History:

Dyshidrotic eczema, also termed as pompholyx, is a form of vesicular palmoplantar dermatitis of unknown etiology.  It is characterized by a pruritic vesicular eruption comprised of clear, deep-seated vesicles without erythema erupting on the lateral aspects of fingers, the central palm, and plantar surfaces.  The eruption has been described as resembling tapioca pudding.  The onset may be acute, recurrent, or chronic. 

Although the exact etiology remains uncertain, it is considered a reaction pattern induced by various endogenous conditions (e.g. contact dermatitis to nickel, balsam, cobalt,  sensitivity to ingested metals, dermatophyte infections, and bacterial infections) and exogenous factors (e.g. environmental factors and emotional stress).  The disorder is also frequently associated with atopy.

First-line treatment includes high-strength topical steroids and cold compresses.   Oral steroids are considered the second line of treatment especially for acute flares.