Overview

Dyshidrotic eczema, also known as pompholyx, is a type of eczema that causes small, intensely itchy blisters on the palms of your hands, soles of your feet, and the sides of your fingers and toes. While the exact cause isn't fully understood, it's thought to be linked to factors like stress, allergies (like hay fever), contact with certain metals (like nickel or cobalt), or moist hands and feet. It most commonly affects young adults, typically between the ages of 20 and 40, and can run in families. Importantly, dyshidrotic eczema is not contagious, so you can't catch it from someone else or spread it to others. Living with the intense itch and discomfort of dyshidrotic eczema can be quite frustrating and can sometimes impact daily activities and sleep.

Symptoms

You might experience a combination of these common signs:

• Small, deep-seated blisters: These often look like tiny bubbles or "tapioca pudding" and appear on the palms, soles, and sides of fingers or toes.
• Intense itching: This is often the first and most bothersome symptom, sometimes starting even before blisters appear.
• Burning or prickling sensation: Along with itching, the affected areas might feel like they are burning.
• Redness and inflammation: The skin around the blisters can become red and swollen.
• Scaling and peeling: As the blisters dry and heal, the skin may become dry, scaly, and start to peel.
• Cracking and fissures: In more severe or chronic cases, the skin can crack, leading to pain and an increased risk of infection.
• Pain: Especially if blisters are large or skin is cracked.
• Symptoms often come in waves or flare-ups - which can be triggered by stress or exposure to irritants.

Diagnosis

A doctor or dermatologist can usually diagnose dyshidrotic eczema by looking closely at your skin and discussing your symptoms and medical history. They'll want to know about any potential triggers you've noticed.

In some cases, if the diagnosis isn't clear, they might perform:

• Skin scraping: To rule out fungal infections, which can look similar.
• Skin biopsy: A small sample of skin might be taken for examination under a microscope, though this is less common.
• Patch testing: If an allergy to a specific substance (like nickel) is suspected as a trigger, this test can help identify it.

Management & Treatment

Finding the right approach to manage dyshidrotic eczema can make a world of difference. For some, a single episode may clear up on its own, but for many, it's a recurring condition that requires ongoing care. The goal of treatment is to heal the blisters, relieve the itch, and prevent new flare-ups.

Over-the-Counter (OTC) Options & Home Care For mild cases, you can often start with strategies at home:

• Cool Compresses: Soaking a clean cloth in cool water and applying it to the affected areas for 15 minutes at a time, several times a day, can help reduce itching and inflammation.
• Soaks: Your doctor might recommend soaking your hands or feet in a solution like potassium permanganate to help dry out blisters and prevent infection.
• Moisturize, Moisturize, Moisturize: Applying a high-quality, fragrance-free moisturizer frequently throughout the day is key. This helps restore the skin's barrier and prevent the dryness and cracking that can follow a flare-up.
• Antihistamines: Over-the-counter antihistamine pills can help relieve the itch, especially if it's disrupting your sleep.

Prescription Treatments If home care isn't enough, it's time to see your doctor. They may recommend:

• Topical Steroids: These are the most common prescription treatment. Corticosteroid creams or ointments are applied directly to the skin to reduce inflammation and help the skin heal. It's important to use these exactly as directed by your doctor.
• Topical Calcineurin Inhibitors: These are another option for topical treatment and can be particularly useful for long-term control without some of the side effects of steroids.
• Oral Medications: For severe or widespread cases, your doctor might prescribe a short course of oral steroids or other medications that work throughout the body to calm your immune system.
• Phototherapy: In some cases, controlled exposure to ultraviolet (UV) light, administered by a dermatologist, can help manage severe symptoms.

Lifestyle Changes

• Identify and Avoid Triggers: Pay close attention to what might be causing your flares. Common triggers include stress, sweat, and contact with certain metals (like nickel), soaps, or chemicals. Keeping a journal can help you pinpoint your personal triggers.
• Gentle Cleansing: Wash your hands with lukewarm water and a mild, fragrance-free cleanser. Avoid hot water and harsh soaps.
• Protect Your Hands and Feet: Wear gloves when doing dishes or working with chemicals. Choose socks made of breathable fabrics like cotton.

You can typically expect to see improvement within a few weeks of starting treatment. However, since dyshidrotic eczema can be chronic, it's important to stick with your management plan even when your skin is clear to help prevent new flares.

Important Safety Considerations Always use medications as prescribed. Long-term use of high-potency topical steroids can lead to skin thinning. If you're not seeing improvement after a few weeks, or if you notice any signs of infection (like pus, increased pain, or yellow-brown crusts), it's crucial to follow up with your healthcare professional. Living with this condition can be challenging, but with the right care, you can find relief and keep your skin healthy.

Duration & Outlook

Dyshidrotic eczema is often a chronic condition, meaning it can last for a long time with periods of flare-ups and remission (periods where symptoms improve or disappear). An individual flare-up of blisters might last for 2-3 weeks before they start to dry up and the skin begins to peel. However, new blisters can form as old ones heal, especially if triggers aren't managed.

With careful management and avoidance of triggers, many people can reduce the frequency and severity of their flare-ups. Warning signs for complications include increased pain, swelling, pus, or warmth in the affected area, which could indicate a bacterial infection. If you notice these, it's important to see your doctor.

Prevention

While it may not always be possible to completely prevent dyshidrotic eczema, especially if you have a genetic predisposition, you can take steps to reduce the frequency and severity of flare-ups:

• Identify and avoid known triggers (see section below).
• Practice gentle skincare: Use lukewarm water and mild, fragrance-free cleansers.
• Moisturize regularly with a thick, plain emollient, especially after washing your hands or feet.
• Protect your hands: Wear waterproof gloves with a cotton liner for wet work (like washing dishes) and appropriate gloves when handling potential irritants.
• Manage stress: Techniques like mindfulness, exercise, or yoga may help, as stress can be a significant trigger.
• Keep hands and feet dry: Change socks frequently if your feet sweat, and dry hands thoroughly after washing.

Causes & Triggers

The exact cause of dyshidrotic eczema is still not fully known, but it's believed to involve a combination of genetic and environmental factors. It’s not an allergy in itself, but allergic reactions or sensitivities can trigger it.

Common triggers include:

• Stress: Emotional or physical stress is a well-known trigger for many people.
• Contact with certain metals: Nickel (found in some jewelry, coins, zippers) and cobalt are common culprits.
• Seasonal changes: Some people find their eczema flares more in certain seasons, like spring or summer, possibly due to heat, humidity, or pollen.
• Irritants: Frequent handwashing, harsh soaps, detergents, solvents, or other chemicals can irritate the skin and trigger a flare-up.
• Moist or sweaty hands and feet: Prolonged moisture can sometimes worsen symptoms.
• Certain ingredients in personal care products: Fragrances or preservatives can be problematic for sensitive skin.

People most likely to develop dyshidrotic eczema include:

• Those with a personal or family history of other types of eczema (like atopic dermatitis).
• Individuals with hay fever or other allergies.
• People who have frequent or prolonged exposure to water or irritants (e.g., healthcare workers, hairdressers, cleaners).
• Those with a sensitivity to metals like nickel.

When to see a doctor

It's always a good idea to see a doctor or dermatologist if you suspect you have dyshidrotic eczema, especially for a proper diagnosis and to rule out other conditions.

You should definitely seek medical advice if:

• The itching is severe and unbearable, or it’s significantly impacting your sleep or daily activities.
• The blisters are widespread, very painful, or look infected (e.g., filled with pus, increased redness, warmth, or red streaks).
• Your symptoms don't improve with home care or seem to be getting worse.
• You develop cracks in your skin that are deep or bleeding.
• You’re unsure what’s causing your skin condition.
• You need help identifying potential triggers.

A dermatologist can confirm the diagnosis and discuss management strategies tailored to your specific situation. We are here to help you understand and manage your skin.

Frequently Asked Questions (FAQs):

• Is dyshidrotic eczema related to sweat glands? The name "dyshidrotic" once suggested a link to sweat glands (hidrosis means sweating), but research hasn't confirmed that sweating or blocked sweat glands are the primary cause. However, sweaty hands or feet can sometimes aggravate the condition for some individuals.
• Can diet affect dyshidrotic eczema? For some people, certain foods might act as triggers, particularly those high in nickel (like cocoa, whole grains, some nuts) or cobalt (like shellfish, liver, some green vegetables) if they have a sensitivity to these metals. However, this isn't the case for everyone, and it's best to discuss any dietary concerns with your doctor or a dietitian.
• Will dyshidrotic eczema leave scars? Typically, the blisters of dyshidrotic eczema do not leave scars if they are allowed to heal naturally. However, deep scratching or secondary infections could potentially lead to scarring or changes in skin color, so it's important to manage itching and prevent infection.
• Can children get dyshidrotic eczema? Yes, while it's most common in young adults, children can also develop dyshidrotic eczema, though it might be less frequent than other types of eczema in childhood. If you're concerned about your child's skin, please consult their pediatrician or a dermatologist.

References

• American Academy of Dermatology Association. (n.d.). Eczema types: Dyshidrotic eczema diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/eczema/types/dyshidrotic-eczema/treatment
• Cleveland Clinic. (2022, May 9). Dyshidrotic Eczema (Dyshidrosis): Symptoms, Causes, Treatments. Retrieved from https://my.clevelandclinic.org/health/diseases/17728-dyshidrotic-eczema
• National Health Service. (2021, November 18). Pompholyx. Retrieved from https://www.nhs.uk/conditions/pompholyx/
• National Eczema Society. (n.d.). Pompholyx (dyshidrotic) eczema. Retrieved from https://eczema.org/information-and-advice/types-of-eczema/pompholyx-eczema-2/
• Medscape. (2023, August 2). Dyshidrotic Eczema (Pompholyx) Treatment & Management. Retrieved from https://emedicine.medscape.com/article/1122527-treatment