Dyshidrotic eczema

Definition

Dyshidrotic eczema is a condition in which small, itchy blisters develop on the hands and feet.

Alternative Names

Dyshidrosis; Pompholyx

Causes, incidence, and risk factors

This blistering type of eczema is twice as common in women than men.

People are more likely to develop dyshidrotic eczema when:

• They are under stress
• They have allergies, such as hayfever
• Their hands are often in water or moist
• They do cement work or other work that exposes their hands to chromium, cobalt, nickel

The cause is unknown. The condition seems to appear during certain times of the year.

Symptoms

Small fluid-filled blisters called vesicles appear on the fingers, hands, and feet. They are most common along the edges of the fingers, toes, palms, and soles. These blisters cause intense itching and scaly patches of skin that flake constantly or become red, cracked, and painful.

Scratching leads to skin changes and skin thickening. Large blisters may cause pain.

Signs and tests

Your doctor may be able to diagnose this condition by simply looking at your skin.

Sometimes, a skin biopsy or skin scraping may be needed to rule out other causes, such as a fungal infection.

If your doctor thinks the condition may be due to an allergic reaction, allergy testing (patch testing) may be done.

Treatment

Scratching the hands when they itch only makes the condition worse. Yet scratching can be hard to stop.

Anti-itch medicines taken by mouth, such as diphenhydramine (Benadryl) and loratiadine (such as Claritin), may help you break this cycle. If you scratch while asleep, take an anti-itch medicine before bed.

Ointments or creams should be used on the hands at least two times per day, and after every hand washing.

• Heavy ointments are best. Petroleum jelly (such as Vaseline), mineral oil or vegetable shortening may be best but can be messy.
• Creams are better than lotions. Creams such as Eucerin and Lubriderm may be helpful.

Your doctor may prescribe steroid (or corticosteroid) ointments creams, or other creams or ointments such as tacrolimus or pimecrolimus.

Your doctor may recommend the following if you have severe symptoms:

• Steroid pills
• Coal tar preparations
• Phototherapy (ultraviolet light therapy)

Do not scratch the blisters. You should avoid frequent bathing, hand washing, and irritating substances, which can make itching worse.

Support Groups

Expectations (prognosis)

There is no cure. Dyshidrotic eczema normally goes away without problems, but symptoms may return later. Excess scratching may lead to thick, irritated skin, which is more difficult to treat and takes longer to heal.

Complications

• Pain and itching that limits the use of the hands
• Secondary bacterial infection

Calling your health care provider

Call your doctor if you have:

• Tenderness, redness, warmth, or fever, which may be signs of an infection
• Any type of rash that does not go away with simple home treatments

Prevention

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References

Veien NK. Acute and recurrent vesicular hand dermatitis. Dermatol Clin. 2009 Jul;27(3):337-53.

Eczema and hand dermatitis. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 3.