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Dyshidrotic eczema

Definition

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

Eczema (atopic dermatitis) is a long-term (chronic) skin disorder that involves scaly and itchy rashes.

Alternative Names

Dyshidrosis; Pompholyx

Causes

The cause is unknown. The condition seems to appear during certain times of the year.

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

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 or can get infected.

Exams and Tests

Your doctor 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

SKIN CARE AT HOME

Keep the skin moist by 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. 

MEDICINES

Medicines that help relieve itching can be bought without a prescription.

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

Your doctor may prescribe topical medicines. These are ointments or creams that are applied to the skin. Types include:

  • Corticosteroids, which calm swollen or inflamed skin
  • Immunomodulators, which help keep the immune system from reacting too strongly

Follow instructions on how to apply these medicines. Do not apply more than you're supposed to use.

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

  • Corticosteroid pills
  • Corticosteroid shots
  • Coal tar preparations
  • Phototherapy (ultraviolet light therapy) 

Outlook (Prognosis)

Dyshidrotic eczema usually 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; 2014:chap 190.

James WD, Berger TG, Elston DM. Atopic dermatitis, eczema, and noninfectious immunodeficiency disorders. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 5.


Review Date: 7/23/2015
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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