Dyshidrotic dermatitis is a skin disorder characterized by small, itchy blisters on the palms of the hands, fingers, or feet. They become scaly patches within a few weeks. Also known as dyshidrotic eczema, hand and foot eczema, and pompholyx, it can be associated with atopic dermatitis and seasonal allergies. It can be cured, but dyshidrotic dermatitis will likely return and cannot be cured.
The word " dyshidrotic" comes from the now outdated belief that the condition is caused by a malfunction of the sweat glands. Pompholyx comes from the Greek word for bubble , which means bubbles.
Dyshidrotic dermatitis usually affects the palms of the hands and the sides of the fingers. The soles of the feet and the area between the toes can also be affected.
- Deep vesicles (small fluid-filled bumps)
- Inflamed red skin
- Severe itching
- Dry, flaky, and cracked areas
- Peeling skin
- Pain and burning
The pain can make it difficult to walk or work with your hands.
The rash can start suddenly as a collection of transparent blisters, similar to tapioca. Burning and itching sensations may precede the rash.
The vesicles dissolve after three to four weeks and are replaced with 1-3 mm rings of scaly skin. These spots can crack and peel off before the skin finally heals.
Sometimes the bubbles can merge with each other to form large bubbles. Open blisters can become infected. Call your doctor if you notice increased redness, warmth, pain, swelling, weeping, or scabbing.
In chronic dyshidrotic eczema, the skin becomes red, thickened, and deeply cracked, especially if it has been repeatedly scratched. It can also cause nail changes.
The cause of dyshidrotic dermatitis is unknown, but it is not contagious and it is not a dysfunction of the sweat glands, as previously thought, but rather occurs around these glands.
The disease occurs most often between the ages of 20 and 40, although it can appear at any age. Women are twice as likely to develop this disease as men. You are also more likely to develop dyshidrotic eczema if you have family members who also have it.
There is a close relationship between this condition and atopic dermatitis . Almost 50% of people with dyshidrotic dermatitis also suffer from atopic dermatitis.
This leads some professionals to believe that dyshidrotic dermatitis is a form of atopic dermatitis on the hands and feet.
There are many factors that can aggravate dyshidrotic dermatitis or make an existing rash worse:
- Contact with Metals, Especially Nickel – Commonly exposed to zippers, jewelry, coins, and belt buckles. Metal allergy can be a very significant trigger, and sometimes avoiding metal can eliminate the condition completely.
- Long-term wet hands or feet: People who work in occupations that require their hands to be in contact with water many times a day (such as hairdressers and healthcare professionals) can develop dyshidrotic eczema on the hands. Prolonged exposure to wet socks can lead to foot breakouts.
- Hyperhidrosis or excessive sweating can aggravate the disease : sweat can not only get wet, but also irritate the skin.
- Weather: extreme temperatures or changes in humidity can trigger an outbreak. In some people, dyshidrotic eczema worsens during the change of season.
- Emotional stress: Emotional stress can trigger a flare-up.
There is no specific test that can unequivocally diagnose dyshidrotic eczema. This is usually diagnosed by a physical exam combined with a detailed medical history.
Your healthcare professional will ask you about any allergies and your profession and hobbies to see if you are exposed to anything that may be contributing to your symptoms.
When in doubt, your healthcare provider may also prescribe:
- Skin scraping or biopsy to check for infection.
- Patch test for allergens
- A blood test to detect, among other things, allergies and autoimmune diseases.
Dyshidrotic eczema is often misdiagnosed and easily confused with other skin problems such as:
- Atopic dermatitis on the hands.
- Contact dermatitis
- Palmoplantar pustulosis
There is no cure for this condition, but it can be treated. Most dyshidrotic eczema attacks resolve on their own in one to three weeks.
The rash can be very uncomfortable and you can use medications to control the itching and speed healing. In some cases, medications are used to prevent flare-up of dyshidrotic eczema.
Most people require a combination treatment.
Topical steroids are used as a first-line treatment to help control itching and reduce inflammation. Because the skin on the hands and feet is thick and slowly absorbs the drug, powerful steroids are prescribed. Oral steroids can be used in short courses in severe cases and during flare-ups.
In some cases, topical calcineurin inhibitors have been shown to be effective. These are non-steroidal medications that help stimulate the release of anti-inflammatory compounds in the skin.
Immunosuppressants (such as methotrexate ) are sometimes prescribed for severe cases when other treatments do not respond to treatment. They are most often used in conjunction with other treatments.
Over-the-counter oral antihistamines do not improve the rash, but they may relieve the itching. Ask your doctor if they can help you with your situation.
Moist bandages can be used to soothe and relieve the itching. A tissue moistened with water or Burrow's solution (aluminum subacetate) is applied to the affected area several times a day after emollient or medicine has been applied to the skin. Follow your doctor's instructions and recommendations for wet wrap therapy.
Oral antibiotics are sometimes given if the rash becomes infected. Treating the infection can help clear the rash .
Botox injections do not treat dyshidrotic eczema rashes, but can be used to treat hyperhidrosis of the hands or feet. Stopping excessive sweating can help reduce breakouts if sweat and clammy skin are causing breakouts.
A healthcare professional can remove large blisters to reduce pain and prevent infection.
While outbreaks cannot be completely prevented, you can significantly reduce their frequency with careful treatment.
If you have triggers, knowing them may be the best defense against future outbreaks.
Follow these guidelines for personal care:
- Keeping the skin well hydrated will help keep the skin barrier healthy and reduce the possibility of irritation. Use after every shower, hand wash, and throughout the day as needed. Hypoallergenic unscented products are preferred .
- Use a mild hand cleanser to help keep skin dry.
- Protect your hands and feet: Wear waterproof gloves when washing dishes and soft cotton gloves when gardening. Moisture wicking socks keep feet cool and dry.
Get the word of drug information
The intense itching and pain with dyshidrotic eczema can drive you crazy. Remember, prevention is your best defense. If you have triggers, avoid them whenever possible. Whether you have certain triggers or not, proper skin care can help prevent breakouts. When flare-ups occur, your doctor can help you plan your treatment.