[Genetic-morphological peculiarities of response to standard therapy in patients with dyshidrotic eczema of palms and soles].

OBJECTIVE: Introduction: Dyshidrotic eczema of palms and soles (DEPS) is an inflammatory skin disorder that has a multifactorial nature and is characterized by the development of vesical elements with the histological picture of spongiosis and development of intraepidermal vesicles. The aim: Establishment of the features of pathomorphological changes of the epidermis and dermis in patients with manifestations of dyshidrotic lesions of palms and soles with different genotypic variants of the C646G of the NR3C1 gene before treatment based on the study of skin biopsies taking into account the response to standard therapy. PATIENTS AND METHODS: Materials and methods: In 57 patients with dyshidrotic lesions, a pathomorphological and immunohistochemical examination of biopsy specimens from a lesion focus of the skin were carried out and a genetic examination was carried out to determine the polymorphic variant C646G of the NR3C1 gene. RESULTS: Results: The results of this study in patients with DEPS showed that in patients with genotype 646 CC, which are torpid to treatment, there is a complex of immune defense with the activation of complement system with activation of C3 and C4d. The activity of expression of CD4 + cells indicating the intensity of the inflammatory response compared with patients with the 646 CC genotype, which were sensitive to treatment. In cases of 646 CG genotypes which were sensitive to topical treatment with steroid, there was a slight decrease in C3 and a decrease in C4d. There was no change in the activation of CD4 + lymphocytes compared with insensitive patients with genotype 646 CG. Moreover, in determining the prognosis and choosing treatment tactics, of great practical value is the presence of immunological parameters that were revealed by the immunohistochemical examinations and were determined by the genotypic peculiarities in patients with DEPS. CONCLUSION: Conclusions: Integral evaluation of the pathomorphological study of biopsy dyshidrotic lesions of sensitive and insensitive patients with different genotypic variants of the C646G of the NR3C1 gene before treatment allows obtaining objective information on the direct effect of glucocorticosteroid therapy. According to the results of our study, the association between NR3C1 gene variants, the pathomorphological features and degree of healing of dyshidrotic lesions of palms and soles was established: the polymorphic version of 646 CC in insensitive patients was associated with additional complement activation of the complement of fractions of C3 and C4d in comparison with sensitive patients of this genotype; рolymorphic variants of 646 CG in sensitive patients - with a slight decrease in the deposition of complement fractions of C3 and C4d іn comparison with insensitive patients of the corresponding genotype.

A Severe Case of Recalcitrant Pompholyx.

BACKGROUND: Pompholyx is an inflammatory vesiculobullous skin disease of the hands and feet belonging to the spectrum of eczema. OBJECTIVE: To report a severe case of pompholyx, its clinical presentation, and its management. METHODS: A medical chart review was conducted on a patient with this condition. RESULTS: The patient was patch tested according to the North American Contact Dermatitis Group (NACDG) Standard Screening Series, and results were negative. In the past, she was treated with corticosteroid creams as well as narrow band ultraviolet B (UVB), and Psoralen ultraviolet A (PUVA) therapies, and none were beneficial. When the frequency of the episodes increased, methotrexate was introduced but failed to control the condition. Next, mycophenolate mofetil was started and gradually increased to 3.5 g daily along with a separate trial of radiotherapy with marked success. CONCLUSION: Pompholyx can be challenging to manage, and treatment can involve an assortment of therapies over a prolonged period of time.

Pompholyx: a review of clinical features, differential diagnosis, and management.

Pompholyx is a vesicobullous disorder of the palms and soles. The condition is hard to treat because of the peculiarities of the affected skin, namely the thick horny layer and richness of the sweat glands. In this article, we review the available therapies, and score the treatments according to the level of evidence. The cornerstones of topical therapy are corticosteroids, although calcineurin inhibitors also seem to be effective. Topical photochemotherapy with methoxsalen (8-methoxypsoralen) is as effective as systemic photochemotherapy or high-dose UVA-1 irradiation. Systemic therapy is often necessary in bullous pompholyx. Corticosteroids are commonly used although no controlled study has been published to date. For recalcitrant cases, corticosteroids are combined with immunosuppressants. Alitretinoin has efficacy in chronic hand dermatitis including pompholyx. Another evolving treatment seems to be the intradermal injection of botulinum toxin. Radiotherapy might be an option for selected patients not responding to conventional treatment. In practice, patients benefit most from a combination of treatments.

Exposure to sunlight as adjuvant therapy for dyshidrotic eczema.

Manifestations of dyshidrotic eczema can be alleviated by exposure to medium and high doses of ultraviolet A1 (UVA1) radiation. Since the induction of apoptosis of T cells by UVA1, as the basic mechanism of therapy, is proportional to the dose of radiation it is to be expected that in mild cases or for maintenance therapy low doses of radiation will also be effective. UVA1 radiation is a constituent of sunlight, so exposure to sunlight could prove beneficial in treating dyshidrotic eczema.

Dyshidrosis: epidemiology, clinical characteristics, and therapy.

Dyshidrosis is a common chronic dermatitis of the hands and feet that may cause significant physical discomfort, psychological distress, and occupational impairment. Topics reviewed in this article include epidemiology, clinical findings, quality of life, and therapeutic considerations. Dyshidrosis is often difficult to manage; therefore, extra attention is given in this review article to current treatment options.

Comparison of localized high-dose UVA1 irradiation versus topical cream psoralen-UVA for treatment of chronic vesicular dyshidrotic eczema.

BACKGROUND: Vesicular dyshidrotic palmoplantar eczema is a common disorder but treatment is difficult. Localized photochemotherapy (cream psoralen-UVA [PUVA]) has widely been used for therapy. Although the efficacy of cream PUVA therapy is well known, potential side effects may occur. Therefore, a more standardized safe and effective UV therapy should be carried out. OBJECTIVE: This study compared the effects of localized high-dose UVA1 irradiation versus topical cream PUVA for treatment of chronic vesicular dyshidrotic eczema. METHODS: On the basis of the assessment of the Dyshidrotic Area and Severity Index, the decrease of score points on the UVA1-treated side was compared with the decrease on the cream PUVA-treated side in 27 patients. In addition, analysis of serum markers was performed. RESULTS: Of 27 patients, 24 showed a good response to localized UVA1 irradiation or cream PUVA. Dyshidrotic Area and Severity Index scores significantly decreased on both sides and were reduced to half of the pretreatment values. No statistically significant differences between localized UVA1 irradiation or cream PUVA could be detected. CONCLUSION: This study demonstrates that localized UVA1 phototherapy is easy to perform and appears to be an effective and safe treatment for vesicular dyshidrotic eczema.

Resolution of dyshidrotic dermatitis of the hand after treatment with continuous positive airway pressure for obstructive sleep apnea.

Eczema of the palm and obstructive sleep apnea (OSA) are common disorders. Proinflammatory cytokines and cell adhesion molecules are elevated in both of these disorders. We describe an unusual patient with OSA who had recurrent free remission of dermatitis after treatment with continuous positive airway pressure. We speculate that the resolution of the patient's skin condition may reflect the effects of increased tissue oxygenation during sleep, reduced sleep fragmentation, and/or a reduction in sympathetic tone associated with successful sleep apnea treatment.

[Therapy of hyperhidrosis with tap water iontophoresis. Positive effect on healing time and lack of recurrence in hand-foot eczema]. / Therapie der Hyperhidrosis mittels Leitungswasseriontophorese. Positive Effekte auf Abheilungszeit und Rezidivfreiheit bei Hand-Fuss-Ekzemen.

Hyperhidrosis is due to an overfunction of eccrine glands (triggered by the autonomous nervous system) and may be a cofactor for palmoplantar eczema (dermatitis). Tapwater iontophoresis was used in 54 patients with hyperhidrosis manuum et pedum. After 10 applications directed by the dermatologist, 89% of patients noted an improvement in their hyperhidrosis. 20 patients suffering from palmoplantar eczema (dermatitis) who continued the treatment at home for at least 6 months were compared with a historical sex- and age-matched group of 20 eczema-patients without iontophoresis: The factors evaluated were the time needed for clearing and the relapse-free interval. Though iontophoresis-treated patients had a slightly faster clearing, this was statistically not significant (20 vs. 22.3 days; p > 0.05). However, the difference for relapse-free interval between the two groups was statistically highly significant (24.8 weeks vs. 8.35 weeks; p < 0.0001). Tapwater iontophoresis seems to be effective not only to control sweating. According to recently published data, galvanization seems to have a capsaicin-like effect as well. Our hypothesis is therefore, that galvanization with tapwater iontophoresis interrupts the neurogenic inflammation and prolongs the relapse-free interval in hyperhidrotic palmoplantar eczema (dermatitis).

Hand dermatitis. The perennial scourge.

Hand eczema continues to bedevil both patients and physicians. While appropriate and judicious intervention minimizes aggravation, discomfort, and inconvenience, recurrences are frequent. Treatment with corticosteroids is often effective for irritant dermatitis. Efforts to avoid the irritant, protect the hands, and use emollients are vital in preventing recurrence. Protection and avoidance are also the key techniques to teach patients with allergic dermatitis. In the case of pompholyx, experts now believe the condition is caused by stress or emotional turmoil, so the most helpful intervention may be patient education about stress management. Recognizing the role of irritants encountered at work, at home, and in the recreational setting offers physicians the opportunity to intervene preemptively. When patients avoid unnecessary exposure and protect the skin against climatic instability, the toll exacted by hand eczema can be dramatically reduced.

[Dyshidrosis]. / Dysidrose.

Dyshidrosis is a vesicular, non inflammatory and recurrent disease of the palms and soles related to eczema. Sometimes hyperhidrosis can induce inflammatory reactions. The diagnosis becomes obvious when a period of ferocious pruritus, vesicle develop on the sides of the fingers and the palms. These vesicles are imbedded in the epidermis below the thick stratum corneum. They are strongly distended and painful when they grow in size. They dry up and disappear within three weeks. Relapses are frequent in patients with a topy, sweat gland disorders or neurovegetative disturbances. Several clinical aspects are observed: bullous dyshidrosis, superinfection, psoriasiform keratodermia. Dyshidrosis in infectious, fungal or allergic origin can be cured by suppressing the causative agent, but complex or idiopathic lesions follow their own course and persist.

Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current.

The efficacy of tap water iontophoresis in treating palmoplantar hyperhidrosis has been sufficiently documented and has led to its extensive use in clinical practice. In order to test the efficacy of this treatment modality in cases of dyshidrotic hand eczema, 20 patients were treated with tap water iontophoresis in addition to two-sided steroid-free topical therapy in a randomized half-side-study. A special score for dyshidrotic eczema including objective and subjective criteria was developed to document the success of the therapy. Only those sides treated with tap water iontophoresis showed significant improvement. This significant effect of iontophoresis indicates the efficacy of this treatment in cases of dyshidrotic hand eczema.

Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx.

In some cases that have been diagnosed as contact allergy to nickel, there are repeated cutaneous eruptions of pompholyx, even in areas with no direct contact with the metal. The possible alimentary origin of dyshidrotic eczema should be considered when deciding on therapy. We have collected the clinical data for 24 patients with dyshidrotic eczema caused by nickel, to evaluate the benefit of a low-nickel diet versus treatment with oral disodium cromoglycate, comparing both objective and subjective symptoms. A low-nickel diet does not improve these patients but those treated with DSCG reacted better, from both objective and subjective point of view, than either the controls or the patients treated by diet. We next did intestinal permeability tests before therapy and after 15 days of treatment. We found that nickel uptake diminishes simultaneously with the reduction of absorption through the smaller aqueous "pores". This phenomenon was greatest after DSCG. We suggest that DSCG can help selected cases of pompholyx.

Biofeedback training in the therapy of dyshidrosis.

Biofeedback training for hand warming and relaxation was used with five patients with severe dyshidrotic eczema who were poorly responsive to conventional therapy. Improvement was seen in all five patients, especially those who most noted flaring of their disease under stress. Biofeedback is being used in the treatment of diverse stress-related disorders, and may have potential in dermatologic diseases.