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Dyshidrotic eczema

Dyshidrotic eczema is a condition in which small blisters develop on the hands and feet. 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, 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

Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions. Moisturizers:

  • Should be free of alcohol, scents, dyes, fragrances, or other chemicals.
  • Work best when they're applied to skin that is wet or damp. After washing or bathing, pat the skin dry and then apply the moisturizer right away.
  • May be used at different times of the day. For the most part, you can apply these substances as often as you need, to keep your skin soft.

You can buy medicines that help you stop scratching without first seeing your doctor .

  • Take an anti-itch medicine before bed if you scratch in your sleep.
  • Newer antihistamines cause little or no sleepiness. These include fexofenadine (Allegra), loratadine (Claritin, Alavert), cetirizine (Zyrtec), and diphenhydramine (Benadryl).

Topical corticosteroids are medicines used to treat eczema.

  • Topical means you place it on the skin. You will be prescribed a cream or ointment. Topical corticosteroids may also be called topical steroids or topical cortisones.
  • Do not use more medicine or use it more often than your doctor advises you to.

Your doctor may also prescribe other creams or ointments, such as tacrolimus or pimecrolimus, to use on the skin.

If symptoms are very bad, you may need other treatments, such as:

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

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.

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.

Updated: 10/18/2013

Richard J. Moskowitz, MD, Dermatologist in private practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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