An Overview of Dyshidrotic Dermatitis

Dyshidrotic dermatitis is a skin condition characterized by small, itchy blisters over the palms, fingers, or 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. It can be treated, but dyshidrotic dermatitis will most likely recur and can't be cured.

The word dyshidrotic stems from a now-outdated belief that this condition is caused by sweat gland malfunction. Pompholyx comes from the Greek word for bubble, which describes the blisters.

Symptoms

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)
• 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 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.

Causes

The cause of dyshidrotic dermatitis isn't known, but 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 is most common between ages 20 and 40, although it may appear at any age. Females are twice as likely as males to develop the condition. You are also more likely to develop dyshidrotic eczema if you have relatives who also have it.

This leads some professionals to believe that dyshidrotic dermatitis is a form of atopic dermatitis on the hands and feet.

It's 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

There are many factors that 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 of time in damp socks can trigger a flare on the feet.
• Hyperhidrosis, or excessive sweating, may trigger a flare-up: 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.

Diagnosis

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

Treatment

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.

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.

Prevention

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.

A Word From Verywell

The intense itch and pain of dyshidrotic eczema can make it a maddening condition to deal with. Remember, prevention is the best defense. If you have any triggers, avoid them when possible. Whether you have specific triggers or not, appropriate skincare may help prevent flares. When flares do occur, your physician can help you create a treatment plan.