Successful treatment of severe foot dermatitis by iontophoresis and local bath-PUVA.

Sir, Dermatitis of the feet can be difficult to treat. Therapyresistant foot dermatitis is not limited to a particular type of dermatitis; it is encountered in allergic contact eczema, atopic eczema and endogenous forms. The key principle in the management of allergic contact dermatitis is avoidance of the relevant allergen; for example, chromate or rubber substances in the shoes. However, wearing allergen-free shoes does not always result in remission of the dermatitis, which may have a notoriously chronic course. This chronic course can be explained by an occlusive effect from the shoes and sweating activity. Sweating may negatively influence dermatitis severity, especially in dyshidrotic, vesicular forms of dermatitis. Tap water iontophoresis (TWI) has been used successfully in palmoplantar hyperhidrosis (1). TWI had a clear effect on itching and vesicles of hand eczema, but not on erythema and desquamation (2). A second study on dermatitis has shown a beneficial effect of TWI on the relapse-free interval, and a slightly faster clearing in dyshidrotic palmoplantar dermatitis (3). Another type of treatment of hand and foot dermatitis is local bath-PUVA, which has been found to be an effective and safe treatment modality for this indication (4, 5). In severe cases, however, the success rate of local bath-PUVA in our hands was not as high as stated in the literature. We describe four patients with hyperhidrosis and severe dermatitis of the feet. In the first two, TWI was given and had a good effect on sweating, but insufficient effect on dermatitis activity. It was therefore decided to combine TWI with local bath-PUVA in these and the next two patients.