Dyshidrotic eczema is a fiercely itchy, deep-seated, blistering rash. It is seen most often on the palms of the hands, sides of the fingers, and soles of the feet.
Dyshidrotic eczema was once thought to be due to trapping of sweat beneath thick skin of the palms and soles. The cause is unknown; it has been suggested that it may be caused by an inherited allergic response. The skin of the palms, sides of the fingers, and soles of the feet react to something in the environment by forming itchy blisters.
Symptoms of dyshidrotic eczema include: cracks and fissures in the skin excessive sweatingpain and swelling at the rash sitesevere itchingtiny, deep-seated blistersweeping and crusting skin lesions
Dyshidrotic eczema can affect people of any age but appears to be more common in men between the ages of 20 and 50. There may be a genetic component to the disorder. It has also been suggested that it could be caused by an allergic response to something in the environment. Experts suspect that nickel, balsam, and cobalt may cause the allergic response. Nickel is found in costume jewelry, while the other substances are used in manufacturing.
Risk factors that increase a person's risk for dyshidrotic eczema include: anxietybacterial infectioncertain skin infectionsdifficulty expressing feelings or emotionshot or cold temperaturesincreased humiditypersonal or family history of asthma, sinusitis, or hay feverrecent immunoglobulin therapyseasonal changesstress
Some experts believe that a fungal infection elsewhere in the body can cause dyshidrotic eczema on the hands. For example, someone with athlete's foot may develop eczema lesions on his or her hands.
The following factors have been reported in association with dyshidrotic eczema, but more research is needed to be sure: aspirincigarette smoking metal implants, such as total hip replacementsoral contraceptives
A person can help prevent dyshidrotic eczema by: allowing feet to air frequentlyavoiding excessive sweating and excessive drynessavoiding jewelry and other objects made of nickelavoiding unnecessary exposure to soapy waterbathing with mild soap and lukewarm water and rinsing soap off wellfollowing measures to prevent athlete's foottaking good care of his or her skinusing heavy-duty gloves to protect the hands against chemicalswearing cotton socks
A person also can reduce the risk of this condition by managing stress and learning how to express his or her feelings.
Diagnosis of dyshidrotic eczema begins with a medical history and physical exam. The healthcare professional may order blood tests to check for other causes of the rash.
Dyshidrotic eczema can cause a recurrent rash. The skin may heal completely between reoccurrences. At times, the skin may peel and crack. The person is at risk for an infection. In some cases, the eczema can be so severe that the person is unable to work or carry out normal activities.
Dyshidrotic eczema is not contagious and poses no risk to others.
When an outbreak of dyshidrotic eczema occurs, treatment includes keeping skin dry and cool. Heat, sweating, and moisture can make symptoms worse. Treatment options include: antihistamines to decrease itchingchelation therapy, to minimize the effect of nickelcompresses of Burrow's solution for fluid-filled lesionsdrainage of fluid-filled lesionsmedicines that suppress the immune system, such as azathioprine (i.e., Azasan, Imuran), methotrexate (i.e., Trexall, Rheumatrex), or cyclosporine (i.e., Sandimmune, Neoral, Gingraf)PUVA, or phototherapy with ultraviolet A light, which may be combined with a medicine called psoralenoral or topical antibiotics for secondary infectionsoral steroids for severe casestopical corticosteroid creams to reduce itching and inflammation
A diet low in nickel or cobalt may be considered. However, these diets are hard to follow, and their effectiveness has not been proven. Nickel levels are high in canned foods and foods cooked in nickel-plated utensils. Nickel is also found in a variety of fruits and vegetables, tea, cocoa, chocolate, and baking powder. Cobalt is found in a variety of fruits, vegetables, and spices. It is also high in cocoa, chocolate, and coffee.
Long-term use of steroid creams can cause thinning of the skin. Antibiotics may cause rash, stomach upset, or other allergic reactions .
Dyshidrotic eczema usually heals completely with treatment, but it may reoccur. Careful management may decrease the number of outbreaks. Biofeedback therapy for stress reduction has been successful in limiting outbreaks in some individuals.
Any new or worsening symptoms should be reported to the healthcare professional.
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Complete Guide to Symptoms, Illness,&Surgery, H. W. Griffith, 2000
Harrison's Principles of Internal Medicine, Fauci, et al., 2000
