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. […] However, hyperhidrosis is an aggravating factor in 40% of patients with dyshidrotic eczema. […] Dyshidrotic eczema may be associated with atopy and familial atopy. Of patients with dyshidrosis, 50% have atopic dermatitis.

• #2 ITCHY BLISTERS ON HANDS AND FEET: PONPHOLYX – Dra. LOREA BAGAZGOITIA

  https://dermatologia-bagazgoitia.com/en/2024/06/itchy-blisters-on-hands-and-feet-ponpholyx-12955

  Dyshidrotic eczema (like so many other skin diseases) is capricious. It usually appears suddenly and can disappear just as suddenly (although, as we will discuss later, there are treatments available to improve it). […] It is known to be more common in warmer climates. It can flare up in times of increased stress and worry, and some cases have been associated with fungal infections, smoking, and some intravenous treatments. In any case, the most common scenario is that the cause is unknown. […] It used to be thought that dyshidrotic eczema was related to sweating of the feet and hands, and that the blisters formed when the sweat glands became occluded. To date, this hypothesis has been discarded, as no evidence or demonstration of this supposed mechanism has been found. […] Dyshidrotic eczema is not a sign of any internal disease, it is not contagious, and it is not related to sweating of the hands or feet. It can be treated with topical corticosteroids, but it may have a tendency to recur, as it follows a capricious course. Its exact cause is not known at this time.

• #3 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. […] The episodes where the disease is recurrent might be due to the residual presence of AQP3 and AQP10 or an incomplete return to their basal expression levels across the very same layers where it was once over-expressed.

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

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

  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. […] 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. […] 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).

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

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

  We hypothesize that over-expression of AQP3 and AQP10 concomitantly to water exposure is the main reason for exacerbation of the disease in patients with increased aquaporin expression. […] 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.

• #6 Pompholyx – Knowledge and References – Taylor & Francis

  https://taylorandfrancis.com/knowledge/Medicine_and_healthcare/Dermatology/Pompholyx/

  Pompholyx is a chronic dermatitis that manifests as clusters of clear blisters on the palms and soles, accompanied by redness and intense itching. […] Acute eczema resulting in blistering on the palms and soles is termed pompholyx (or dyshidrotic eczema). […] Pompholyx is a chronic dermatitis characterized by the appearance of clusters of vesicles (clear blisters) on the palms and soles, accompanied by erythema and intense pruritus, and pustules may be present. […] AQP3 and 10 have been shown to be important in the formation of blisters, in inflammation, and in drying observed in the pathogenesis of pompholyx.

• #7 Pompholyx Eczema – VALINTERMED treatment in Valencia

  https://valintermed.com/en/medlibrary/pomfoliks-ekzema/

  Pompholyx eczema, also known as dyshidrotic eczema, is a chronic inflammatory skin disease that manifests itself as a vesicular rash on the palms and soles. […] The pathology is characterized by the formation of small vesicles filled with serous fluid, which can merge and form exudative foci. […] In the 20th century, with the development of dermatology, serious research began into the etiology and pathogenesis of the disease, which contributed to improved diagnostic and treatment methods. […] Genetic studies suggest that certain groups of people, often with a family history of skin diseases, may be predisposed to developing pompholyx. […] Local mutations in genes responsible for the skins barrier function may also lead to a decrease in the protective properties of the epidermis and contribute to the development of inflammatory processes.

• #8 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. […] 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. […] Emotional stress and environmental factors (eg, seasonal changes, hot or cold temperatures, and humidity) have been reported to exacerbate dyshidrosis. […] 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.

• #9 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. […] As hand eczema constitutes a group of highly heterogeneous conditions, no general pathological mechanisms have been established. 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.

• #10 Dyshidrosis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688690/all/Dyshidrosis?q=Bullous+pemphigoid

  Exact mechanism is unknown; thought to be multifactorial (allergies, genetics, and dermatophyte infection implicated). […] Immunologic reaction: theorized that rapid rise in immunoglobulin levels may precipitate vesicle formation. […] Rare autosomal dominant form of pompholyx found in Chinese population maps to chromosome 18q22.118q22.3.

• #11 Dyshidrosis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688690/all/Dyshidrosis

  Exact mechanism is unknown; thought to be multifactorial (allergies, genetics, and dermatophyte infection implicated). […] Immunologic reaction: theorized that rapid rise in immunoglobulin levels may precipitate vesicle formation. […] Dermatopathology: intraepidermal spongiosis without effect on eccrine sweat glands.

• #12 Autoeczematization: A Strange Id Reaction of the Skin | MDedge Dermatology

  https://www.mdedge9-ma1.mdedge.com/dermatology/article/245813/contact-dermatitis/autoeczematization-strange-id-reaction-skin

  Autoeczematization (AE), or id reaction, is a disseminated eczematous reaction that occurs days or weeks after exposure to a primary stimulus, resulting from a release of antigen(s). […] The pathogenesis of AE is uncertain, but circulating T lymphocytes play a role in this reaction. […] Therefore, the most likely pathogenesis of an id reaction is that T lymphocytes are activated at the primary reaction site due to proinflammatory cytokines released by keratinocytes. […] T lymphocytes and keratinocytes may play a key role in this reaction, with newer research further delineating the process and possibly providing enhanced treatment options.

• #13 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

  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.

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

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

  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. […] 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. […] 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).

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

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

  Pompholyx occasionally resolves when a tinea pedis infection is treated, then relapses when the fungal infection recurs, supporting the existence of this reaction pattern. […] This is a possible factor in dyshidrotic eczema. […] Many patients report recurrences of pompholyx during stressful periods. […] A 3-year prospective study (N = 120) of the causes of dyshidrotic eczema found causes of pompholyx related to contact exposure (67.5%), including to cosmetic products (31.7%) and metals (16.7%); interdigital-plantar intertrigo (10%); and internal factors (6.7%); an additional 15% of patients had undiagnosed (idiopathic) causes probably related to atopic factors. […] The most frequent causes of pompholyx related to contact with substances were hygiene product intolerance (46.7%), metal allergy (25%), and others (28.3%).

• #16 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. […] The only way to tell which is which is with a biopsy. Without a definitive diagnosis, patients could receive suboptimal treatment.

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

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

  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. […] Dyshidrotic eczema occurs in 5-20% of US patients with hand eczema; it more commonly develops in warmer climates and during spring and summer months (seasonal or summer pompholyx).

• #18 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 vesicles are deep-seated and can be multilocular with a characteristic tapioca pudding appearance and can coalesce into bullae. […] Spongiosis is the main pathologic finding.

• #19 Dyshidrotic Eczema | Enliven Archive

  http://www.enlivenarchive.org/articles/dyshidrotic-eczema.html

  Dyshidrotic eczema, also known as dyshidrotic dermatitis or pompholyx, is characterized by pruritic, tense, deep-seated vesicles mainly on the palms and lateral surfaces of the fingers. […] The exact etiology is not known. Most cases are idiopathic. Factors that may predispose to the development of dyshidrotic eczema in a susceptible individual include atopy, contact allergens, contact irritants, dermatophyte infection, allergy to ingested metal (in particular, nickel and cobalt), hyperhidrosis, prolonged use of protective gloves, intravenous immunoglobulin, psychological stress, and smoking. […] In the acute phase, histologic features include intraepidermal spongiosis with vesicle formation and a superficial perivascular inflammatory infiltrate composed mainly of lymphocytes and histiocytes.

• #20 Investigators Link Secukinumab to 2 Cases of Dyshidrotic Eczema in Patients With Psoriasis

  https://www.ajmc.com/view/investigators-link-secukinumab-to-2-cases-of-dyshidrotic-eczema-in-patients-with-psoriasis

  Secukinumab is described by the investigators as a fully human recombinant IgG1K monoclonal antibody that is a specific antagonist of interleukin-17a, which is regarded as the primary immune cell involved in the pathogenesis of psoriasis. […] The pathogenesis of DE is not well understood, the study authors concluded. It is a chronic, relapsing, spongiotic dermatosis belonging to the spectrum of eczema. Secukinumab is a newer treatment for psoriasis and not all adverse reactions are known. As more patients are prescribed this medication, for longer durations, other adverse reactions can be better characterized and managed.

• #21 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. […] The clinically visible vesicles of dyshidrotic eczema are an expression of spongiotic dermatitis of the groin skin. […] 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. […] When the inflammatory quality of the dermatitic reaction is high (often in the summer months), the vesicles can expand into large blisters, resulting in the clinical picture of pompholyx. […] Large vesicular acute dermatitis of the groin skin is referred to by the term pompholyx(cheiropompholyx, podopompholyx). […] 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.

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

  https://www.actasdermo.org/en-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.

• #23 Late-onset and long-term systemic dyshidrotic eczema after intravenous immunoglobulin treatment for Kawasaki disease | BMJ Case Reports

  https://casereports.bmj.com/content/12/3/e229596

  Here, we report the case of a 7-month-old boy who was admitted to our hospital with a 4-day history of fever, conjunctival injection, erythema on the trunk and extremities, lip redness and oedema of the hands and feet. […] Considering the clinical features, we made a diagnosis of pompholyx as a late-onset side effect of IVIG. […] The pathophysiology of IVIG-induced dyshidrotic eczema is unclear. […] Further studies are needed if we are to better understand how IVIG causes pompholyx, identify whether predisposing factors exist and get a more accurate picture of the real incidence of this condition. […] In conclusion, physicians should be aware that generalised dyshidrotic eczema may be a late-onset and long-term side effect of IVIG therapy.

• #24 Pompholyx Eczema as a Manifestation of HIV Infection, Response to Antiretroviral Therapy | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0210

  Pompholyx or dyshidrotic eczema is a pruritic chronic dermatitis chiefly affecting the palms of the hands and soles of the feet. The aetiology is unknown, although there is thought to be a link with nickel exposure. […] This is the first report of pompholyx as a manifestation of symptomatic HIV infection. This patients eczema failed to respond to numerous topical and systemic treatments and only improved when his immune system was reconstituted with combination ART. […] It is therefore interesting that in the case described here, of a man already immunocompromised, resolution occurred only after immune reconstitution. This presumably reflects the complex nature of the underlying pathogenesis of pompholyx and the influence of a compromised immune system in HIV infection or a direct effect of HIV infection.

• #25 Pompholyx Eczema – VALINTERMED treatment in Valencia

  https://valintermed.com/en/medlibrary/pomfoliks-ekzema/

  Artificial models created using genetically modified animals show that dysregulation of certain cellular signaling pathways may contribute to the elimination of horny cells, which in turn opens the way to eczematous reactions. […] These factors interact with each other and can trigger an exacerbation of the disease, which makes their understanding critical for successful correction and treatment. […] Diagnosis of pompholyx eczema involves several key aspects: […] A thorough approach to diagnosis includes both practical observation and modern diagnostic equipment, which allows the doctor to form a complete picture of the patient’s condition. […] The effectiveness of the treatment approach depends on the individual characteristics of the patient and the severity of the disease. […] Monitoring of pompholyx eczema includes the following steps: […] Therefore, it is important to take age-related factors into account when choosing treatment methods. […] Pompholyx eczema is a complex disorder that requires attention and professional approach to effectively manage symptoms and improve the patient’s quality of life.

• #26 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.

• #27 Dyshidrotic Eczema | Enliven Archive

  http://www.enlivenarchive.org/articles/dyshidrotic-eczema.html

  Dyshidrotic eczema is often difficult to treat, possibly because of the thick epidermis with a compact stratum corneum and richness of the sweat glands of the affected skin. Successful treatment requires a systemic multipronged approach that consists of avoidance of triggering factors, optimal skin care, pharmacotherapy during acute exacerbations, and education of patients/caregivers.

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