause of hand dermatitis in adults. […] It is a vesiculobullous disorder of the hands and soles. It is an intraepidermal spongiosis of the thick epidermis in which accumulation of edema causes the formation of small, tense, clear, fluid-filled vesicles on the lateral aspects of the fingers that can become large and form bullae. […] The exact cause of DE has not been established, but there are several risk factors for its occurrence, including atopic dermatitis, exposure to contact allergens and/or irritants, hyperhidrosis, smoking, exposure to ultraviolet light, and intravenous immunoglobulin use. […] Spongiosis is the main pathologic finding.

• #7 Dyshidrotic Eczema (Pompholyx): Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1122527-overview

  In some patients, a distant fungal infection can cause palmar pompholyx as an id reaction. […] Chronic hand dermatitis, including dyshidrotic eczema, has also been associated with defects in the skin barrier, and in a few cases, it has also been associated with mutations in the filaggrin gene; however, these have not reached statistical significance. […] Aquaporins are known to be expressed in patients with atopic dermatitis, and such expression may also be related to exacerbation and chronicity of pompholyx. […] Hypothetically, topical or systemic inhibition of the expression of aquaporins in the epidermis could contribute with the preservation of water and glycerol, decreasing the frequency and severity of pompholyx exacerbations. […] As many as 50% of patients with dyshidrotic eczema have reportedly had personal or familial atopic diathesis (eg, eczema, asthma, hay fever, or allergic sinusitis).

• #8 Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-guidelines-for-diagnosis-treatment-prevention-articulo-S1578219019303737

  Hand eczema, or hand dermatitis, is a multifactorial disease with several etiologic and morphologic variants. It is essentially an inflammatory skin disease that affects the hands; it causes significant discomfort and can have a major impact on patient quality of life. […] It is, however, accepted that genetic factors (e.g., filaggrin mutations) and external factors (e.g., skin irritants) alter the structure and composition of the stratum corneum, disrupting the skin barrier and favoring the development of hand eczema. Filaggrin mutations have also been linked to the development of hand eczema, particularly in endogenous forms of the disease. […] Skin barrier disruption has a pathogenic role in chronic hand eczema and can lead to both irritant and allergic disease. […] The pathogenic role of skin microbiome in chronic hand eczema is attracting increasing attention. Patients with hand eczema have higher rates of S aureus colonization than healthy individuals, and patients with severe disease have a significantly higher density of S aureus than those with milder disease. […] Interleukins (ILs), such as IL-1 (IL-36), may be involved in chronic hand eczema skin inflammation, and IL-36 may therefore become a useful biomarker for helping in the complex diagnosis of chronic hand eczema.

• #9 DYSHIDROTIC ECZEMA | Hand Surgery Resource

  https://www.handsurgeryresource.net/dysh-eczema

  The exact cause of dyshidrotic eczema is unknown, and it likely has a multifactorial etiology. Commonly cited risk factors that may play a role in its pathogenesis include allergy to metals (particularly nickel), genetic determinants, and dermatophyte infection. […] Although the condition appears to run in families and is therefore thought to have a genetic component, no gene has yet been identified to confirm this theory. […] It appears that dyshidrotic eczema occurs primarily as a feature of atopic dermatitis during childhood and adolescence, whereas later in life, the majority of cases develop as an occupational contact dermatitis. Some authors also believe that it is a special variant of atopic dermatitis, but this theory has been questioned by others. […] Although dyshidrotic eczema is a fairly common condition, relatively few randomized controlled trials have been performed to evaluate the efficacy of various interventions.

• #10 What Causes My Dyshidrotic Eczema?

  https://www.healthline.com/health/eczema/dyshidrotic-eczema-causes

  Dyshidrotic eczema may be caused by genetic and environmental factors. Stress and allergens can also cause flare-ups. […] While the exact cause of dyshidrotic eczema is unknown, its likely due to a combination of factors and is most common in individuals between 20 and 40 years old. Flares may result from genes, environmental factors, allergens, or stress. […] Genes may play at least some role in causing dyshidrotic eczema since you are more likely to experience dyshidrotic eczema if you have family members with the condition or another type of eczema. […] Its important to remember that while genetic mutations may make an individual more likely to develop eczema, other environmental factors are often also necessary to trigger symptoms. […] High levels of stress may contribute to having a dyshidrotic eczema flare.

• #11 The Key Role of Aquaporin 3 and Aquaporin 10 in the Pathogenesis of Pompholyx

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4380589/

  Pompholyx remains a chronic skin affliction without a compelling pathophysiological explanation. […] The mechanistic explanation for the epidermal fissuring might lie in the over-expression across the mid and upper epidermis, including the stratum corneum, of two water/glycerol channel proteins aquaporin 3 and aquaporin 10, expressed in the keratinocytes of afflicted pompholyx patients. […] Given its known ability to augment water loss, we hypothesize that AQP3 and AQP10 may play a central role in exacerbating the intensity and chronicity of pompholyx. […] We hypothesize that AQP3 and APQ10 are overexpressed across all layers of the epidermis thereby facilitating dehydration of the affected palms and soles of pompholyx patients. […] This suggests that under physiological conditions the water channels in the stratum lucidum close to the SC remain inhibited by the low pH of normal skin, thus helping the skin retain water.

• #12 The Key Role of Aquaporin 3 and Aquaporin 10 in the Pathogenesis of Pompholyx

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4380589/

  However, under pathological conditions such as pompholyx or AD, the pH of the upper SC is increased. […] Therefore, as shown in Figure 4D, one could reasonably assume that the higher pH favors activity of AQP3 and APQ10 in the lesional palms, keeping the water pores leaky, and prone to be open for longer periods of time. […] In addition, in lesions of pompholyx there is continuous expression of AQP3 and AQP10 across all layers of the skin, connecting the dermis and all its layers with the outer environment. […] The hypothesis advanced herein is that aquaporin over-expression may play a role in increasing skin dehydration, facilitating blister rupture after they have been created and accelerating the expansion of the diseased skin, and thus increasing its chronicity. […] If the hypothesis put forward in this paper is valid, the therapeutic power of alitretinoin resides in its unique ability to down regulate AQP3 and AQP10 expression on keratinocytes in the skin of pompholyx patients.

• #13 Dyshidrotic Eczema and Tap Water Iontophoresis – Daavlin

  https://daavlin.com/blog-post/dyshidrotic-eczema-and-tap-water-iontophoresis/

  Although tap water iontophoresis is most commonly used for hyperhidrosis, it has a long and successful history of use in eczema treatment as well. […] In terms of mechanism, there is a strong argument that aquaporins are involved in the pathology of dishydrodic excema. […] Likewise, there is some evidence that tap water iontophoresis has effects in the aquaporin pathway, in part by the reduction in skin pH shown in patients with successful hyperhidrosis treatment.

• #14 (PDF) Dyshidrotic eczema: relevance to the immune response in situ

  https://www.academia.edu/6408637/Dyshidrotic_eczema_relevance_to_the_immune_response_in_situ

  Context: Pompholyx (called dyshidrosis by some) is one of the most common conditions and its immune response is presently poorly understood. […] The major findings to be reported were: the H E examination revealed spongiotic dermatitis and pompholix. IHC and MDIF studies demonstrated focally deposits of positive CD45, CD3, CD8, anti myeloperoxidase (MPO), and anti-human IgE, C3C, C3D and anti-human fibrinogen within the epidermal spongiotic process, as well as around the blood vessels surrounding the inflammatory process especially at the sweat glands and respective ductus. […] The significance of our findings indicates a complex immunological process including complement, MPO and T-cell immune response. In addition, possibly a secondary allergic process for the presence of IgE immune response and possibly aggravation by application of other medicines. Further immunological studies on pompholyx are needed.

• #15 Dyshidrotic Eczema (Pompholyx): Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1122527-overview

  Exogenous factors (eg, contact dermatitis to nickel, balsam, cobalt; sensitivity to ingested metals; dermatophyte infection; bacterial infection) may trigger episodes. These antigens may act as haptens with a specific affinity for palmoplantar proteins of the stratum lucidum of the epidermis. The binding of these haptens to tissue receptor sites may initiate pompholyx. […] Evidence shows that the ingestion of metal ions such as cobalt can induce type I and type IV hypersensitivity reactions. In addition, they can also act as atypical haptens, activating T lymphocytes through human leukocyte antigen (HLA)-independent pathways, causing systemic allergic dermatitis in the form of dyshidrotic eczema. […] Emotional stress and environmental factors (eg, seasonal changes, hot or cold temperatures, and humidity) have been reported to exacerbate dyshidrosis.

• #16 Dyshidrotic Eczema (Pompholyx): Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1122527-overview

  Nickel sensitivity may be a significant factor in dyshidrotic eczema. […] Increased nickel excretion in the urine has been reported during exacerbations of pompholyx. […] A point-based low-cobalt diet has been proposed to help patients limit cobalt ingestion and to keep the serum level below the threshold for developing flares (approximately 12 g/day). […] Dyshidrotic eczema outbreaks are sometimes associated with exposure to other sensitizing chemicals or metals (eg, chromium, carba mix, fragrance mix, diaminodiphenylmethane, dichromates, benzoisothiazolones, paraphenylenediamine, perfumes, fragrances, balsam of Peru, or Primula plant). […] Pompholyx occasionally resolves when a tinea pedis infection is treated, then relapses when the fungal infection recurs, supporting the existence of this reaction pattern.

• #17 Dyshidrotic Eczema (Pompholyx): Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1122527-overview

  This is a possible factor in dyshidrotic eczema. Many patients report recurrences of pompholyx during stressful periods. […] Isolated reports have described other possible causative factors (eg, aspirin ingestion, oral contraceptive use, cigarette smoking, and the presence of implanted metals). […] In a case series, five patients with prior diagnosis of pompholyx developed lesions morphologically and histologically consistent with a vesicular dermatitis after provocation with long-wavelength UVA light. […] Pompholyx caused by UVA exposure may possibly be considered a variation of seasonal (summer) pompholyx.

• #18 Dyshidrotic dermatitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/91

  Dyshidrotic dermatitis is a chronic, relapsing-remitting vesicular eruption of the palms and soles; classically pruritic; also known as dyshidrotic eczema. […] The common exacerbating factor is irritation, as seen in frequent hand washing, hyperhidrosis, and stress. However, the underlying etiology is unknown. […] Pompholyx is a term often used synonymously with dyshidrotic dermatitis, but some advocate for the term to be reserved for acute, severe eruptions of large bullae on the hands and feet. […] Risk factors include exposure to irritants, atopy, metal allergy, hyperhidrosis, and emotional stress.

• #19 Dyshidrotic dermatitis – Altmeyers Encyclopedia – Department Dermatology

  https://www.altmeyers.org/en/dermatology/dyshidrotic-dermatitis-119146

  Polyetiological, usually episodic, acute, subacute or chronically recurrent, vesicular, also vesiculo-squamous dermatitis on palms and soles with clear, about 0.1 cm large, intraepidermally located, grayish shimmering vesicles or (more rarely) also blisters. […] Occurrence in the context of an atopic diathesis (see below Atopy). […] More rarely also in psoriasis palmoplantaris (see below Psoriasis dyshidrotica), allergic contact dermatitis (e.g. in nickel allergy), mycosis (vesicular mycid), gram-negative foot infection or idiopathic with unexplained cause. […] Dyshidrotic dermatitis occurs preferentially in the warm season. […] The term „dyshidrosis” aims at a defective sweat gland function, which is actually not present, even if sweat plays an indirect role in the maintenance of the process.

• #20 Dyshidrotic Eczema Secondary to Intravenous Immunoglobulin Infusion: A Report of 2 Cases | Actas Dermo-Sifiliográficas

  https://actasdermo.org/es-dyshidrotic-eczema-secondary-intravenous-immunoglobulin-articulo-S1578219016300270

  We present 2 cases of dyshidrotic eczema secondary to intravenous immunoglobulin infusion. […] We diagnosed both patients with dyshidrotic eczema secondary to treatment with intravenous immunoglobulin. […] Eczema is rarely associated with administration of intravenous immunoglobulin. […] No clear mechanism has been identified that might explain the association with eczema, although some authors suggest a hypersensitivity reaction to the drug or vehicle that has not been demonstrated with patch testing or prick testing. […] As this was a first episode of asymptomatic lesions associated in time with infusion of intravenous immunoglobulin and reappearance of the lesions during the second treatment cycle in the first patient, we were able to confirm the diagnosis.

• #21 The Key Role of Aquaporin 3 and Aquaporin 10 in the Pathogenesis of Pompholyx

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4380589/

  Another approach that might shed light on the hypothesis advanced in this paper is the development of safe topical treatment(s) that include specific inhibitors of AQP3 and AQP10. […] If such treatments would be successful in healing pompholyx lesions regardless of lesional skin being exposed to water, it might prove that inhibiting AQP3 and AQP10 are key to successfully reversing pompholyx pathology.

• #22 Eczema types: Dyshidrotic eczema overview

  https://www.aad.org/public/diseases/eczema/types/dyshidrotic-eczema

  This type of eczema causes tiny, intensely itchy blisters on the hands or feet. It is also called pompholyx. […] Dyshidrotic eczema can also be a lifelong, debilitating disease. […] Common triggers include personal care products like shampoo or soap. Coming into contact with nickel or cobalt can also lead to blisters. […] While a dermatologist can help you reduce flare-ups, there is no cure for dyshidrotic eczema. […] Recent research has led to new treatments for difficult-to-treat dyshidrotic eczema. One newer option is a medication called dupilumab. This medication belongs to a class of medications called biologics.

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