25 Year History of Foot and Hand Dermatitis

Abstract: 47 yo woman with plantar dermatitis x 25 years

Presented by Natalie Karishev and David Elpern

History: This 47 yo woman has a 25 y h/o a persistent relapsing vesicular dermatitis of the L sole and to lesser extent R sole and both palms. The dermatitis is associated with mild itching, and painful fissures. KOH prep and culture on one occasion in the distant past was positive for T. rubrum. She was treated with Lamisil po for two months without any improvement. At present the rash is managed by Triamcinolone 0.025% without significant results as well. The involved area is expending

O/E: Well defined scaly patches with deep seated vesicles on the lsft palm and localized non-inflammatory scaling on localized areas of the palms.

Clinical Photo(s)







Lab: Repeat KOH prep and fungal culture are negative (April 2008)
Histopathology: NA
Diagnosis or DDx:

Tinea pedis (appears unlikely)

vs Pompholyx, Dyshidrotic Eczema) Cronic and recurrent vesicular hand/foot dermatitis

vs Psoriasis

Reason(s) Presented: For diagnostic and treatment suggestions

Comment: One of us thinks that Fran Storrs article (referenced below) is helpful for understanding this process, although she addresses a similar condition primarily of the hands. The patient described here needs patch testing (if it has not been done) and a bit more work-up. If there are frank pustules, the diagnosis of pustulosis plantaris need to be added. If diagnostic uncertainty persists, biopsy of an acute lesion may be helpful.

References: Acute and recurrent vesicular hand dermatitis not pompholyx or dyshidrosis. Storrs FJ. Arch Dermatol. 2007 Dec;143(12):1578-80.
So now do we know what pompholyx is and what causes it? I am afraid not. I join the European Dermatolo-Epidemiology Network study’s lament that we use inexact terminology in defining all kinds of hand eczema. This lack of precision in definition has rendered accurate analysis of causation and comparisons of therapeutic strategies impossible. Thorough descriptions of methods and definitions of interpretations and relevance are lacking or are simply not adhered to. In short, as the European Dermato-Epidemiology Network study suggests, we should “start again.”
Clearly, the terms pompholyx and dyshidrosis are obsolete in that really no modern investigators use them as originally defined. Some dermatologists (old ones like me) define them rigidly for use in our own patients’ care, but in studies and reviews such rigidity seldom prevails. Until a more concise label can be agreed on, I propose the use of “acute and recur- rent vesicular hand dermatitis,.” This will not include feet-only situations, but dermatologists caring for these patients know that feet can be included in this primarily hand condition. It is time for pompholyx and dyshidrosis to exit. The full article can be obtained as a PDF from Dave Elpern.