ABSTRACT
I. Introduction and Definition 204
II. Epidemiology 205
III. History and Review 206
IV. Clinical Features 207
V. Histopathology 208
VI. Recurrent Vesicular Hand Eczema and Allergic Contact Dermatitis 209
A. Implanted Metals 211
B. Nickel Eczema and Antabuse® 212
C. Nickel Allergy and Hand Eczema 213
D. Oral Ingestion of Nickel 214
E. Low-Nickel Diets 215
E. Cobalt 216
G. Chromium 216
H. Balsam of Peru 217
VII. Does Food Play a Role? 217
VIII. “id” Reaction on the Hands 217
IX. The Relationship Between Recurrent Vesicular Hand Eczema and Atopy
X. Are Psychological Factors of Significance? 219
XI. Recurrent Palmo-Plantar Dermatitis as a Manifestation of Other Dermatoses
XII. Differential Diagnosis 220
XIII. Conclusions 221
References 222
I. INTRODUCTION AND DEFINITION
Acute or recurrent vesicular hand dermatitis, or pompholyx, is an eruptive, pruritic, vesicular dermatitis, seen on the palmar aspects of the hands and fingers, the sides of the fingers, and the periungual area. The deep-seated sago grain-like vesicles contain a clear fluid and often occur in clusters. Vesicles may coalesce to form small bullae. There is usually little or no inflammation. The individual eruption usually undergoes a stage of scaling before the skin returns to normal. This course was originally described as typical for pompholyx. Frequent recurrences may lead to inflammation, making the distinction between this dermatitis and chronic hand eczema difficult. Repeated eruptions are characteristic and may eventually damage the matrices of the nails. Transverse ridging of the nails is a characteristic feature of recurrent vesicular hand dermatitis.1 Some patients have pompholyx-like lesions on the soles of the feet and/or on the sides of the toes with no involvement of the hands.
