Recurrent vesicular palmoplantar dermatitis: a clinical study in children and adolescents

Abstract

Recurrent vesicular palmoplantar dermatitis (RVPD) earlier known as dyshidrosis or pompholyx is a common disorder characterized by recurrent crops of vesicles or bullae on non-erythematous skin on the lateral aspects of fingers, palms and soles.1,2 It accounts for 5 to 20% of all cases of hand dermatitis.3 Although RVPD occurs worldwide, it is less common among Asians.4,5 The peak age of onset is usually between 20 and 30 years. There is paucity of literature on RVPD previously targeting children and adolescents age group. An earlier study from north eastern India (Manipur) reported 6.5% prevalence among paediatric population.6 RVPD may have significant negative impact on the quality of life due to severe pruritus.3 Until today, the aetiology of RVPD remains largely unknown. The present study was done to determine the demography, aetiology and clinical profile RVPD in children and adolescent population. METHODS A cross sectional study was conducted in 50 patients belonging to children and adolescent population (1-18 years) attending out- patient department of dermatology, venereology and leprology, regional institute of medical sciences, imphal, Manipur for a period of 24 months (October 2019 to September 2021). Children (≤12 years) and adolescents (13-18 years) irrespective of sex with clinical presentations of recurrent vesicular palmoplantar dermatitis coming to dermatology OPD, RIMS, Imphal were included and those who are unwilling to participate and those treated elsewhere were excluded from the study. Diagnosis was based on strict criteria to recognize RVPD: eruption of symmetrical vesicles or bullae on nonerythematous base, self-limited and recurrent exclusively located on palms, soles and inner sides of the fingers; and occasionally associated pruritus. Relevant investigations like skin biopsy and Mycological examination with 10 % KOH were performed. Patch test was performed with 20 allergens of Indian standard battery (Figure 1) on the patients’ back for 48 hours. Readings were taken at 48 and 120 hours. Test readings followed recommendations of the International contact dermatitis research group (questionable reaction, soft erythematous macule (+/−); weak/nonvesicular reaction, with erythema, infiltration and papule (+); strong/nonvesicular reaction, with erythema, infiltration and papules (++); reaction with confluent bullae (+++); negative reaction (−); irritant reaction (IR). Data were collected using questionnaire. Details included sex, age, seasonal variations, hyperhidrosis, individual and family history of atopy, atopic diathesis were included. Diagnosis of atopic status was defined by individual or family history (allergic rhinitis, asthmatic bronchitis and atopic eczema). Ethical approval was obtained from research ethics board. Data were entered in IBM SPSS Statistics 21 for Windows (IBM Corp. 1995, 2012). Descriptive statistics such as frequency, percentages, mean with standard deviation and median were used. Analysis was done using Chi-square test to check the significance between proportion and p value <0.05 was taken as statistically significant. RESULTS Majority (44%) of patients were in the age group 1-5 years (Table 1). In 78% of patients no causative factor were identified. Hyperhidrosis (12%) was identified as second most contributing factor for RVPD (Figure 2). Patch test results were positive for nickel, potassium dichromate and benzocaine in 3 patients out of total 50 patients in whom patch test was conducted. Atopy was the most common associated factor (Figure 3). Personal history of atopy was present in 42% of the patients with allergic rhinitis/sinusitis, bronchial asthma and atopic dermatitis in 57.14%, 28.5% and 14.2% respectively (Table 2). Family history of atopy was also present in 26% of them as allergic rhinitis/sinusitis (69.2%) and bronchial asthma (30.7%).