Dyshidrotic Eczema: Symptoms, Causes, Diagnosis, Treatment, and Prevention

Dyshidrotic eczema is a type of dermatitis that affects the hands and feet. It is also known as dyshidrosis, dyshidrotic dermatitis, foot-and-hand eczema, pompholyx, and vesicular eczema, according to the American Academy of Dermatology Association (AAD). ( 1 ) “It is characterized by tiny blisters or vesicles, usually between the digits, and it can be extremely itchy,” says Peter Lio, MD , a dermatologist who is a clinical assistant professor in the department of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago, as well as a board member and scientific advisory committee member for the National Eczema Association (NEA). “Certain triggers can also make it flare, such as contact with irritating chemicals like soaps or detergents or hand sanitizers, sweating, seasonal changes, and sometimes even just stress.” Other causes and triggers include allergic skin reactions, atopic dermatitis , fungal and bacterial infections, exposure to nickel or cobalt, and excessive exposure to water, according to Chesahna Kindred, MD, a dermatologist in Columbia, Maryland. Dyshidrotic eczema is also a side effect of intravenous immunoglobulin infusions (IVIG), which are typically used to treat certain immune system diseases. Exposure to cement is another risk factor. ( 2 ) The condition is not contagious. It tends to affect women more than men, perhaps because women are more likely to be exposed to certain skin irritants, such as nickel or cobalt in jewelry. It’s also most common in people ages 20 to 40. ( 3 ) Dyshidrotic eczema is the fifth-most common cause of hand eczema, according to a 2015 study. ( 4 ) Dr. Lio says that cleansing measures related to the COVID-19 pandemic also spurred an increase in the cases he saw because of increased hand-washing, hand sanitizer use, and stress.
Signs and Symptoms of Dyshidrotic Eczema Symptoms Common symptoms include: ( 5 ) Small blisters and rashy skin Blisters filled with clear fluid Blisters that appear in clusters between fingers and toes or on the edges of fingers, toes, palms, or soles of the feet Rashy, scaly, red and cracked skin around the blisters Blisters that are very itchy and sometimes painful Blisters that dry and peel in about three weeks
Causes and Risk Factors of Dyshidrotic Eczema Causes “As with other forms of eczema, we do not understand what causes it or why it affects some more than others, but there do appear to be genetics involved, as it is more common in some families,” says Lio. “Frequent hand-washing, sweaty hands and feet, and contact with irritants or chemicals are all the most common [risk factors]. We see it in many healthcare workers, as you can imagine.” According to the AAD, dyshidrotic eczema is more likely to occur if you: (2) Have sweaty or moist hands Are under stress Have atopic dermatitis (also known as eczema) Have sensitive skin in general Have allergies, including hay fever Wash your hands frequently or your hands are often in water Work with cement Expose your hands to metals, such as chromium, cobalt, or nickel Receive intravenous immunoglobulin infusions to treat another medical condition
How Is Dyshidrotic Eczema Diagnosed? Diagnosis Diagnosing the condition usually involves examining the patient, noting the symptoms, and taking the patient’s history, says Lio. “If we suspect that a contact allergen is driving it, we may perform patch testing. Rarely, fungal infection can cause a very similar picture to occur clinically, so we can perform a scraping and a KOH examination to look for fungal forms,” he adds. A KOH examination involves scraping the problem area of your skin with a needle or scalpel blade and examining the tissue under a microscope on a slide to which KOH (the chemical potassium hydroxide, a form of lye or potash) has been added. ( 6 ) Prognosis of Dyshidrotic Eczema e60dc2a1-f33c-4a05-9b50-8e3e8e597629ec06a45f-0c6c-45dd-8391-cf7290899f87 “We do not have a cure, but we have many good treatments and many more in development,” says Lio. “Usually we can help people get their skin much better so that they can be comfortable and return to normal activities.” Some people have a single outbreak that clears without treatment, but it is much more common for people to have recurring flare-ups throughout life. ( 7 )
Duration of Dyshidrotic Eczema Duration If you are experiencing a flare-up, the blisters usually clear with within two or three weeks, according to the AAD. (1)
Treatment and Medication Options for Dyshidrotic Eczema Treatment While there is no cure for dyshidrotic eczema, as Lio says, you can manage most of the symptoms on your own with a doctor’s direction. “Typically, we start with gentle skin care and avoiding triggers ,” he says. “I have some favorite gentle cleansers to use instead of harsh soaps, some super-protective moisturizers, and even a gentle hand sanitizer. If that is enough — and it can be for milder cases — then we can get by without any medications at all.” Dr. Kindred says that keeping skin moisturized is an important part of treating dyshidrotic eczema. “Use lotions containing ceramides and then cover with a barrier ointment, such as petroleum jelly,” she says. The AAD has additional tips for self-care , such as how to cleanse, moisturize, and avoid triggers. But with more severe dyshidrotic eczema, medication and other treatments are necessary for symptom relief, say both doctors. Medication Options “We usually will add either a topical steroid or a nonsteroidal topical such as tacrolimus (Protopic) to cool things down,” says Lio. These are among the medications that may be prescribed: ( 8 , 9 ) Potent topical steroids such as clobetasol, fluocinonide (Lidex), halobetasol (Bryhali), and triamcinolone (Kenalog) Tacrolimus and pimecrolimus (Elidel), topical medications that suppress your immune system’s response in order to help quell a flare-up Oral steroids such as prednisone (Deltasone), which may be prescribed for two to four weeks if topical medications aren’t effective Oral medications that alter your immune response, such as cyclosporine (Neoral), methotrexate, or azathioprine (Imuran) “If that is still not enough, we often use phototherapy with narrow band ultraviolet (UVB) light to cool the inflammation with a specialized light,” Lio says. If the problem is a specific irritant or allergy, the treatment may even be dietary. “Sensitivity to nickel is fairly common, and in extreme cases, we can recommend a nickel-free diet which, while onerous, can help some patients with severe sensitivity,” says Lio. It may also be worth asking your doctor about patch testing on your skin to determine whether your dyshidrotic eczema has some type of allergic component. Patch testing can determine potential irritants, such as nickel. Note, though, that while patch testing may uncover a trigger, it may not be the only culprit causing your dyshidrotic eczema. Nickel is present in most foods, and depending on the soil that the food is grown in, the concentrations can vary greatly. ( 10 ) A nickel-free diet should avoid cocoa, chocolate, soybeans, oatmeal, nuts, almonds, legumes, drinks and vitamin supplements with nickel; canned food (due to leaching of nickel from cans into food); and fish that show high concentration of nickel, such as tuna, herring, shellfish, salmon, and mackerel. He notes that whole wheat, whole grain, rye, oats, millet, buckwheat, and licorice are high in nickel, as are some vitamin supplements. (10) Integrative and Complementary Approaches “There are many natural moisturizers that can be soothing, such as sunflower seed oil and coconut oil ,” says Lio. He adds that soaking in diluted apple cider vinegar or black tea can help to dry blisters. “For milder cases, these can be enough to get people through, but usually if things are more severe, we often need more powerful treatments.” Research into the bathing remedies he mentions have had mixed results on people with related types of eczema. A study from 2019 followed 22 German people with facial eczema who received treatment with gauze compresses soaked in black tea, followed by cold cream, for six days. Though small, the study suggests this remedy led to significant decreases in itchiness and other symptoms, the researchers write. ( 11 ) On the other hand, another small study, also from 2019, found that soaking skin in diluted apple cider vinegar (0.5 percent acetic acid solution) up to the forearms led to irritation in 73 percent of the treated participants with atopic dermatitis and did not improve the condition of the skin barrier. ( 12 )
Prevention of Dyshidrotic Eczema While you can’t prevent dyshidrotic eczema, you can do a number of things to avoid or minimize flare-ups. “Avoid triggers, wear cotton-lined gloves when washing dishes and doing other wet work, and keep other skin diseases under control,” counsels Kindred. To this list, Lio adds: Wear lightweight clothing and avoid gloves, socks, and shoes that trap moisture and don’t allow your skin to breathe.
Complications of Dyshidrotic Eczema Complications The complications of this condition can be very painful and disruptive. “Sometimes the hands are cracked, fissured, and bleeding, and it can cause lots of pain,” says Lio. “Some people can’t work due to the severity. I recently had a surgeon [as a patient] with such bad dyshidrotic eczema that he was on disability. I’m happy to say that we got him better, and he is operating again.” The AAD concurs that symptoms range from mild to debilitating. “A severe flare on your feet can make walking difficult. Having many blisters on your hands can make it difficult to work and perform everyday tasks like shampooing your hair and washing dishes,” according to the organization. (1) Constant scratching also tears the skin, increasing the risk of skin infection. According to the AAD, a staph infection (caused by the bacteria staphylococcus) may result. Signs of a staph infection include the development of pus in blisters, pain, swelling, and crusting. (5) Usually skin staph infections are mild, but if they are left untreated and the bacteria enter your bloodstream or other organs, life-threatening complications such as sepsis could result. ( 13 )
Research and Statistics: How Common Is Dyshidrotic Eczema? Research and Statistics There isn’t much recent research about the prevalence of dyshidrotic eczema. But a study from 2015 found that dyshidrotic eczema was the fifth most common cause of hand eczema, behind irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis (also known as eczema), and protein contact dermatitis (or contact urticaria ). (4) The condition tends to affect women more than men, and it is most common in adults between ages 20 and 40. (3) Mental Health and Dyshidrotic Eczema In addition to physical anguish, flare-ups of dyshidrotic eczema can lead to mental anguish. For those whose hands are affected, “it is in a highly visible area that can’t be covered with clothing, so many patients feel ashamed or embarrassed about their skin,” notes Lio. Also, severe cases can interfere with a person’s ability to work or carry out routine daily tasks involving hands or feet — stressful situations brought on by a condition that itself is aggravated by stress. The NEA reports that a survey they conducted about a related condition, atopic dermatitis, found that 30 percent of people with atopic dermatitis were also diagnosed with depression or anxiety. The organization recommends speaking with your healthcare provider or a mental health professional if you are experiencing symptoms of mental illness. Self-care is important too, such as getting adequate sleep, practicing relaxation techniques, and finding a peer support group. ( 14 )
Related Conditions and Causes of Dyshidrotic Eczema Related Conditions As mentioned, atopic dermatitis or contact dermatitis, especially when related to a nickel allergy, can increase your risk of having dyshidrotic eczema. (2) Differentiating between the conditions can be a challenge, and sometimes they are related anyway, says Kindred. “Atopic dermatitis prefers skin folds, such as the insides of the elbows and the knees. Contact dermatitis is usually within the location that the skin was in contact with the trigger. The confusing part is that both atopic dermatitis and contact dermatitis may be associated with dyshidrotic eczema, confusing the picture.” Learn more about these conditions from the NEA: Atopic Dermatitis Also simply known as eczema, atopic dermatitis is chronic and is the most common type of eczema. ( 15 ) Contact Dermatitis This happens when physical contact with an irritating substance or allergen triggers an irritation or inflammation reaction of the skin. ( 16 )
Q & A’s
Resources We Trust Mayo Clinic: DyshidrosisCleveland Clinic: Dyshidrotic Eczema (Dyshidrosis)American Academy of Dermatology: Eczema Types: Dyshidrotic Eczema Self-CareNational Eczema Association: Dyshidrotic EczemaHarvard Health Publishing: Dyshidrotic Eczema: Effective Management Strategies



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