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.
Get full access to this article
View all access options for this article.
References
1.
FoxT.On dyshidrosis. Am J Syph Dermatol, 1873; 4:1-7.
2.
FoxT.Dyshidrosis: an undescribed eruption. Br Med J, 1873; 2: 365-6.
3.
HutchinsonJ.Cheiro-pompholyx: notes of a clinical lecture. Lancet, 1876; 1:630-1.
4.
FowlerJF, StorrsFJ. Nickel allergy and dyshidrotic eczema: are they related?. Am J Contact Dermat, 2001; 12:119-21.
5.
AgrupG.Hand eczema and other hand dermatoses in south Sweden. Acta Derm Venereol (Stockh), 1969; 49Suppl 61:5-91.
6.
MaginaS, BarrosMA, FerreiraJA, Mesquita-GuimaraesJ. Atopy, nickel sensitivity, occupation, and clinical patterns in different types of hand dermatitis. Am J Contact Dermat, 2003; 14:63-8.
7.
LodiA, BettiR, ChiarelliG, et al.Epidemiological, clinical and allergological observations on pompholyx. Contact Dermatitis, 1992; 26:17-21.
8.
Lehucher-MichelMP.Dyshidrotic eczema and occupation: a descriptive study. Contact Dermatitis, 2000; 43:200-5.
9.
De BoerEM, BruynzeelDP, Van KetelWG. Dyshidrotic eczema as an occupational dermatitis in metal workers. Contact Dermatitis, 1988; 19:184-8.
10.
EdmanB.Palmar eczema: a pathogenetic role for acetylsalicylic acid, contraceptives and smoking?. Acta Derm Venereol (Stockh), 1988; 68:402-7.
11.
ThelinI, AgrupG. Pompholyx—a one year series. Acta Derm Venereol (Stockh), 1985; 65:214-17.
12.
BryldLE, AgnerT, MenneT. Relation between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy. Acta Derm Venereol, 2003; 83:186-8.
VocksE, PlotzSG, RingJ. The Dyshidrotic Eczema Area and Severity Index—a score developed for the assessment of dyshidrotic eczema. Dermatology, 1999; 198:265-9.
15.
European Task Force on Atopic Dermatitis. severity scoring of atopic dermatitis: the SCORAD index. Dermatology, 1993; 186:23-31.
16.
JamecJBE, WulfHC. The applicability of clinical scoring systems: SCORAD and PASI in psoriasis and atopic dermatitis. Acta Derm Venereol (Stockh), 1997; 77:392-3.
17.
AbramsBB.Atopic dermatitis: elements in clinical study design and analysis. Acta Derm Venereol Suppl (Stockh), 1989; 144:15-9.
18.
KutznerH, WurzelR, WolffH.Are acrosyringia involved in the pathogenesis of “dyshidrosis”?. Am J Dermatopathol, 1986; 8:109-16.
19.
AckermanAB. Histologic diagnosis of inflammatory skin diseases. Philadelphia: Lea & Febiger; 1978. p. 499-500.
20.
ChristensenOB, MollerH. Nickel allergy and hand eczema. Contact Dermatitis, 1975; 1:129-35.
21.
ChristensenOB, MollerH. External and internal exposure to antigen in the hand eczema of nickel allergy. Contact Dermatitis, 1975; 1:136-41.
22.
MeneghiniC, AngeliniG. Contact and microbial allergy in pompholyx. Contact Dermatitis, 1979; 51:46-50.
23.
TagamiH.Trichophyton contact sensitivity in patients with dermatophytosis. Arch Dermatol, 1977; 113:1409.
24.
MortzCG, LauritsenJM, Bindslev-JensenC, et al.Nickel sensitization in adolescents and association with ear piercing, use of dental braces and hand eczema. Acta Derm Venereol, 2002; 82: 359-64.
25.
VeienNK, KaaberK. Nickel, cobalt and chromium sensitivity in patients with pompholyx (dyshidrotic eczema). Contact Dermatitis, 1979; 5:371-4.
26.
BryldLE, AgnerT, KyvikKO, et al.Hand eczema in twins: a questionnaire investigation. Br J Dermatol, 2000; 142:298-305.
27.
YokozekiH, KatayamaJ, NishiokaK, et al.The role of metal allergy and local hyperhidrosis in the pathogenesis of pompholyx. J Dermatol, 1992; 19:964-7.
28.
LiLF, WangJ. Contact hypersensitivity in hand dermatitis. Contact Dermatitis, 2002; 47:206-9.
29.
HindsenM, BruzeM, ChristensenOB. Individual variation in nickel patch test reactivity. Am J Contact Dermat, 1999; 10:62-7.
30.
CrostiC, LodiA. Pompholyx: a still unresolved kind of eczema. Dermatology, 1993; 186:241-2.
31.
JainVK, AggarwalK, PassiS, GuptaS. Role of contact allergens in pompholyx. J Dermatol, 2004; 31:188-93.
32.
ShelleyWB.Chromium in welding fumes as cause of eczematous hand eruption. JAMA, 1964; 189:772.
33.
VeienNK, HattelT, JustesenO, et al.Oral challenge with metal salts in vesicular patch-test negative hand eczema. Contact Dermatitis, 1983; 9:402-6.
34.
MenneT, HjorthN. Reactions from systemic exposure to contact allergens. Semin Dermatol, 1982; 1:15-24.
35.
EkelundAG, MollerH. Oral provocation in eczematous contact allergy to neomycin and hydroxyl-quinolones. Acta Derm Venereol (Stockh), 1969; 49:422-6.
36.
PrystupaK, RudzkiE. Oral tolerance of nickel in patients with dyshidrosis. Contact Dermatitis, 2000; 42:276-7.
37.
PeckSM.Epidermophytosis of the feet and epidermophytids of the hand. Arch Dermatol, 1930; 5:371-4.
38.
ManI, IbbotsonS, FergusonJ. Photoinduced pompholyx: a report of 5 cases. J Am Acad Dermatol, 2004; 50:55-60.
39.
IannacconeS, SferrazzaB, QuattriniA, et al.Pompholyx (vesicular eczema) after IV immunoglobulin therapy for neurologic disease. Neurology, 1999; 53:1154-5.
WollinaU, NaserMBA. Pharmacotherapy of pompholyx. Expert Opin Pharmacother, 2004; 5:1517-22.
45.
SilversteinP.Smoking and wound healing. Am J Med, 1992; 93: 22S-4S.
46.
ZiaS, NdoyeA, LeeTX, et al.Receptor-mediated inhibition of keratinocyte migration by nicotine involves modulations of calcium influx and intracellular concentration. J Pharmacol Exp Ther, 2000; 293:973-81.
47.
SmithJB, NeilAF. Cutaneous manifestations and consequences of smoking. J Am Acad Dermatol, 1996; 34:717-32.
48.
DouwesKE, KarrerS, AbelsC, et al. Does smoking influence the efficacy of bath-PUVA therapy in chronic palmoplantar eczema? Photodermatol Photoimmunol Photomed 2000;16:25-9.
49.
Van der VleutenC, van der ValkP. Dyshidrotic eczema giving rise to painful lower leg ulceration as a result of smoking? Acta Derm Venereol 2001;82:76-7.
50.
MoselyLH, FinsethF. Cigarette smoking: impairment of digital flow and wound healing in the hand. Hand, 1977; 9:97-101.
PeacockEE, Van WinkleW. Wound repair. Philadelphia: W.B. Saunders; 1976. p.46.
53.
MatinS, BliwiseD, WellmanJ, et al.Resolution of dyshidrotic dermatitis of the hand after treatment with continuous positive airway pressure for obstructive sleep apnea. South Med J, 2002; 95: 253-4.
54.
WilkinsonJD.Vesicular palmoplantar eczema. In: Fitzpatrick T, Eisen A, Wolff K, et al, editors, Dermatology in general medicine, 4th ed. New York: McGraw-Hill; 1993. p.1574.
55.
WhiteJW.Localized eczematous disease. In: Sam W, Lynch P, editors. Principles and practice of dermatology. New York: Churchill Livingstone; 1990. p.411.
PicardiA, AbeniD, RenziC, et al.Increased psychiatric morbidity in female outpatients with skin lesions on visible parts of the body. Acta Derm Venereol, 2001; 81:410-4.
59.
WarshawE.Therapeutic options for chronic hand dermatitis. Dermatol Ther, 2004; 17:240-50.
60.
HarperJ.Topical corticosteroids in skin in infants and children. Drugs, 1988; 36,Suppl 5:34-7.
61.
Van CoevordenAM, CoenraadsPJ, SvensseonA, et al.Overview of studies of treatment for hand eczema—the EDEN hand eczema survey. Br J Dermatol, 2004; 151:446-51.
62.
SchnoppC, RemlingR, MohrenschlagerM, et al.Topical tacrolimus (FK506) and mometasone furoate in the treatment of dyshidrotic palmar eczema: a randomized, observed-blinded trial. J Am Acad Dermatol, 2002; 46:73-7.
63.
VeienNK, LarsenPO, et al.Long-term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol, 1999; 140:882-6.
64.
VoldenG.Successful treatment of chronic skin diseases with clobetasol propionate and a hydrocolloid occlusive dressing. Acta Derm Venereol (Stockh), 1991; 72:69-71.
65.
LebwohlM, AliS. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol, 2001; 45:487-98.
66.
OlsenEA, CornellRC. Topical clobestasol-17-propionate: review of its clinical efficacy and safety. J Am Acad Dermatol, 1986; 15:246-55.
67.
HaapasaariKM, RisteliJ, OikarinenA. Recovery of human skin collagen synthesis after short-term topical corticosteroid treatment and comparison between young and old subjects. Br J Dermatol, 1996; 135:65-9.
68.
SengokuT, MoritaK, SakumaS, et al.Possible inhibitory mechanism of FK506 (tacrolimus hydrate) ointment for atopic dermatitis based on animal models. Eur J Pharmacol, 1999; 379: 183-9.
69.
NagaiH, HiyamaH, MatsuoA, et al.FK506 and cyclosporine A potentiate the IgE antibody production by contact sensitization with hapten in mice. J Pharmacol Exp Ther, 1997; 283:321-7.
70.
ReitamoE, KissanenJ, RemitzA, et al.Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial. J Invest Dermatol, 1998; 111:396-8.
71.
MrowietzU, GraeberM, BrautigamM, et al.The novel ascomycin derivative SDZ ASM 981 is effective for psoriasis when used topically under occlusion. Br J Dermatol, 1998; 139:992-6.
72.
RemitzA, ReitamoS, ErkkoP, et al.Tacrolimus ointment improves psoriasis in a microplaque assay. Br J Dermatol, 1999; 141: 103-7.
73.
ZonneveldIM, RubinsA, JablonskaS, et al.Topical tacrolimus is not effective in chronic plaque psoriasis: a pilot study. Arch Dermatol, 1998; 134:1101-2.
74.
BelsitoDV, FowlerJFJr, MarksJGJr, et al.Pimecrolimus cream 1%: a potential new treatment for chronic hand dermatitis. Cutis, 2004; 73:31-8.
75.
GrassbergerM, BaumrukerT, EnzA, et al.A novel antiinflammatory drug, SDZ ASM 981, for the treatment of skin diseases: in vitro pharmacology. Br J Dermatol, 1999; 141:264-2.
76.
LugerT, Van LeentEJ, GraeberM, et al.SDZ ASM 981: an emerging safe and effective treatment for atopic dermatitis. Br J of Dermatol, 2001; 144:788-94.
77.
HarperJ, GreenA, ScottG, et al.First experience of topical SDZ ASM 981 in children with atopic dermatitis. Br J Dermatol, 2001; 144:781-7.
78.
CronsteinBN, NaimeD, OstadE. The anti-inflammatory mechanism of methotrexate: increased adenosine release at inflamed sites diminishes leukocyte accumulation in an in vivo model of inflammation. J Clin Invest, 1993; 92:2675-82.
79.
MorabitoL, MontestinosMS, SchreibmanDM, et al.Methotrexate and sulfasalazine promote adenosine release by a mechanism that requires ecto-5′-nucleotidase-mediated conversion of adenine nucleotides. J Clin Invest, 1998; 101:295-300.
80.
CronsteinBN.The mechanism of action of methotrexate. Rheum Dis Clin North Am, 1997; 23:739-55.
81.
EganC, RallisT, MeadowsK, KruegerG. Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Derm, 1999; 40:612-4.
82.
ScerriL.Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol, 1996; 455:343-8.
83.
KonstantopoulouM, BelgiA, GriffithsKD, et al.Azathioprineinduced pancytopenia in a patient with pompholyx and deficiency of erythrocyte thiopurine methyltransferase. Br Med J, 2005; 330: 350-1.
84.
ReitamoS, GranlundH. Cyclosporin A in the treatment of chronic dermatitis of the hands. Br J Dermatol, 1994; 130:75-8.
85.
SowdenJM, Berth-JonesJ, RossJS, et al.A multicentre, doubleblind, placebo-controlled crossover study to assess the efficacy and safety of cyclosporine in adult patients with severe refractory atopic dermatitis. Lancet, 1991; 338:137-40.
86.
GranlundH, ErkkoP, ErikssonE, ReitamoS. Comparison of cyclosporine and topical betamethasone-17,21-dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol (Stockh), 1996; 76:371-6.
KrutmanJ.Phototherapy for atopic dermatitis. Clin Exp Dermatol, 2000; 25:552-8.
93.
SimonJC, KrutmanJ, ElmetsCA, et al.Ultraviolet B-irradiated antigen-presenting cells display altered accessory signaling for T-cell activation: relevance to immune responses initiated in the skin. J Invest Dermatol, 1992; 98,Suppl 6:66S-9S.
94.
KouluLM, JansenCT. Antipsoriatic, erythematogenic, and Langerhans cell marker-depleting effect of bath-psoralens plus ultraviolet A treatment. J Am Acad Dermatol, 1988; 18:1053-9.
95.
KingCM, ChalmersRJG. A double-blind study of superficial radiotherapy in chronic palmar eczema. Br J Dermatol, 1984; 111: 451-4.
96.
FairrisGM, MackDP, RowellNR. Superficial x-ray therapy in the treatment of constitutional eczema of the hands. Br J Dermatol, 1984; 111:445-9.
97.
RowellNR.Adverse effects of superficial x-ray therapy and recommendations for use in benign dermatoses. J Dermatol Surg Oncol, 1978; 4:630-4.
98.
SulzbergerMB, BaerRL, BorotaA. Do roentgen-ray treatments as given by skin specialists produce cancers and other sequelae? Arch Derm Syphilol 1952;65:639-55.
99.
Sheehan-DareRA, GoodfieldMJ, RowellNR. Topical psoralen (PUVA) and superficial radiotherapy in the treatment of chronic hand eczema. Br J Dermatol, 1989; 121:65-9.
LindelofB, EklundG. Incidence of malignant skin tumors in 14,140 patients after Grenz ray treatment for benign skin disorders. Arch Dermatol, 1986; 122:1391-5.
102.
FairrisGM, JonesDH, MackDP, RowellNR. Conventional superficial x-ray versus Grenz ray therapy in the treatment of constitutional eczema of the hands. Br J Dermatol, 1985; 112:339-41.
103.
CartwrightPH, RowellNR. Comparison of Grenz rays versus placebo in the treatment of chronic hand eczema. Br J Dermatol, 1987; 117:73-6.
104.
LindelofB, WrangsjoK, LidenS. A double-blind study of Grenz ray therapy in chronic eczema of the hands. Br J Dermatol, 1987; 117:77-80.
105.
StambaughM, DeNittisA, WallnerP, HeymannW. Complete remission of refractory dyshidrotic eczema with the use of radiation therapy. Cutis, 2000; 65:211-4.
106.
MobackenH, RosenK, SwanbeckG. Oral psoralen photochemotherapy (PUVA) of hyperkeratotic dermatitis of the palms. Br J Dermatol, 1983; 109:205-8.
107.
MorisonWL, ParrishJA, FitzpatrickTB. Oral methoxsalen photochemotherapy of recalcitrant dermatoses of the palms and soles. Br J Dermatol, 1978; 99:297-302.
108.
MurrayD, CorbettMF, WarinAP. A controlled trial of photochemotherapy for persistent palmoplantar pustulosis. Br J Dermatol, 1980; 102:659-63.
109.
TegnerE, ThelinI. PUVA treatment of chronic eczematous dermatitis of the palms and soles. Acta Derm Venereol, 1985; 65: 451-3.
RosenK, MobakenH, SwanbeckG. Chronic eczematous dermatitis of the hands: a comparison of PUVA and UVB treatment. Acta Derm Venereol (Stockh), 1987; 67:48-54.
112.
LassusA, LauharantaL, EskelinenA. The effect of etretinate compared with different regiments of PUVA in the treatment of persistent palmoplantar pustulosis. Br J Dermatol, 1985; 112:455-9.
113.
LoweNJ, WeingartenD, BourgetT, MoyLS. PUVA therapy for psoriasis: comparison of oral and bath-water delivery of 8-methoxypsoralen. J Am Acad Dermatol, 1986; 14:754-60.
114.
SternR, NicholsK, VakevaL. Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). N Engl J Med, 1997; 336:1041-5.
115.
SternR, LairdN, MelskiJ, et al.Cutaneous squamous-cell carcinoma in patients treated with PUVA. N Engl J Med, 1984; 310: 1156-61.
116.
LindlofB, SigureirssonB, TegnerE, et al.PUVA and cancer: a large-scale epidemiological study. Lancet, 1991; 338:91-3.
117.
NijstenTEC, SternRS. The increased risk of skin cancer is persistent after discontinuation of psoralen + ultraviolet A: a cohort study. J Invest Dermatol, 2003; 121:252-8.
118.
SchemppC, MullerH, CzechW, et al.Treatment of chronic palmoplantar eczema with local bath-PUVA therapy. J Am Acad Dermatol, 1997; 36:733-7.
119.
BehrensS, von KobyletzkiG, GrussC, et al.PUVA-bath photochemotherapy (PUVA-soak therapy) of recalcitrant dermatoses of the palms and soles. Photodermatol Photoimmunol Photomed, 1999; 15:47-51.
120.
AbelEA, GoldbergLH, FarberEM. Treatment of palmoplantar psoriasis with topical methoxsalen plus long-wave ultraviolet light. Arch Dermatol, 1980; 116:1257-61.
121.
Grundmann-KollmanM, BehrensS, PeterRU, KerscherM. Treatment of severe recalcitrant dermatoses of the palms and soles with PUVA-bath versus PUVA-cream therapy. Photodermatol Photoimmunol Photomed, 1999; 15:87-9.
122.
WilkinsonJF, RalfsIG, HarperJI, BlackMM. Topical methoxsalen photochemotherapy in the treatment of palmoplantar pustulosis and psoriasis. Acta Derm Venereol, 1979; 59:193-8.
123.
LaytonAM, Sheehan-DareR, CunliffeWJ. A double-blind, placebo-controlled trial of topical PUVA in persistent palmoplantar pustulosis. Br J Dermatol, 1991; 124:581-4.
124.
DavisM, McEnvoyM, el-AzharyR. Topical psoralen-ultraviolet A therapy for palmoplantar dermatoses: experience with 35 consecutive patients. Mayo Clin Proc, 1998; 73:407-11.
125.
GrattanCEH, CarmichaelAJ, ShuttlewortGJ. Comparison of topical PUVA with UVA for chronic vesicular hand eczema. Acta Derm Venereol (Stockh), 1991; 71:118-22.
126.
LeyRD, FourtanierA. UVA1-induced edema and pyrimidine dimmers in murine skin. Photochem Photobiol, 2000; 72:485-7.
127.
SeiteS, MoyalD, VerdierMP, et al.Accumulated p53 protein and UVA protection level of sunscreens. Photodermatol Photoimmunol Photomed, 2000; 16:3-9.
128.
PoldermanMCA, GovaertJCM, le CessieS, PavelS. A doubleblind placebo-controlled trial of UVA-1 in the treatment of dyshidrotic eczema. Clin Exp Dermatol, 2003; 28:584-7.
129.
PeteringH, BreuerC, HerbstR, et al.Comparison of localized high-dose UVA1 irradiation versus topical cream psoralen-UVA for the treatment of chronic vesicular dyshidrotic eczema. J Am Acad Dermatol, 2004; 50:68-72.
130.
SchmidtT, AbeckD, BoeckK, et al.UVA1 irradiation is effective in treatment of chronic vesicular dyshidrotic hand eczema. Acta Derm Venereol (Stockh), 1998; 78:318-9.
131.
EdstromDW, PorwitA, RosAM. Effects on human skin of repetitive ultraviolet-A1 (UVA1) irradiation and visible light. Photodermatol Photoimmunol Photomed, 2001; 17:66-70.
132.
KaaberK, VeienNK, TjellJC. Low nickel diet in the treatment of patients with chronic nickel dermatitis. Br J Dermatol, 1978; 98: 197-201.
133.
VeienNK, HattelT, JustesenO, NorholmA. Dietary restrictions in the treatment of adult patients with eczema. Contact Dermatitis, 1987; 17:223-8.
ChristensenOB.Prognosis in nickel allergy and hand eczema. Contact Dermatitis, 1982; 8:7-15.
136.
FisherA.Possible role of diet in pompholyx and nickel dermatitis, a critical survey. Cutis, 1978; 22:412-24.
137.
JordanWP, KingSE. Nickel feeding in nickel-sensitive patients with hand eczema. J Am Acad Dermatol, 1979; 1:506-8.
138.
GawkrodgerDJ, CookSW, FellGS, et al.Nickel dermatitis: the reaction to oral nickel challenge. Br J Dermatol, 1986; 115:33-8.
139.
BurrowsD. Is systemic nickel important? J Am Acad Dermatol 1992;26:632-5.
140.
MollerH. Yes systemic nickel is probably important! J Am Acad Dermatol 1993;28:511-2.
141.
CroninE, DiMichielA, BrownS. Oral challenge in nickel-sensitive women with hand eczema. In: Brown S, Sunderman F Jr, editors. Nickel toxicology. New York: Academic Press; 1980. p. 149-55.
142.
NielsenGD.Absorption and retention of nickel from drinking water in relation to food intake and nickel sensitivity. Toxicol Appl Pharmacol, 1999; 154:67-75.
143.
VeienN, HattelT, LaurbergG. Low nickel diet: an open prospective trial. J Am Acad Dermatol, 1993; 29:1002-7.
144.
MenneT, KaaberK. Treatment of pompholyx due to nickel allergy with chelating agents. Contact Dermatitis, 1978; 4:289-90.
145.
KaaberK, MenneT, Veien, HougaardP. Treatment of nickel dermatitis with Antabuse: a double-blind study. Contact Dermatitis, 1983; 9:297-9.
146.
GamboaP, JuareguiI, UrrutiaI, et al.Disulfiram-induced recall of nickel dermatitis in chronic alcoholism. Contact Dermatitis, 1993; 28:255.
147.
KaaberK, MenneT, TjellJ, VeienN. Antabuse treatment of nickel dermatitis. Chelation—a new principle in the treatment of nickel dermatitis. Contact Dermatitis, 1979; 5:221-8.
148.
PigattoPD, GibelliE, FumagalliM, et al.Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx. Contact Dermatitis, 1990; 22:27-31.
149.
CoxJSG.Disodium cromoglycate. Mode of action and its possible relevance to the clinical use of the drug. Br J Dis Chest, 1971; 65:189-204.
150.
BusincoL, CantaniA, BenincoriN, et al.Effectiveness of oral sodium cromoglycate (SCG) in preventing food allergy in children. Ann Allergy, 1983; 51(1 Pt 1):47-50.
151.
SantucciB, CristaudoA, CannistraciC, PicardoM. Nickel sensitivity: effects of prolonged oral intake of the element. Contact Dermatitis, 1988; 19:202-5.
152.
TroostRJJ, KozelMA, van Helden-MeeuwsenCG, et al.Hyposensitization in nickel allergic contact dermatitis: clinical and immunologic monitoring. J Am Acad Dermatol, 1995; 32:576-83.
153.
OdiaS, VocksE, RakoskiJ, RingJ. Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol (Stockh), 1996; 76:472-4.
154.
WollinaU, KaramfilovT. Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left-right comparison. J Eur Acad Dermatol Venereol, 2002; 16: 40-2.
155.
HummAM, PabstC, LauterburgT, BurgunderJM. Enkephalin and aFGF are differentially regulated in rat spine motoneurons after chemodenervation with botulinum toxin. Exp Neurol, 2000; 161:361-72.
156.
IshikawaH, MitsuiK, YoskitomiT, et al.Presynaptic effects of botulinum toxin type A on the neuronal evoked response of albino and pigmented rabbit iris sphincter dilator muscles. Jpn J Ophthalmol, 2000; 44:106-9.
157.
KleinAW.Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin [reply]. J Am Acad Dermatol, 2004; 50:153.
158.
SwartlingC, NaverH, LindbergM, AnvedenI. Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin. J Am Acad Dermatol, 2002; 47:667-1.
159.
KellumRE.Dyshidrotic hand eczema. A psychotherapeutic approach. Cutis, 1975; 16:875-8.
160.
NiemeierV, NippesenM, KupferJ, et al. Psychological factors associated with hand dermatoses: which subgroup needs additional psychological care? Br J Dermatol 2002;146: 1031-7.
161.
KoldysK, MeyerR. Biofeedback training in the therapy of dyshidrosis. Cutis, 1979; 24:219-21.
162.
SilvanM.An integrated approach to the treatment of psychodermatology patients. Dermatol Psychosom, 2001; 2:86-92.
163.
MusalekM, HoblB, MossbacherU. Diagnostics in pyschodermatology. Dermatol Psychosom, 2001; 2:110-5.
