Dyshidrotic eczema

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Definition

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

Alternative Names

Dyshidrosis; Pompholyx

Causes

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

You are more likely to develop dyshidrotic eczema when:

  • You are under stress
  • You have allergies, such as hay fever
  • Your hands are often in water or moist
  • You work with cement or do other work that exposes your hands to chromium, cobalt, or 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 can be very itchy. They also cause scaly patches of skin that flake or get red, cracked, and painful.

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

Exams and Tests

Your health care provider may be able to diagnose this condition by looking at your skin.

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

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

Treatment

Scratching makes the condition worse. To reduce itching, your health care provider may recommend taking anti-itch medicines such as diphenhydramine (Benadryl) and loratadine (Claritin) by mouth. You may take anti-itch medicine before bed if you scratch in your sleep.

Apply ointments or creams to your hands at least 2 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 these products can be messy.
  • Creams such as Eucerin and Lubriderm are thicker than lotion and may be helpful.

Your doctor may prescribe steroid (or corticosteroid) ointments or creams. Other creams or ointments, such as tacrolimus or pimecrolimus may also be used.

If your symptoms are very bad, your doctor may recommend the following:

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

Avoid frequent bathing, excessive hand washing, and irritating substances, which can make itching worse.

Outlook (Prognosis)

There is no cure. Dyshidrotic eczema normally goes away without problems, but symptoms may come back. Excess scratching may lead to thick, irritated skin. This makes the problem harder to treat.

Possible Complications

Dyshidrotic eczema can lead to:

  • Pain and itching that limits the use of the hands
  • Bacterial infection from scratching

When to Contact a Medical Professional

Call your health care provider if you have:

  • Signs of infection such as tenderness, redness, warmth, or fever
  • A rash that does not go away with simple home treatments

References

Burdick AE, Camach ID. Pompholyx. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 190.

Reider N, Fritsch PO. Other eczematous eruptions. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 13.

Version Info

  • Last reviewed on 11/12/2014
  • Richard J. Moskowitz, MD, dermatologist in private practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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