Dyshidrotic eczema / Palmoplantar pustulosis
Red spots, blisters, and peeling on the palms and soles may be seen in tenea, but dyshidrotic eczema and palmoplantar pustulosis may reveal similar lesions. In dyshidrotic eczema the contents of the blisters look clear, while those of palmoplantar pustulosis look "pustular." Since dyshidrotic eczema is caused by inflammation around the exit of sweat duct, it is frequently seen around palms and soles where sweat duct is abundant. Pulmoplantar pustulosis is related to excessive immune response on the palms and soles. Smoking habit, tooth decay, allergy to dental metals, common cold, sinusitis, and tonsillitis are thought to aggravate the symptoms. Neither dyshidrotic eczema nor palmoplantar pustulosis is contagious.
The management of dyshidrotic eczema includes topical steroid. If too much sweating is a problem, topical aluminum chloride and antiperspirant cream called D-tube are suggested. For palmoplantar pustulosis, the patients are encouraged to stop smoking, since the effect of the treatment is limited without doing so. Topical steroid, topical Vitamin D3, and keratolytic ointment are used. Oral biotin tablets ,probiotics. and anti histamines are combined with topical medicine. Antibiotics may be prescribed for 2-3 months. In severe cases, oral etretinate may be prescribed, but this requires contraception and blood donation is no longer permitted after having taken etretinate, thereby younger patients are not indicated for this mode of treatment. A patch test for metal allergy may be performed.