Bleomycin toxicity can present as dyshidrotic eczema on acral surfaces, distinct from classic flagellate erythema. This rare eruption is often refractory to corticosteroids but resolves upon drug discontinuation. Early recognition is crucial to avoid unnecessary antimicrobial therapy and to guide timely chemotherapy modification.

We report the case of a 39-year-old man with long-standing ileocolonic Crohn's disease, with a history of prior ileocecal resection and secondary loss of response to infliximab and ustekinumab, who initiated treatment with upadacitinib (UPA) 45 mg/day due to severe clinical, biochemical, and endoscopic recurrence. The patient achieved a rapid clinical response with normalization of inflammatory biomarkers. Two weeks after UPA initiation, he developed pruritic vesicular lesions on the palms and fingers, which were diagnosed as de novo dyshidrotic eczema by an expert dermatologist. The cutaneous manifestation was mild to moderate and resolved rapidly with topical corticosteroids, without the need to discontinue UPA. Crohn's disease remained in clinical and biochemical remission after 9 months of follow-up. Possible immunological mechanisms underlying this paradoxical reaction are discussed, including selective JAK1 inhibition-related immune imbalance, with disruption of the Th1/Th2 axis, altered IL-4 and IL-13 signaling, and a potential predominance of Th1/Th17 responses. Although UPA has been exceptionally used as a therapeutic option for refractory dyshidrotic eczema, and this condition has been reported as an infrequent adverse event in pivotal ulcerative colitis trials, this case likely represents the first report of upadacitinib-induced dyshidrotic eczema in Crohn's disease.

Eczema is an inflammatory skin condition that affects individuals of all ages worldwide. Patients may develop various forms of eczema, including atopic dermatitis, contact dermatitis, which is often associated with an allergic response to various stimuli, dyshidrotic eczema which develops on the palms and soles, asteatotic dermatitis that predominantly occurs in elderly patients, nummular eczema characterized by its cylindrical shape lesions and seborrheic dermatitis often located on patient's scalps, back, face and chest. Extensive studies have been conducted on atopic dermatitis, however, limited information such as their etiology, effect on the immune system and potential treatments are available on the other types of eczema. The socioeconomic impacts of eczema include the cost of conventional treatments such as corticosteroids, immunosuppressive agents and phototherapy, expenses related to specialists' consultation and the effect on work and school productivity. The impact of atopic dermatitis on patients' quality of life, social functioning and individual healthcare expenses has been extensively studied in other countries but remains underreported in South Africa. Reports have estimated the annual direct and indirect costs in Australia, the United Kingdom and the United States, however reports are limited for South Africa. This study aimed to provide information on the different types of eczema's etiology, their respective socioeconomic impact in South Africa in correlation to the above mentioned inflated yearly cost, and conventional, targeted and alternative treatments commercially available. Several knowledge gaps were identified in this study, including the limited availability of information on asteatotic dermatitis, dyshidrotic dermatitis and nummular eczema, the effect most commercially available treatments have on other eczema subtypes and an in-depth review of the socioeconomic impact of eczema within the African continent.

Atopic dermatitis and contact dermatitis are among the most common dermatologic conditions encountered by the primary care clinician. Their presentation varies and can mimic infectious and other noninfectious conditions, making a thorough history essential, with particular emphasis on exposure to environmental and occupational irritants, as well as recognition of commonly affected sites. For all of these conditions, control of symptoms is often the goal of treatment, starting with general supportive care measures like frequent emollient use and often relying on topical steroidal and nonsteroidal agents as first-line therapies.