Hand dermatitis is among the most common conditions dermatologists are asked to deal with. It consists of a spectrum of diseases from very mild annoyances with dryness and irritation, to a severe disabling condition. Dermatitis by itself means inflammation of the skin. This is an all-encompassing category of disease. We need some modifiers to better classify these problems. Eczema refers to a red, denuded and weepy dermatitis normally with considerable complaints of severe itching. This would then be an eczematous dermatitis. Many occur in isolated patches separated by normal appearing skin. When found with the above, it would be called a patchy eczematous dermatitis.
Since these areas are often denuded of the epidermis, body fluid (serum) leaks from these areas. This is a great culture media for bacteria, which are always present on the skin.
Impetigo (superficial bacterial infection of the skin) is the result. When combined with the above characteristic, we have an impetiginized, patchy eczematous dermatitis.
The palms and soles have great numbers of sweat glands. With increasing inflammation in the skin, the sweat ducts which carry sweat to the surface of the skin is compressed like standing on a garden hose. The sweat distends the duct below the obstruction producing deep-seated blisters at varying depths. In its common form, this is referred to as dyshidrosis and in its more severe form, it is called pomphylox. The blister fluid is clear with the composition of sweat.
There are times when the palms and soles are covered with deep-seated pustules which occur with pustular psoriasis and its various subtypes. Therapy for these problems is quite effective and can usually limit disability and improve the quality of life.