Br J Dermatol. 2009 Mar 9.

Pearce VJ, Mortimer PS.
Lymphoedema Service, Department of Dermatology, St George's Hospital,
London SW17 0QT, U.K.

Hand dermatitis is common, with lymphoedema of the hand and forearm a
rare complication. The mechanism of lymphoedema in such cases is
poorly understood, hence management can be challenging. To investigate
the underlying mechanism of lymphoedema associated with hand
dermatitis and outline recommendations for management, we identified
all patients with lymphoedema associated with hand dermatitis referred
to our lymphoedema service, a tertiary referral centre. Treatment
outcome was assessed by telephone interview and through correspondence
with primary physicians and therapists. In total, nine patients, six
with bilateral and three with unilateral lymphoedema associated with
hand dermatitis, attended our service over a 4-year period. Most had
long-standing bilateral pompholyx eczema. Three patients reported no
signs of infection prior to the onset of swelling. All patients had
recurrent episodes of infection after the onset of swelling.
Lymphoscintigraphy, when used, revealed a failure of small initial
lymphatics of the hand to absorb and drain lymph to regional nodes.
Prophylactic antibiotics together with aggressive management of the
dermatitis, often with systemic therapy, were required to reduce
swelling. Possible mechanisms for lymphoedema associated with hand
dermatitis include obliterative lymphangitis from infection, an
inflammatory effect of the dermatitis on local lymphatics or a
constitutive weakness of lymph drainage exposed to chronic
inflammation, or any combination of the three. Treatment is only
successful once both infection and inflammation from the dermatitis
are controlled.

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