Dyshidrotic Dermatitis Overview

Dyshidrotic dermatitis is a skin condition characterized by small, itchy blisters over the palms, fingers, or the soles of the feet. These progress to scaly spots over the course of several weeks.

Also known as dyshidrotic eczema, foot-and-hand eczema, and pompholyx, it can be associated with atopic dermatitis and seasonal allergies. There is no cure for the condition, which can be treated but will most likely recur.

This article discusses dyshidrotic eczema and its symptoms and causes. It also covers how the condition is diagnosed and treated.

What Does Dyshidrotic Dermatitis Look Like?

Dyshidrotic dermatitis usually involves the palms of the hands and sides of the fingers. The soles of the feet and the area between the toes can also be involved.

Symptoms include:

• Deep-seated vesicles (small, fluid-filled bumps)
• Sweating around the vesicles
• Red, inflamed skin
• Intense itching
• Dry, scaly, cracked patches
• Peeling skin
• Pain and burning sensation

The pain can make it difficult to walk or use your hands.

The rash can begin suddenly as a crop of clear, tapioca-like vesicles that appear in clusters. Burning and itching sensations may precede a breakout. The vesicles can sometimes blend into each other, forming large blisters.

The vesicles resolve in three to four weeks and are replaced by 1- to 3-millimeter rings of scaling skin. These patches may crack and peel before the skin eventually heals.

Chronic dyshidrotic eczema leaves the skin reddened, thickened, and with deep cracks, especially if it has been repeatedly scratched. It may also cause changes in the nail.

What Triggers Dyshidrotic Dermatitis?

The cause of dyshidrotic dermatitis isn't known. It's not contagious and it's not a dysfunction of the sweat glands, as once thought, but it does occur around those glands.

The condition has an average age of onset of 37, although it may appear at any age. It is more common in females than males. You are also more likely to develop dyshidrotic eczema if you have relatives who also have it.

There is a strong link between this condition and atopic dermatitis. This leads some professionals to believe that dyshidrotic dermatitis is a form of atopic dermatitis on the hands and feet.

Dyshidrotic dermatitis is also more common if you have seasonal allergies or a history of contact dermatitis. Taking intravenous immunoglobulin therapy is associated with a higher risk of developing the condition.

Trigger Factors

Many factors can contribute to a flareup of dyshidrotic dermatitis or make an existing rash worse:

• Contact with metal, especially nickel: Common exposures include zippers, jewelry, coins, and belt buckles. Metal allergy may be a very important trigger factor, and sometimes avoidance of metal can completely clear up this condition.
• Prolonged damp hands or feet: People who work in professions that require their hands to be in contact with water many times per day (for example, hair stylists and medical professionals) may develop dyshidrotic eczema on their hands. Spending long periods in damp socks can trigger a flare on the feet.
• Hyperhidrosis (excessive sweating): In addition to being wet, sweat may irritate the skin.
• Weather: Temperature extremes or changes in humidity may trigger a flare. For some people, dyshidrotic eczema is worse during season changes.
• Emotional stress: Emotional stress can trigger a flare.

How Dyshidrotic Dermatitis Is Diagnosed

There is no specific test that can definitively diagnose dyshidrotic eczema. It's generally diagnosed by a physical exam coupled with a detailed medical history.

Your healthcare provider will ask about any allergies, as well as your profession and hobbies to see if you're exposed to anything that could be contributing to your symptoms.

If there is any uncertainty, your healthcare provider may also order:

• A skin scraping or biopsy to check for infection
• Patch testing to check for allergens
• Blood testing to test for, among other things, allergies and autoimmune disorders

Dyshidrotic eczema is often misdiagnosed and can easily be confused with other skin problems like:

• Atopic dermatitis on the hands
• Contact dermatitis
• Palmoplantar pustulosis

What Is the Fastest Way to Cure Dyshidrotic Dermatitis?

There is no cure for the condition, but it can be managed. Most dyshidrotic eczema attacks resolve on their own within one to three weeks.

The rash can be intensely uncomfortable, and you can use medication to control itching and speed up healing. In some cases, medications are used to help keep dyshidrotic eczema flares at bay. Most people need a combination of treatments.

• Topical steroids are used as first-line treatments to help control itching and reduce inflammation. Because the skin of the hands and feet is thick and absorbs medication slowly, high-strength steroids are prescribed. Oral steroids may be used for short courses in severe cases and during acute flares.
• Topical calcineurin inhibitors have been shown to be effective in some cases. These are non-steroid medications that help stimulate the release of anti-inflammatory compounds in the skin.
• Immunosuppressants (such as methotrexate) are sometimes prescribed in severe cases that aren't responding to other treatments. They're most often used along with other therapies.
• Over-the-counter oral antihistamines don't improve the rash but may help relieve itching. Ask your healthcare provider if these may be of help in your situation.
• Wet dressings can be used to soothe and relieve itching. A cloth dampened with water or Burrow's solution (aluminum subacetate) is applied to the affected areas several times per day after placing an emollient or medication on the skin. Follow your doctor's instructions and guidance for wet wrap therapy.
• Oral antibiotics are sometimes prescribed if the rash becomes infected. Treating infection may help clear up the rash.
• Botox injections don't treat dyshidrotic eczema rash, but they can be used to treat hyperhidrosis of the hands or feet. Stopping excessive sweating can help reduce flareups if sweat and damp skin tend to trigger your flares.

Large blisters can be drained by a healthcare provider to help reduce pain and prevent infections.

How to Prevent Flare-Ups

Although it's not possible to completely prevent flare-ups, you can greatly reduce their frequency with careful treatment.

If you have triggers, knowing them can be the best defense for preventing future outbreaks.

Commit to these personal care suggestions as well:

• Keep your skin well-moisturized: This helps keep the skin's barrier healthy and less likely to become irritated. Apply after every shower, handwashing, and throughout the day as needed. Hypo-allergenic, fragrance-free products are preferred.
• Use gentle hand cleansers: This helps avoid drying your skin.
• Protect your hands and feet: Use waterproof gloves when cleaning or washing dishes, and soft cotton gloves if working in the yard. Moisture-wicking socks can help keep your feet cool and dry.

Summary

Dyshidrotic dermatitis is a type of dermatitis that causes small blisters to form on the palms, fingers, and soles of the feet. It usually begins suddenly and progresses to scaly rings that may crack and peel.

There is no cure for dyshidrotic dermatitis, but the condition can be treated with topical and oral medications. Avoiding triggers is an important way to prevent future outbreaks.