Dyshidrotic Eczema (Pompholyx Eczema), also known as Dyshidrosis or Vesicular eczema, is a skin condition which is characterized by the appearance of fluid filled blisters on the soles of the feet as also the palms of the hands or the sides of the fingers [1]. The condition is also usually accompanied with an inflammation and a dryness of the skin surface.

Dyshidrotic eczema is a relatively uncommon form of eczema when compared to atopic eczema or other forms of the skin disorder. The blisters that appear on the skin surface in case of Dyshidrotic eczema typically last for a period of two to three weeks and it involves intense itching throughout the duration of the condition. Once the fluid filled blisters dry up, the skin surface becomes dry, scaly and patchy. In most cases, the blisters reappear and it is often the case that blisters start reappearing on the skin surface even before the earlier blisters have healed.

Dyshidrotic eczema is not a very serious condition and the signs and symptoms of this disease are usually controlled with the help of simple home remedies, lifestyle changes and in cases of severe conditions, medication can prove to be effective.

Causes of Dyshidrotic Eczema

Dyshidrotic eczema is a fairly rare disorder as compared to other forms of eczema. As in general with other general types of eczema, the exact causes of the skin condition are yet to be determined. However, it is generally suspected by experts that the causes of dyshidrotic eczema prove to be the same as those that are believed to cause atopic eczema. As such, dyshidrotic eczema can be thought of to be caused by an allergic reaction of the skin surface when exposed to certain triggering factors. The condition is also associated with other allergies including seasonal allergies such as hay fever and asthma.

The flare ups of blisters that are associated with dyshidrotic eczema are also seasonal typically and they are very often accompanied with nasal allergies. Similar to atopic eczema, the sensitivity of the skin surface may be linked to genetic factors as also continued exposure to harsh climates, irritants or other triggering environmental factors. Sometimes, a dysfunction in the immunological function of the body may also prove to cause abnormalities in the skin surface, making an individual more prone to developing the conditions of dyshidrotic eczema. Taking up a lot of stress is known to be detrimental to the immunological functioning of the body and may be associated with the development of dyshidrotic eczema.

People more prone to develop Dyshidrotic eczema

Certain individuals are more likely to develop conditions of dyshidrotic eczema than others. The condition is more likely to occur in an individual in the following cases:

  • Dyshidrotic eczema is found to be much more common in females as compared to males
  • The signs and symptoms of dyshidrotic eczema seem to manifest more often if a person has been taking up a lot of stress
  • Continued exposure of the skin surface to certain metals such as cobalt, nickel and chromium, typically as observed in industrial scenarios can lead to an individual developing dyshidrotic eczema
  • People with certain allergies or those who develop rashes on the skin easily on the exposure to irritants are more prone to developing conditions of dyshidrotic eczema
  • People who keep their hands and feet moist more often than not are at a higher risk of developing dyshidrotic eczema
  • Individuals who have developed or experienced episodes of atopic eczema flare ups also stand a risk of developing dyshidrotic eczema

Signs and symptoms of Dyshidrotic Eczema

While dyshidrotic eczema may be a rare condition, the signs and symptoms of the disease prove to be similar across individuals, as also does the location on the part of the body [2]. Dyshidrotic eczema is characterized by the presence of fluid filled blisters or sacs which appear on the palms of the hands, the sides of the fingers, the toes and also the soles of the feet. These blisters prove to be much more prominent on the edges of the limbs. These blisters could be both painful as well as itchy. These blisters may be accompanied with redness and inflammation in the affected areas and dyshidrotic eczema is almost always also associated with a fever. There may also be flaking, cracking and dryness of skin.

Blisters associated with dyshidrotic eczema are usually small in size and are as big as the width of a pencil head only. Usually, these blisters form in clusters with an appearance that is similar to that of tapioca. In severe cases of dyshidrotic eczema, these small blisters prove to merge together to form larger blisters.

These blisters may take around two to three weeks to heal completely. After the blisters disappear, thick patches appear on the affected areas which further lead to flaking and pain around the areas. The skin surface is very tender at this point of time and usually appears to be reddened as well.

The signs and symptoms of dyshidrotic eczema recur at a high frequency over months and sometimes even years.

Diagnosis of Dyshidrotic Eczema

Typically, dyshidrotic eczema does not need any type of special diagnosis and a clinical examination involving a visual checkup as well as a history of the patient’s medical record is all that is required for diagnosing the disorder.

Dyshidrotic eczema may be diagnosed by the examination of skin by an experienced physician along with a medical history of the appearance of the symptoms. In very rare or special cases, the physician may choose to perform a biopsy on a small patch of skin in order to eliminate any other possible skin diseases such as those caused by bacterial or fungal infections. Skin allergy testing may also be performed and the patch test is commonly used in order to diagnose dyshidrotic eczema.

Prevention of Dyshidrotic Eczema

Dyshidrotic eczema is a rare condition and not much is known about what exactly proves to be the cause of the disease. However, it is believed that the disorder has some correlation with atopic eczema and seasonal allergies such as asthma and hay fever. As such, the best ways to avoid the occurrence of dyshidrotic eczema is by following proper prevention methods that are suitable for preventing allergic attacks. It is also important to remember that there is no complete cure available for dyshidrotic eczema and as such, it is best to prevent the disease in order to avoid the pain and the complications associated with the condition.

While dyshidrotic eczema can seem to be just an irritating condition which is not too serious, severe flares of blisters can limit the use of an individual’s hands and feet to a great extent. Scratching of the blisters can also lead to a lot of skin infections. It is important to prevent dyshidrotic eczema in order to avoid these painful and irritating complications.

The following are some of the suggested methods that can help people avoid dyshidrotic eczema [3]:

  • Avoiding contact with irritants such as harsh soaps and detergents or other substances that may elucidate allergic reactions
  • Avoiding foods like chocolates, oatmeal or canned food which prove to be high in nickel content
  • Avoiding prolonged exposure to chromium, cobalt and nickel
  • Avoiding taking up too much stress
  • Keeping the skin moist and lubricated by applying moisturizer twice daily on the skin
  • Avoiding exposing the skin to extremely hot or extremely cold conditions
  • Avoiding exposing the skin to sudden changes in humidity
  • Avoiding activities that involve too many activities
  • Finding out more and discovering possible allergens and avoiding contact with them in the future

Treatment of Dyshidrotic eczema

Similar to other forms of eczema, there is no complete cure for dyshidrotic eczema and treatment of the condition is limited to managing the signs and symptoms of the disease. However, management of the condition proves to be quite simple and involves following some basic life style tips and home remedies. It is only in severe conditions that medication may be required.

Some of the commonly used life style measures and home remedies that can help in alleviating the signs and symptoms of dyshidrotic eczema include the following:

  • Limiting the duration of baths and preferring the use of lukewarm water over hot water
  • Keeping the skin surface moist and lubricated at all times
  • Using cold dressings and compressions in order to provide relief from itching
  • Soaks of potassium permanganate may be used to dry out the blisters and to kill any bacteria
  • Using petroleum jelly on the skin surface
  • Using mineral oils o the skin surface

In case medication is to be used for the treatment of dyshidrotic eczema, it must only be done so under a licensed medical professional’s prescription as some of them may prove to cause side effects. Some of the commonly prescribed medications for treating this condition include the following:

  • Prescription antihistamines such as Benadryl or Claritin to relieve the symptoms
  • Use of antibacterial drugs including sulphonamides such as dapsone
  • Application of corticosteroid or steroid ointments on the blisters
  • Application of heavy creams such as Eucerin or Lubriderm

In case of a severe outbreak of blisters, the following treatment measures may be used:

  • Administration of oral steroid tablets including corticosteroids
  • Administration of immune suppressant drugs such as Elidel or Protopic
  • Using ultra violet light therapy
  • Using denorex or other coal tar preparations

It must be remembered that patients suffering from dyshidrotic eczema may also be prone to contracting a number of other allergic reactions and these reactions may even be caused by the drugs and the medication that is being employed to treat the blisters or the rashes in the first place [4]. It has been reported quite often than many patients develop a condition known as contact eczema, which is a result of an allergic reaction of the body to corticosteroids that had been administered to help the body get rid of eczema in the first place. As such, it is essential to always try and determine all possible allergens and triggering factors for the disorder in individuals before moving on to the use of any medication.

Recurrence and future complications

Dyshidrotic eczema is known to be a recurring condition. It is observed quite frequently that a new bout of blisters and flares may pop up even before the first round of blisters has not completely dried off. The signs and symptoms and the appearance of blisters as associated with dyshidrotic eczema may prove to recur for a period of months in not years.

It has also been noticed that individuals who develop conditions of dyshidrotic eczema may go on to develop other allergies such as asthma or hay fever and may even go on to develop other forms of eczema, most commonly atopic eczema. As such, any skin allergens and irritants should be determined in order to prevent complications of these diseases in the future.

The blisters associated with dyshidrotic eczema are known to be both very itchy and also very painful. Invariably, most people end up scratching their blisters whether they like it or not. Scratching can lead to a host of complications. Often, the fingernails may not be clean enough and scratching can cause infection from the dirt in the fingernails. At other times, excessive scratching may also lead to cause a rupture in the surface and the skin may easily get infected by certain fungi and bacteria, most notably the staphylococcus aurues bacterium.

Individuals suffering from dyshidrotic eczema are also more prone to encountering viral infections from other individuals [5]. Eczema sufferers are known to be prone to infection from the simplex herpes virus and as such, any contact with a person suffering from the viral infection should be avoided at all costs.

The pus filled blisters may prove to dry off and subside in a few weeks. However, even after the condition subsides, the blisters usually tend to leave behind scars or marks around the area where the rashes were seen.

While dyshidrotic eczema may not be a life threatening condition, it proves to be a frustrating and irritating condition and is also associated with a number of complications.

References


[1] Expert Reviews in Molecular Medicine, Caroline Bussmann ,Wen-Ming Peng,Thomas Bieber; 10 / 2008, e21- 14 July 2008 –DOI:10.1017/S1462399408000756http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1926724&fileId=S1462399408000756


[2] Ten Questions about Eczema Herpeticum, Gavin Yamey, William Lynn; 0010012-November 30, 2004-DOI: 10.1371/journal.pmed.0010012, http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0010012


[3] Identifying Genetic Determinants of Eczema Herpeticum and Other Viral Infections in Individuals With Atopic Dermatitis, Gao PS, Leung DY, Rafaels NM; 132(3 Pt 1):650-7- 2012 Mar– DOI: 10.1038/jid.2011.374. Epub 2011 Nov 24, http://clinicaltrialsfeeds.org/clinical-trials/show/NCT00515047


[4] Risk Factors for Eczema Herpeticum, Beck LA, Boguniewicz M, Hata T;124(2):260 269- December 2009- DOI:10.1016/j.jaci.2009.05.020,http://aapgrandrounds.aappublications.org/content/22/6/65.short


[5] Methylation Patterns in Whole Blood From Healthy Controls and Patients with Atopic Dermatitis with and without a History of Eczema Herpeticum, Chris Cheadle; V131,I2, PAB105- February 2013- DOI:10.1016/j.jaci.2012.12.1047, http://www.jacionline.org/article/S0091-6749(12)03048-5/abstract