HEALTH PROBLEM: Dyshidrotic Eczema is a Small, Intensely Itchy Blisters on the Edges of the Fingers, Toes, Palms, and Soles of the Feet

HEALTH PROBLEM: Dyshidrotic Eczema is a Small, Intensely Itchy Blisters on the Edges of the Fingers, Toes, Palms, and Soles of the Feet

WHAT IS DYSHIDROTIC ECZEMA?

www.cedars-sinai.org: Dyshidrotic eczema is an ongoing (chronic) skin condition. It causes a burning, itching feeling. Severe dyshidrotic eczema may also cause a blistering rash. It can affect your palms, the sides of your fingers, and the soles of your feet. It’s most common in people in their 20s, 30s, and 40s. But it can happen at any age.

Skin has several layers. The outer layer is the epidermis. Under this is the dermis. The dermis contains blood vessels, nerve endings, hair roots, and sweat glands. With eczema, your skin becomes inflamed. Inflammatory cells of your immune system invade the epidermis. They irritate and destroy some of the tissues there. Eczema is common. It’s also known as atopic dermatitis.

Dyshidrotic eczema is a certain form of this skin inflammation. It can cause mild to severe symptoms. In some cases, symptoms go away in a few weeks with no treatment or just with using hand lotion. More often, it happens over many months or years.

WebMD: These blisters will come and go over time because there is no cure. But you can manage them with medicine, moisturizers, and good hygiene. They might start to taper off once you get into middle age. And if you have a mild case, it could eventually go away on its own.

You’re more likely to get it if you have allergies like hay fever, a family history of dyshidrotic eczema, or other forms of eczema.

National Eczema AssociationDoctors also may refer to dyshidrotic eczema as:

  • Cheiropompholyx
  • Dyshidrosis
  • Foot-and-hand eczema
  • Pompholyx
  • Vesicular eczema
  • Palmoplantar eczema

Because of the association with seasonal allergies, the dyshidrotic eczema blisters are known to erupt more frequently during the spring allergy season. The blisters may last up to three weeks before they begin to dry and can sometimes be large and painful. As the blisters dry, they may turn into skin cracks or cause the skin to feel thick and spongy, especially if you’ve been scratching the area.

The good news is like all types of the condition, it isn’t contagious. You cannot “catch” dyshidrotic eczema from another person, or give it to someone else.

Image result for wikipedia pic of allergy in finger Blisters on hand.. Image credit: Skin Treatment Key to Success: Treat INTERNALLY, with Chinese Herbs

WHAT DOES DYSHIDROTIC ECZEMA LOOK LIKE?

National Eczema Association: All types of eczema cause itching and redness. But some, like dyshidrotic eczema, look and act slightly different than others. It is possible to have dyshidrotic eczema and another form of eczema such as contact dermatitis, at the same time.

Finger Pompholyx 1.tif Dyshidrotic Eczema or Finger Pompholyx   Source:Wikipedia 

Image result for wikipedia pic of allergy in finger     Dyshidrotic eczema on hand .. Image credit: Healthline

Image result for wikipedia pic of allergy in finger     Dyshidrotic eczema .. Image credit: Healthline

WHO IS AT RISK  FOR DEVELOPING DYSHIDROTIC ECZEMA?

Healthline: Doctors believe that you have a greater chance of developing the condition if you’re experiencing a high level of stress (either physical or emotional) or have allergies. Some doctors think that dyshidrotic eczema may be a type of allergic reaction.

You may be more likely to develop dyshidrotic eczema if your hands or feet are often moist or in water, or if your work exposes you to metal salts, such as cobalt, chromium, and nickel.

DYSHIDROTIC ECZEMA FOR CHILDREN: 

Healthline: Eczema, or atopic dermatitis, is more common in children and infants than in adults. About 10 to 20 percent have some form of eczema. However, half will outgrow atopic dermatitis or eczema by adulthood.

Conversely, dyshidrotic eczema can affect children, but it’s usually seen in adults ages 20–40.

WHAT ARE THE SYMPTOMS OF DYSHIDROTIC ECZEMA? 

www.cedars-sinai.org: Often the first symptom is sudden itching on the palms, the sides of your fingers, or the soles of the feet. Next, small fluid-filled blisters (vesicles) may start to appear. These cause more intense itching and pain. These blisters may get bigger. In some people, these symptoms can cause a lot of problems with daily activities. The blisters often last for a few weeks before they dry up and flake away.

Dyshidrotic eczema is more likely to affect the hands than the feet. In most cases, the symptoms happen on both hands or both feet.

Some people have symptoms in frequent episodes. The episodes may happen every month or so for months or years. Over time, this may cause ongoing (chronic) hand dermatitis and lead to more symptoms, such as:

  • Reddened, hard skin
  • Scaling and peeling skin
  • Cracks in your skin
  • Color changes in your nails

Healthline: The small, itchy blisters are the most noticeable sign. These usually pop up in clusters, and you may itch or feel a burning pain before they appear. The skin around the blisters might sweat more than usual, and your nails might thicken and change colors, too.

  • With this skin condition, itchy blisters develop on the soles of the feet or the palms of the hands.
  • The cause of this condition is unknown, but it may be related to allergies, like hay fever.
  • Itchy skin occurs on the hands or feet.
  • Fluid-filled blisters appear on the fingers, toes, hands, or feet.
  • Dry, red, scaly skin with deep cracks are other symptoms.

If you have dyshidrotic eczema, you’ll notice blisters forming on your fingers, toes, hands, or feet. The blisters may be more common on the edges of these areas and will probably be full of fluid.

Sometimes, large blisters will form, which can be particularly painful. The blisters will usually be very itchy and may cause your skin to flake. Affected areas may become cracked or painful to the touch.

The blisters may last up to three weeks before they begin to dry. As the blisters dry up, they’ll turn into skin cracks that may be painful. If you’ve been scratching the affected areas, you may also notice that your skin seems thicker or feels spongy.

Dyshidrotic eczema can be mild or severe. If you have a severe case that affects your feet, the blisters can make it hard to walk. Blisters on your hands can make it hard to do things like cook, type, or wash dishes.Sometimes the blisters can get infected, especially if you scratch them a lot. Signs that you have an infection include:

  • Pain
  • Swelling
  • Crusting
  • Pus in the blisters
It’s important to understand which type of eczema you may have and also your symptoms and triggers, so that you can better treat and manage it. The only way to be sure that you have dyshidrotic eczema, is to make an appointment with your doctor.
www.cedars-sinai.org: You may be diagnosed by a general healthcare provider or a dermatologist. A dermatologist is a healthcare provider who specializes in skin diseases.

Your healthcare provider will ask about your health history and your symptoms. Tell him or her about contact you’ve had to possible irritants. You will also have a physical exam. Your provider will need to make sure your symptoms aren’t caused by other conditions. These may include allergic contact dermatitis, ringworm, herpes, or a rare autoimmune disease. You may also have tests such as:

  • Skin scraping or biopsy. This is done to check for infection.
  • Patch skin testing. This test looks for allergic causes.
  • Blood tests. These are done to check for an autoimmune cause.

 Healthline : In many cases, your doctor will be able to diagnose dyshidrotic eczema by examining your skin carefully. Because the symptoms of dyshidrotic eczema can be similar to those of other skin conditions, your doctor may choose to run certain tests.

The tests may include a skin biopsy, which involves removing a small patch of skin for lab testing. The biopsy can rule out other possible causes of your blisters, such as a fungal infection.

If your doctor believes that your outbreak of dyshidrotic eczema is directly related to allergies, they may also order allergy skin testing.

You might need to see an allergy doctor (allergist). Patch tests can show if you have an allergy to nickel, cobalt, or another metal. During this tests, your doctor will put patches with a small amount of different metals or other things on your skin to see if it will react to your skin.

WHAT CAUSES DYSHIDROTIC ECZEMA?

WebMD: People with contact dermatitisatopic dermatitis or hay fever, are at higher risk of developing dyshidrotic eczema. Dyshidrotic eczema seems to run in families, so if you have a close relative with this form of eczema, your chance of also developing it is increased.

www.cedars-sinai.org: Experts are still working to learn the causes. But some factors may increase your risk of having it, such as:

  • Having had atopic dermatitis in the past
  • Having allergies, such as allergic rhinitis
  • Being exposed to allergens or irritants, such as certain metals
  • Smoking
  • Receiving UV radiation
  • Having overactive sweat glands

Certain things can trigger episodes, such as:

  • Stress
  • Very warm or cold weather
  • Very dry or humid air

WebMD: There are some common triggers for dyshidrotic eczema:

  • Stress
  • Pollen
  • Moist hands and feet from excessive sweating or prolonged contact with water
  • Nickel in everyday objects such as jewelry, keys, cell phones, eyeglass frames, stainless steel items, and metal buttons, snaps and zippers
  • Nickel in foods such as cocoa, chocolate, soy beans, oatmeal, nuts, almonds, fresh and dried legumes, and canned foods
  • Cobalt in everyday objects such as cobalt-blue colored dishware, paints and varnishes; certain medical equipment; jewelry; and in metal snaps, buttons and zippers
  • Cobalt in foods such as clams, fish, leafy green vegetables, liver, milk, nuts, oysters, and red meat
  • Chromium salts used in the manufacturing of cement, mortar, leather, paints and anticorrosives
  • Warm, humid weather
  • HIV infection
  • Certain treatments for a weak immune system (immunoglobulin)

HOW IS DYSHIDROTIC ECZEMA TREATED?

There are a number of ways that a dermatologist can treat dyshidrotic eczema. The severity of your outbreak and other factors determine which treatments they will suggest. It also may be necessary to try more than one treatment before finding the right one for you.

National Eczema Association: At-home treatment for dyshidrotic eczema includes soaking hands and feet in cool water or applying compresses for 15 minutes to the affected area two to four times a day followed by a rich moisturizer or a skin barrier repair cream.

HealthlineFor mild outbreaks, medications include corticosteroid cream or ointment that you apply directly to your skin to bring down swelling and help get rid of the blisters. Your skin will take in the medicine better if you put a wet compress on it after you use the cream. If you have a severe flare-up, you might need to take a steroid drug, like prednisone, in a pill.

An antihistamine like diphenhydramine (Benadryl) or loratadine (Alavert, Claritin) can help with the itch, too. Or you might hold a cold, wet compress on the blisters for 15 minutes at a time several times a day.

National Eczema Association: For more severe outbreaks, you may be prescribed a topical steroid, steroid injection, or pill or you might try one of these.

  • Light therapy: This uses ultraviolet light (PUVA) light to clear up your skin. You might get a medicine first to help your skin respond better to the light.
  • Botulinum toxin: These shots stop your hands and feet from sweating, which can trigger the blisters.
  • Medicines that slow down your immune system: Tacrolimus (Protopic) ointment or pimecrolimus(Elidel) cream can calm the swelling and irritation. These drugs can be options if you don’t want to take steroids.
  • Draining the blisters: Your dermatologist can drain fluid from the blisters. Don’t try to do this yourself. You could make the eczema worse.

If your symptoms don’t decrease, you may need more tests to help check for other possible causes of your symptoms.

TO CONTROL THE BLISTER AT HOME:

National Eczema Association: At-home treatment for dyshidrotic eczema includes soaking hands and feet in cool water or applying compresses for 15 minutes to the affected area two to four times a day followed by a rich moisturizer or a skin barrier repair cream.

WebMD:

  • Take your rings off before you wash your hands. Moisture can get trapped under your rings and cause more blisters.
  • Wear gloves with cotton liners or plastic gloves whenever your hands are in water, like when you wash dishes, shampooing, dyeing hair, applying hair lotion,etc.
  • Avoid direct contact with household cleaners and detergents. Wear cotton or plastic gloves when doing housework.
  • Avoid exposing hands to known irritants (e.g. handling fresh fruits, vegetables, fresh meat, wool etc.). Wear warm gloves in cold weather. Use plastic rather than rubber gloves (rubber can further aggravate hand dermatitis). It is best to wear white cotton gloves under the plastic gloves. Several pairs of cotton gloves should be purchased so they can be changed frequently. Do not wear plastic gloves for more than 20 minutes at a time. Remember to follow the above instructions for 4-6 months after the hands have healed.
  • Put a thick moisturizer on your hands and feet every time you shower or wash. Rub it on while your skin is still wet to seal in water. You also might use a cream that has dimethicone to protect your skin.
  • Turn on a humidifier in dry weather to keep your skin from cracking.
  • If allergies set off your eczema, try to stay away from things that trigger them.
  • Don’t scratch the blisters — you’ll make them worse.
  • Immune-suppressing ointments, such as Protopic and Elidel (this is a rare treatment option)
  • If your skin becomes infected, then you will also be prescribed antibiotics or other medications to treat the infection.
  • Wash your hands or feet immediately after coming into contact with a potential trigger
  • Learn to manage stress as it is a common trigger of dyshidrotic eczema
  • When possible, avoid rapid changes of temperature and activities that make you sweat
  • www.cedars-sinai.org:For pompholyx of the feet, attention to regular changes of cotton socks should be observed. Although internal medicines constitute the primary method of treatment, the use of external soaks is a very useful adjunctive therapy during acute attacks. Itching, and vesiculation can be reduced significantly after even one soak, however several days will be needed for an acute attack to subside totally. If there is marked dryness accompanying the vesicular stage, then soaks should be used sparingly or not at all, especially if the patient finds that the drying effect of the soak is too strong. In the majority of cases, 10-14 weeks of treatment are required to resolve the condition completely. To ensure compliance of the patient to treatment, I find it very useful to explain at the outset the commonest mode of resolution. This most often involves a continuation of the characteristic ebbing and flowing of the condition for several weeks as treatment progresses, although the severity and frequency of eruptions is often markedly reduced within 4-6 weeks of treatment. Eventually no eruptions are observed. Once satisfied that the condition has stabilised, it is wise for the patient to continue taking the medicine on half dose for a period of 2 or 3 weeks, before weaning off completely.
  • Keep your fingernails short to help prevent scratching from breaking the skin
  • Looking after the hands (as explained above) for several months after clearing is important and will ensure a good long term prognosis. Most rapid results are achieved in the following types: 1. Recent onset (up to 6 months). 2. Eruptions only in spring and summer. 3. Predictable oscillation of eruptions, with distinct vesicular and desquamating phases.

Healthline: Soaking your hands and feet in cool water or applying wet, cold compresses for 15 minutes at a time, two to four times a day, can help reduce the discomfort associated with itchy skin.

Your doctor may recommend that you apply an ointment or rich moisturizer after you use compresses. A moisturizer may also help with the dryness, and therefore reduce some itching as well.

These moisturizers may include:

www.cedars-sinai.org:  Most rapid results are achieved in the following types:

1. Recent onset (up to 6 months).2. Eruptions only in spring and summer. 3. Predictable oscillation of eruptions, with distinct vesicular and desquamating phases.

Slowest results are seen in the following types, although perseverance with treatment almost always yields good long term results:

1. Chronic disease (over 2 years). 2. Indistinct and overlapping vesicular and dry phases. 3. Widespread eruptions reaching the dorsum of the hands, and inner aspect of the arms and face. 4. A history of eruptions with much vesiculation, that have since been replaced by chronic dry, scaly, lichenified and fissured eczema. Treatment by biomedicine is usually of only palliative value.

The mainstay of treatment is the use of the most potent topical steroid with occlusion (covered with poly thene). It is necessary to use potent steroids because weaker ones don’t penetrate the thick epidermis of the palms and soles sufficiently. The steroids that many patients end up relying upon for long periods have a very observable detrimental effect on the skin, thinning it and predisposing to further attacks.

DIET:

Changing your diet may help if medications don’t seem to be keeping up with flare-ups. Since it is believed that a nickel or cobalt allergy can cause eczema, removing foods that contain these may help.

Some have said that adding vitamin A to your diet will help, but be sure to ask your doctor before doing so.

TREATMENT FOR FEET:

Dyshidrosis can also occur on the soles of your feet, although it’s not as common as on your fingers or the palms of your hands. The treatment for your feet is similar to the treatment for other areas.

To avoid making your pain and itching worse, try not to scratch or break your blisters. Although it’s important to wash your hands regularly, you may want to avoid extensive contact with water, such as frequent hand-washing.

You should also avoid using products that can irritate your skin, such as perfumed lotions and dishwashing soap.

COMPLICATIONS OF DYSHIDROTIC ECZEMA:

The main complication from dyshidrotic eczema is usually the discomfort from itching and the pain from the blisters.

This can sometimes become so severe during a flare that you are limited in how much you use your hands or even walk. There is also the possibility of getting an infection in these areas.

In addition, your sleep may be disrupted if the itching or pain are severe.

PREVENTION AND CONTROL OF OUTBREAKS:

Unfortunately, there is no proven way to prevent or control outbreaks of dyshidrotic eczema. The best advice is to help strengthen your skin by applying moisturizers daily, avoiding triggers such as perfumed soaps or harsh cleansers, and staying hydrated.

WHAT CAN BE EXPECTED IN THE LONG TERM?

Dyshidrotic eczema will usually disappear in a few weeks without complications. If you don’t scratch the affected skin, it may not leave any noticeable marks or scars.

If you scratch the affected area, you may experience more discomfort or your outbreak may take longer to heal. You could also develop a bacterial infection as a result of scratching and breaking your blisters.

Although your outbreak of dyshidrotic eczema may heal completely, it can also recur. Because the cause of dyshidrotic eczema isn’t known, doctors have yet to find ways to prevent or cure the condition.

www.cedars-sinai.org:TIPS TO HELP YOU GET THE MOST FROM A VISIT TO YOUR HEALTHCARE DOCTOR: 

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

 

National Eczema AssociationDecoding the mystery of dyshidrotic eczema

This common form of eczema is often misunderstood and sometimes even misdiagnosed, but the symptoms and treatment options are all too familiar.

Joan Wanamaker has lived with eczema practically since birth. She’s had all the various subtypes, co-occurring at different times in her life, with hand eczema being her constant (yet unwanted) companion.

“A few years ago, my doctor told me it’s dyshidrotic eczema,” Wanamaker said. “He prescribed a succession of different creams, and eventually a topical steroid worked.”

With all the recent advances in eczema research, treating dyshidrotic eczema is still pretty much hit-or-miss, according to Dr. Elaine Siegfried, a professor of pediatrics and dermatology at Saint Louis University School of Medicine in St. Louis. She believes dyshidrotic eczema is the least understood of the condition’s many subtypes.

Even its name creates confusion: “The term dyshidrotic means ‘disordered sweat.’ It was first coined in the late 19th century, reflecting the belief that a malfunction of the sweat glands in the hands caused this type of eczema. Today, we know that sweat may trigger the itch-scratch cycle, but it doesn’t actually cause eczema,” Siegfried explained.

Dyshidrotic eczema goes by several other names, such as palmoplantar eczema, foot-and-hand eczema, vesicular eczema and pompholyx. This last term comes from the Ancient Greek word for “bubble.”

That’s what the condition’s characteristically small blisters looked like to our forebears-and the name stuck. It’s still used today, but dyshidrotic eczema is the most common term for the small, itchy blisters that appear on the edges of the fingers as well as the palms of the hands and soles of the feet, often quite suddenly.

At their most severe, the blisters can be painful and even crippling. As a child at summer camp, Wanamaker developed them on her feet. “It was painful to walk,” she said, “and it took all summer for them to clear up. Apparently, I had an allergic reaction to the chemicals in the swimming pool. What’s puzzling is that the very next year, I had no problem with the pool chemicals. Over the years, my triggers have changed.”

Still, knowing and avoiding your triggers remains the first line of defense against dyshidrotic eczema.

Likely suspects that cause dyshidrotic eczema

An overview of dyshidrotic eczema on Medscape estimates that close to 50 percent of those who develop dyshidrotic eczema already have atopic dermatitis (AD), making already existing eczema a leading risk factor. Clearly, explained Siegfried, there’s a genetic component to the condition.

Adult females between ages 20 and 40 are at particular risk. However, many triggers of dyshidrotic eczema fall into the “manageable” category, including nickel, cobalt, balsam and bacterial or fungal infection, with nickel considered the prime suspect.

“Some doctors believe that an allergy to nickel is the principal cause of dyshidrotic eczema,” Siegfried said, given the high levels of nickel in sweat and the concentration of sweat glands in the palms and soles of the feet.

“There’s no consensus yet among experts about this, but patients can test the nickel hypothesis by consulting a nutritionist and trying a nickel-free diet for six weeks to see if it helps clear the blisters.” Editor’s Note: The wellness newsletter Healthline offers a list of popular nickel-containing foods.

Avoiding such everyday objects as nickel-rich coins, zippers, cellphones, belt buckles and eyeglass frames can also help to confirm or rule out nickel as a trigger in some people with the condition. For a comprehensive list of sources of nickel, see the Mayo Clinic’s nickel allergy fact sheet.

Dyshidrotic eczema is also strongly linked to seasonal allergies, especially to changes in humidity. It normally takes six weeks for the body to adapt to seasonal change, said Siegfried. And by the time a person adapts, the season might start changing again.

Treatment options for dyshidrotic eczema

That doesn’t mean patients should throw up their hands and give up. The most important step is to get a proper diagnosis.

“Dyshidrotic eczema can mimic contact dermatitis and even palmoplantar pustulosis, a type of psoriasis appearing on the hands and feet,” said Siegfried. “The only way to tell which is which is with a biopsy. Without a definitive diagnosis, patients could receive suboptimal treatment.”

On the positive side of the line, people with the condition have several options. In addition to avoiding triggers, Siegfried pointed to the following treatments and their limitations. “Topical corticosteroid cream can be helpful as a quick-acting remedy,” she said.

“Think of it as the ‘hare’ in the fable of ‘The Tortoise and the Hare.’ It may get quick results, but it can also weaken the skin over time, leading to a cycle of flare and remission.It’s best to switch to another therapy after a couple of weeks, such as a topical calcineurin inhibitor or phototherapy.”

Over the years, Wanamaker has tried all these and more. Her grandmother used to create a paste from cornstarch and water and apply it to her young granddaughter’s hands—a home remedy that brought short-term relief for her itchy skin.

As an adult, Wanamaker remains open to “exploring and experimenting” with a variety of options, from nutrition to natural cleaning products. She and her husband enjoy making their own soap, shampoo and laundry detergent, using tallow and local plants found near their home in Orange County, New York, during the summer.

And they’re hopeful that better treatments are on the way. We’re at the dawn of the “decade of eczema,” as Siegfried sees it. With all the medications in the pipeline for AD, can dyshidrotic eczema be far behind?

Elaine Siegfried, MD is a member of NEA’s Scientific Advisory Committee and Director of Pediatric Dermatology at SSM Health Cardinal Glennon Children’s Hospital. She is board certified by the American Board of Dermatology in both Dermatology and Pediatric Dermatology. She is also a Professor of Pediatrics and Dermatology at Saint Louis University School of Medicine.

 

 

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