Date of Graduation

Summer 8-9-2014

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson, PA-C

Second Advisor

Annjanette Sommers, PA-C, MS

Abstract

Background: Dyshidrotic hand eczema is a relatively common vesicobullous disorder of the palms and soles. It is also known as pompholyx, dyshidrotic hand dermatitis, and palmoplantar eczema. It is characterized by pruritic lesions that can erupt in a chronic or relapsing pattern with episodes lasting months to years.The condition can be difficult to treat because of the thickness of the affected skin and the numerous sweat glands. Current treatments are not always effective and pose their own risks. Studies have shown associations between hyperhidrosis and dyshidrotic hand eczema. Botulinum toxin A (BTXA) has been used to treat hyperhidrosis with success. This leads to the possibility that BTXA may be an effective treatment option for refractory cases of dyshidrotic hand eczema.

Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, EBMR Multifile, CINAHL, and Web of Science. The keywords dyshidrotic eczema, eczema, pompholyx, and botulinum toxins were used in the search. The relevant articles were evaluated for quality using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.

Results: Two prospective control studies met inclusion criteria and were included in this systematic review. The first study investigated whether BTXA injections used with topical corticosteroids could treat dyshidrotic hand eczema better than topical therapy alone. Eight adult patients were enrolled with dyshidrotic hand eczema. Itching and vesiculation were inhibited earlier when using both BTXA and corticosteroids compared to corticosteroids alone. The second study evaluated the effects of BTXA injections as a treatment for dyshidrotic hand eczema with the other hand as an untreated control. Ten patients with bilateral hand eczema enrolled in the study. There were significant reductions in patient important outcomes and disease processes in the BTXA treatment hand compared to the control.

Conclusion: BTXA can be a reasonable treatment option for patients with refractory dyshidrotic hand eczema. This treatment may be even more valuable in patients with hyperhidrosis.

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