Dyshidrotic Dermatitis

Dyshidrotic Dermatitis

Dyshidrotic Dermatitis

Occurring only on the palms of the hands, sides of the fingers, and soles of the feet, this common eczema typically causes a burning or itching sensation and a blistering rash. Some patients say the blisters resemble tapioca pudding.

Other Names

• Hand eczema
• Pompholyx
• Vesicular eczema
• Vesicular palmoplantar eczema

Signs and Symptoms

• Small, deep blisters can form on the palms, sides of the fingers, and/or soles
• Intense burning or itching
• Inflamed skin (reddish and hot to the touch)
• Cracking and peeling skin
• Affected areas may sweat excessively
• Skin may become infected, causing oozing blisters and crusts
• Skin between the fingers can soften; skin may feel spongy
• Nail changes if dyshidrotic dermatitis persists for a long time. The fingernails can develop ridges and pitting. The nails may thicken and discolor.
• Sometimes as the skin clears, the skin peels and a new crop of blisters appear
• Extensive peeling and cracking in severe cases

Who Gets

• Most frequently begins between 20 and 40 years of age, but can develop earlier or later. Rare in children, but can develop in children who have atopic dermatitis.
   
• Occurs in all races

Causes

• Unknown
• Researchers now believe that a person’s reaction to events occurring within the body (e.g., having another medical condition) and factors occurring outside the body (e.g., the weather) play a role.
• Research shows that excessive sweating — originally believed to be the cause — does not cause dyshidrotic dermatitis.

Risk Factors
Researchers have identified several factors that can increase one’s risk of developing dyshidrotic dermatitis and the risk of flare-ups:

• Stress. Probably the most common risk factor, many patients report a stressful period before an outbreak.
   
• Gender. Females tend to develop dyshidrotic dermatitis more frequently than males.
   
• Weather. Flare-ups are most frequent in hot humid weather. In fact, the weather is a common trigger for many patients. A study of 104 patients found that the following weather conditions triggered flare-ups: heat (29.8% of patients), humidity (24% of patients), and cold (12.5% of patients).
   
• Pre-existing atopic condition (e.g., atopic eczema, hay fever, or asthma). Having one or more of these conditions significantly increases the risk.
   
• Pre-existing contact dermatitis. Having contact dermatitis significantly increase the risk of developing dyshidrotic dermatitis.
   
• Pre-existing infection. Having an infection in another part of the body may increase the risk. A study found that one-third of the patients saw the dyshidrotic dermatitis on their hands clear after they received treatment for their athlete’s foot.
   
• Metal implant, such as a hip replacement. Studies show a direct correlation between a metal allergy and developing dyshidrotic dermatitis.
   
• Aspirin, oral contraceptives, and smoking. One study suggests that smoking as well as taking aspirin or an oral contraceptive increases the risk.

Duration
While some patients experience only one outbreak that clears in 2 or 3 weeks without treatment, others have recurring flare-ups that can range in frequency from once a month to once a year.

How Diagnosed

• Diagnosis begins with a complete medical history and visual examination of the skin.
   
• A dermatologist may swab the affected skin if it looks infected.
   
• A type of testing called “patch testing” may be scheduled to find out if the patient has allergies.
   
• Blood tests may be ordered to find out if other medical conditions exist.

Treatment
This condition can be a challenge to treat, and some patients say dyshidrotic dermatitis seems unresponsive to treatment. To overcome these obstacles, dermatologists often call upon an array of treatment options to control the condition:

Medications

• Topical corticosteroid and cold compresses are typically used first.
   
• Dermatologists may drain large blisters to relieve pain.
   
• Prescription antibiotics are used to treat an infection.
   
• Topical medication, such as pramoxine, can help relieve pain and itch.
   
• For severe cases that seem resistant to treatment, dermatologists may prescribe an oral corticosteroid or another immunosuppressive medication (e.g., methotrexate, cyclosporine, or mycophenolate mofetil) along with bedrest.
   
• PUVA therapy (a type of light treatment) helps some patients with chronic dyshidrotic dermatitis.
   
• Topical calcineurin inhibitors (e.g., pimecrolimus and tacrolimus), which are used to treat atopic dermatitis, can effectively reduce inflammation.
   
• Injections of botulinum toxin type A, a popular wrinkle treatment, have effectively cleared some patients. While the reason remains unclear, it is believed that the botulinum toxin type A may relax the muscles or inhibit nerve impulses.

Lifestyle Changes

• Reduce stress. Some patients find that practicing stress-reduction techniques along with using medication as directed helps to clear their skin. For information about stress-reduction techniques that can help patients with eczema, visit Stress Reduction Techniques.
   
• Avoid allergens and irritants. A medical test called “patch testing” can identify common substances to which the person is allergic. Patch testing cannot identify irritants; however, a dermatologist can ask a number of questions to help identify anything that is irritating the skin. Avoiding known allergens and irritants can help reduce flare-ups.
   
• Follow a dermatologist-recommended skin care plan. Dermatologists often recommend that patients follow a recommended skin care plan. This can help prevent flare-ups.
   
• Avoid excessive sweating and dry conditions. Both are believed to be triggers.
   
• Protect the skin from further injury. Using gloves to protect the hands from irritants and allergens, wearing socks made of 100% cotton, and avoiding strong soaps can help protect damaged skin. For more information, see Preventing Flare-ups.

References:
Edman B. “Palmar eczema: a pathogenetic role for acetylsalicylic acid, contraceptives and smoking?” Acta Dermato-Venereologica. (Swedish, translated into English) 1988;68(5):402-407.

Egan CA et at. “Low-dose oral methotrexate treatment for recalcitrant palmoplantar dyshidrotic dermatitis.” Journal of the American Academy of Dermatology. 1999. April;40(4):612-614.

Janniger CK et al. “Dyshidrotic Eczema.” eMedicine. Last updated June 26, 2006. Last accessed August 2006.

Klein AW et al. “Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin.” Journal of the American Academy of Dermatology. 2004 January;50(1):153-154.