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Author: Amanda Oakley, Dermatologist, Hamilton New Zealand, 1997. Updated July 2014.
Vesicular hand dermatitis is a form of hand eczema characterised by vesicles or bullae (blisters). A similar condition can affect the feet (vesicular foot dermatitis).
The most common variant of vesicular hand dermatitis is also called vesicular endogenous eczema, dyshidrotic eczema, and pompholyx; cheiropompholyx affects the hands and pedopompholyx affects the feet.
Vesicular hand/foot dermatitis
Vesicular hand/foot dermatitis most often affects young adults.
Vesicular hand/foot dermatitis is multifactorial. In many cases, it appears to be related to sweating, as flares often occur during hot weather, humid conditions, or following an emotional upset. Other contributing factors include:
Vesicles can also occur in other types of hand dermatitis.
Vesicular hand/foot dermatitis presents as recurrent crops of deep-seated blisters on the palms and soles. They cause intense itch or a burning sensation. The blisters peel off and the skin then appears red, dry and has painful fissures (cracks).
Secondary bacterial infection with Staphylococcus aureus and/or Streptococcus pyogenes is common in vesicular hand/foot dermatitis and results in pain, swelling, and pustules on the hands and/or feet.
Infected vesicular hand dermatitis
The clinical presentation of vesicular hand/foot dermatitis is typical.
Other forms of hand dermatitis should be considered in the differential diagnosis.
Vesicular hand/foot dermatitis is challenging to treat. Topical therapy is relatively ineffective because of the thick horny layer of skin of palms and soles.
People with vesicular hand dermatitis found to be allergic to nickel must try to avoid touching nickel items.
Vesicular hand/foot dermatitis generally gradually subsides and resolves spontaneously. It may recur in hot weather or after a period of stress, and in some patients is recalcitrant.
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