Clinical Characteristics of Hand-foot Dermatitis in Atopic Dermatitis

Lee, Hyun Jeong; Roh, Kee Young; Kim, Dong Jae; Ha, Hye Jeong; Ha, Seog Jun; Park, Young Min; Byun, Dae Gyoo; Kim, Jin Wou

Abstract

BACKGROUND: Hand-foot (H-F) dermatitis is common in atopic dermatitis patients, but its clinical characteristics have not been studied well. OBJECTIVE: We performed this study to examine the clinical characteristics of H-F dermatitis of AD and to assess its etiologic associations. METHODS: Clinical manifestations of H-F dermatitis were examined in 134 patients with H-F dermatitis of AD between May 1997 and July 1998 at our AD clinic. RESULTS: Both hand and foot were involved in 63(47.0%) patients, and either hand or foot involvement was observed in 20(14.9%) and 51(38.1%) patients, respectively. It usually began in childhood with an early onset of AD. Pruritus was the most frequent symptom, and erythema, scales, lichenification, hyperkeratosis, fissures, and keratolysis exfoliativa were also common. Palmar or plantar involvement showed an equal frequency with the dorsal lesions. The great toe was affected more often than the other toes. Two thirds presented with manifestations of ichthyosis triad (ichthyosis vulgaris, hyperlinear palm and keratosis pilaris) and sandpaper-like skin lesions on the elbow, knee, and lateral malleolus. Palmar or plantar hyperhidrosis was reported in 21% and 27% respectively. The ichthyosis-associated group showed a significantly higher incidence of sandpaper-like skin lesions, fissures, and scales, mainly involving the dorsa of hands and feet. The hyperhidrosis- associated group showed an association with glassy lesions, localized to palmar or plantar areas. CONCLUSION: Clinical characteristics of AD-associated H-F dermatitis were demonstrated. The disease was suggested to be associated with the nonimmunologic etiologies of AD and clinical subgroups could be identified on the basis of nonimmunologic backgrounds.