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.
What is going on in the body?
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.
What are the causes and risks of the condition?
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:
- bacterial infection
- certain skin infections
- difficulty expressing feelings or emotions
- hot or cold temperatures
- increased humidity
- personal or family history of asthma, sinusitis, or hay fever
- recent immunoglobulin therapy
- seasonal changes
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:
What can be done to prevent the condition?
A person can help prevent dyshidrotic eczema by:
- allowing feet to air frequently
- avoiding excessive sweating and excessive dryness
- avoiding jewelry and other objects made of nickel
- avoiding unnecessary exposure to soapy water
- bathing with mild soap and lukewarm water and rinsing soap off well
- following measures to prevent athlete's foot
- taking good care of his or her skin
- using heavy-duty gloves to protect the hands against chemicals
- wearing cotton socks
A person also can reduce the risk of this condition by managing stress and learning how to express his or her feelings.
How is the condition diagnosed?
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.
Long Term Effects
What are the long-term effects of the condition?
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.
What are the risks to others?
Dyshidrotic eczema is not contagious and poses no risk to others.
What are the treatments for the condition?
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 itching
chelation therapy, to minimize the effect of nickel
compresses of Burrow's solution for fluid-filled lesions
drainage of fluid-filled lesions
medicines 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 psoralen
oral or topical antibiotics for secondary infections
oral steroids for severe cases
- topical 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.
What are the side effects of the treatments?
Long-term use of steroid creams can cause thinning of the skin. Antibiotics may cause rash, stomach upset, or other allergic reactions .
What happens after treatment for the condition?
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.
How is the condition monitored?
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