Dyshidrosis is a skin condition that is characterized by small blisters on the hands or feet. It
is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized
by a sudden onset of many deep-seated pruritic, clear vesicles; later, scaling, fissures and
lichenification occur. Recurrence is common and for many can be chronic. Incidence/prevalence
is said to be 1/5,000 in the United States. However, many cases of eczema are diagnosed
as garden-variety atopic eczema without further investigation, so it is possible that this
figure is misleading. This condition is not contagious to others,
but the compromised integument can increase susceptibility to infection, and the accompanying
itching can be a source of psychological duress. The name comes from the word "dyshidrotic,"
meaning "bad sweating," which was once believed to be the cause, but this association is unproven;
there are many cases present that have no history of excessive sweating. There are many
different factors that may trigger the outbreak of dyshidrosis such as allergens, physical
and/or mental stress, or seasonal changes.
Symptoms Small blisters with the following characteristics:
Blisters are very small. They appear on the tips and sides of the fingers, toes, palms,
and soles. Blisters are opaque and deep-seated; they
are either flush with the skin or slightly elevated and do not break easily. Eventually,
small blisters come together and form large blisters.
Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact
with soap, water, or irritating substances. Scratching blisters breaks them, releasing
the fluid inside, causing the skin to crust and eventually crack. This cracking is painful
as well as unsightly and often takes weeks, or even months to heal. The skin is dry and
scaly during this period. Fluid from the blisters is serum that accumulates
between the irritated skin cells. It is not sweat as was previously thought.
In some cases, as the blistering takes place in the palms or finger, lymph node swelling
may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps
present in the arm pits. Nails on affected fingers, or toes, may take
on a pitted appearance.
Causes Causes of dyshidrosis are unknown. However,
a number of triggers to the condition may include:
Allergic reactions of various kinds, including allergies to nickel which is present in many
foods and vitamins. A randomized, double-blind, placebo-controlled
cross-over study by the University Medical Center Groningen reported that dishydrosis
outbreaks on the hands increased significantly among those allergic to house dust mites,
following inhalation of house dust mite allergen. Treatment
There are many treatments available for dyshidrosis. However, few of them have been developed or
tested specifically on the condition. Topical steroids - while useful, can be dangerous
long-term due to the skin-thinning side-effects, which are particularly troublesome in the
context of hand dyshidrosis, due to the amount of toxins and bacteria the hands typically
come in contact with. Potassium permanganate dilute solution soaks
- also popular, and used to 'dry out' the vesicles, and kill off superficial Staphylococcus
aureus, but it can also be very painful. Undiluted it may cause significant burning.
Dapsone is an antibacterial sulfonamide. It has been recommended for the treatment of
dyshidrosis in some chronic cases. Antihistamines: Fexofenadine up to 180 mg
per day. Alitretinoin has been approved for prescription
in the UK. It is specifically used for chronic hand and foot eczema. It is made by Basilea
of Switzerland. In the case of a nickel allergy or sensitivity
a low nickel diet may lead to improvement. This includes avoiding high nickel foods like
oatmeal and chocolate, canned foods, and using vitamins that do not contain nickel. In this
situation avoiding excessive exposure to environmental nickel may also be helpful, such as not using
stainless steel pots and silverware. See also
List of cutaneous conditions Dermatology
Epidermolysis bullosa - a genetic disorder that causes similar, but more severe, symptoms
to dyshidrosis References
External links Dyshidrotic eczema at MedlinePlus
Images of dyshidrotic eczema at Skinsight MedAdvice.com
Pompholyx at DermNet NZ Information, advice and shared experiences
for Pompholyx sufferers