Tylotic eczema, also called hyperkeratotic rhagadiform eczema or eczema hyperkeratoticum et rhagadiforme, is a form of eczema on the hands (fingers) or feet with flaking, dry skin and cracks. Tylotic eczema is persistent and very treatment resistant. Treatment consists of locally applying strong dermacorticosteroids (popularly known as ‘hormone ointments’) and greasy ointments or creams. Light therapy is also possible if hormone ointment has insufficient effect. Tylotic eczema can have a significant impact on daily life, due to the pain and discomfort it causes. Because this form of eczema often recurs and is chronic in nature, it is important to treat this eczema patiently and consistently. Work closely with your doctor or dermatologist to develop the right treatment strategy and manage symptoms effectively.
- What is tylotic eczema?
- Who does it occur to?
- Synonyms
- Causes
- Symptoms of tylotic eczema
- Examination and diagnosis
- Physical examination
- Differential diagnosis
- Treatment of tylotic eczema
- Course and prospects
Tylotic eczema under the feet / Source: Dbrandsma, Wikimedia Commons (CC BY-SA-4.0)
What is tylotic eczema?
Tylotic hand eczema is a form of hand eczema characterized by flaking, abnormal keratinization of the epidermis (hyperkeratosis), and fissures on the palm and flexion of the fingers. The skin abnormality can also occur under the feet. The cause of tylotic eczema is unknown. This skin condition is difficult to treat and has a chronic course.
Who does it occur to?
Tylotic eczema is more common in men than in women. It is mainly seen in people between the ages of 40 and 60.
Synonyms
Tylotic eczema is also called eczema hyperkeratoticum et rhagadiforme or hyperkeratotic rhagadiform eczema.
Causes
The exact cause is unknown. Etiological factors include atopy, contact allergy, irritation, pressure and friction. For example, in certain professions, such as concrete braiders, pressure and friction play a role. Atopy means that you have an allergic predisposition, with characteristics of food allergy, eczema, asthma and hay fever. Experts also suspect that a hereditary factor plays an important role. It is possible that smoking also plays a role in the development of the condition.
Symptoms of tylotic eczema
The skin does not show blisters, blisters or redness as is often the case with ‘normal’ eczema, but is instead dry and flaky with hyperkeratotic plaques. Fissures may occur, which are painful and very uncomfortable. The condition may be accompanied by (some) itching. These are sharply defined areas, with flaking, calluses and (sometimes deep) fissures. This skin abnormality occurs in the palms, the flexion side of the fingers and the feet. The gaps can seriously hinder your daily functioning. In severe cases it is very disabling and often leads to disability.
Examination and diagnosis
Physical examination
The diagnosis is made immediately. Further investigation is rarely necessary. Allergy tests must rule out a contact allergy. Often no contact allergy is found.
Differential diagnosis
Differentially diagnostically, the following skin conditions should be considered:
- psoriasis;
- mycosis or fungal disease;
- palmoplantar keratosis (abnormal keratinization of the skin of the palms and soles);
- acrokeratosis paraneoplastica from Bazex.
Treatment of tylotic eczema
Tylotic hand eczema is a persistent and difficult form of eczema to treat. Treatment is often started with strong local corticosteroid ointments (hormone ointments), if necessary under a occlusive dressing, and greasy (neutral) ointments and creams. Derivatives of vitamin A acid can also be considered by the doctor. If this does not provide sufficient relief, ultraviolet light therapy may provide a solution. The effect of light therapy can be enhanced by applying methoxalene emulsion, which is smeared on the affected areas about an hour before exposure. This emulsion binds to skin cells when ultraviolet A light falls on it. The result is that it inhibits the growth of these skin cells.
Course and prospects
Most patients with hyperkeratotic dermatitis usually have a stable chronic course. It is a persistent, difficult to treat form of hand eczema. In the vast majority of patients, the condition remains unchanged.
read more
- Atopic eczema: symptoms, causes, treatment, prognosis
- Hand eczema (eczema of the hands): symptoms and treatment
- Hand fungus: symptoms and treatment of fungus on hands
- Crackle eczema (asteatotic eczema): symptoms and cause
- Seborrheic eczema: red spots & redness on the face