Dyshidrotic Eczema – Definition, Causes, Symptoms, Diagnosis, Treatment and Prevention

What is dyshidrotic eczema?

Dyshidrotic eczema is a type of eczema (dermatitis) of unknown cause that is characterized by itchy small blisters usually restricted to the fingers, palms, and soles.

It is also known as pompholyx(the Greek word for bubble) and dyshidrosis(abnormal sweating)  Many of the modern dermatologists prefer to use the term ‘vesicular hand dermatitis’.

It can occur both in teenagers and adults, but most common before age of 40 years. It is found in both sexes but females are affected more than males.

Dyshidrotic Eczema on hand and leg
Dyshidrotic Eczema on hand and leg : Is dyshidrotic eczema contagious?

What are the causes?

The exact causes of dyshidrosis are unknown. Previously sweat gland dysfunction was claimed to be the cause. But recent studies disputed the association of sweat ducts with dyshidrotic eczema.

Dyshidrotic eczema may be familial and an autosomal gene responsible for it is also detected. But still, the pathophysiology is unclear. There are some factors which are found to be associated with it and may act as triggering factor. For example:

  • Contact dermatitis

Allergy to heavy metals like nickel and cobalt may aggravate it. Irritant contact dermatitis to cosmetic products, soap, detergents, solvents etc is found related in many studies.The preservatives used in these products are mainly responsible for this.

  • Hyperhidrosis

Excessive sweating may trigger the development of pompholyx.

  • Chronic bacterial skin infection infection

  • Emotional stress

A stress may trigger up the recurrence. The mechanism is unclear.

    1. Environmental factors such as seasonal changes, hot or cold temperatures, humidity etc are reported to exacerbate dyshidrosis
  • Fungal infection

Dermatophytoses and candidiasis may act as triggering factor for dyshidrotic eczema. And in many cases, the disease responds to antifungal therapy.

    1. Intake of immunosuppressive drugs, especially immunoglobulin inhibitors may trigger the development of blisters.
  • Ultraviolet exposure

It is found more among the people who work more in the sun during summer. But interestingly, UVA phototherapy is an effective treatment option for dyshidrotic eczema.

What triggers Dyshidrotic eczema
Can Dyshidrotic eczema spread to other people?

What are the symptoms of pompholyx?

  • The patients usually present with itchy, clear vesicles that are typically located on the sides of the fingers, but they can also occur on the palms and, less commonly, on the soles of the feet and the lateral aspects of the toes.
  • At the initial stage, the vesicles are very small and clear and resemble little bubbles. Later, as they dry and resolve without rupturing, they turn golden brown vesicles.
  • Vesicles are deep-seated and usually described as ‘tapioca’ like or ‘sago’- like without any surrounding erythema. They may coalesce to become large, form bullae, and become confluent. Vesicles typically resolve without rupturing, followed by desquamation.
  • After desquamation, the skin becomes red, dry and cracked.
  • With long-standing disease, the presentation may be complicated. Dystrophic changes may develop along the fingers. There may be discoloration, skin thickening, pitted appearance, irregular transverse ridging etc. Desquamation and maceration of the interdigital spaces may occur even without the presence of fungal infection. Vesicles may become infected secondarily, and pustular lesions may be present. In untreated cases, cellulitis and lymphangitis may develop.

How to diagnose dyshidrosis?

The diagnosis of dyshidrotic eczema is clinical. Usually, no lab investigation is required. Biopsy and histopathology are not required but usually done in reluctant cases to exclude differential diagnosis like ‘dyshidrosis-like variant of adult T-cell leukemia’.

Bacterial culture and sensitivity test may exclude secondary bacterial infection. Blood tests are not done but usually show raised eosinophil count.

Is there any cure for dyshidrotic eczema?

Complete cure for Dyshidrotic eczema is unexpected because of the severe inflammatory process involved and because of frequent recurrences.  In some cases, eczema spontaneously resolves within few weeks. But sometimes the disease become nonresponsive or recurrent frustrating both patient and physician. The management requires the involvement of both doctor and patient. Besides drug therapy, reduction of aggravating factors is also required.

General Management:

  • Keep the affected area clean. But do not wash frequently.
  • It is better to use lukewarm water for washing the affected area as very hot or cold water may cause irritation. Remember to avoid soap and use an emollient or soap substitute.
  • Be very careful about detergents, cleansing agents etc. when doing any jobs in the home. If required, use hand gloves to avoid direct contact. Cotton-lined gloves are preferable than rubber or plastic gloves alone. Even when you need to shampoo your hair, always wear cotton-lined gloves as above. If possible,  during the active phase of the disease, ask someone else to do the shampooing and other household works for you.
  • Do not use waterless cleansers as they contain alcohol, solvents or some other ingredients which may make things worse and trigger flaring.
  • If the itching is so severe to cause sleep disturbance, sedating antihistamines may be helpful at night.
  • If there are large blisters, those can be drained by a large sterile needle. Make a small tear in the blister rather than a pinprick. Because a tiny hole will be sealed up rapidly. But be careful about the overlying layer of skin, do not remove it. if the protective layer is removed, soreness may increase and secondary infection may occur.  It will delay the healing process making the treatment process difficult.
  • Use 100% cotton or silk made gloves, tights, stockings, and socks if possible. Because synthetic fabrics such as nylon are less absorbent than cotton and more irritant.
  • If you have pompholyx on your feet, it may be the result of sensitivity to chromate or chemicals, which are used in shoe leather production. Be aware of using shoes.
  • Covering the skin bandaging or wrapping the feet or hands can bring some relief. It will help to protect the skin and provide maximum opportunity to applied creams and ointments for absorption. Any weeping blisters, however, should be covered with a non-stick dressing, to prevent tearing the blister roof.
  • You can use steroid impregnated tape if it is difficult to keep topical steroids on the hands and feet, which would need to be prescribed by your doctor.

Medical treatment:

The mainstay of pharmacologic treatment are topical high strength steroid and emollient creams. In recalcitrant cases, systemic corticosteroids are the next line of treatment. You need to contact your physician to find out the appropriate drugs and doses for you.

Beside commercially available emollient drugs, natural emollients like olive oil, jajoba oil, petroleum jelly etc are also helpful.

In severe cases, immune modulating medicines are indicated. These include pimecrolimus, methotrexate, mycophenolate mofetil, azathioprine, and ciclosporin.

Where available, alitretinoin is used for resistant disease.

Other treatment options include botulinum toxin A injections which have shown great efficacy in some studies. But still, some more research needed to prove its safety.

Some newer types of anti-inflammatory oral drugs, such as leukotriene inhibitors and phosphodiesterase-4 (PDE4) inhibitors also works in dyshidrotic eczema. Phototherapy with high-dose UVA-1 and UV-free phototherapy have shown efficacy too.

Causal treatment of the pompholyx related to  metal allergy includes avoidance of any contact with nickel-containing metals, a low – nickel/chromium/cobalt diet (in both the child and the mother in cases of breastfed infants)  and, in cases of clearly defined nickel allergy, the administration of chelating agents, such as diethyldithiocarbamate and tetraethyl thiuram disulphide and disodium cromoglycate have occasionally been helpful.

Causal treatment of pompholyx related to superficial mycosis involves the eradication of the fungus and local hygiene.

If there are secondary bacterial infections, antibiotics will be necessary.

Note that, all of these drugs have their own supervision and require supervision by your physician. Contact a dermatologist for best treatment.

How do you get rid of Dyshidrotic eczema?
How do you get rid of Dyshidrotic eczema?

How to prevent dyshidrotic eczema?

As the cause of the disease is unknown, we can’t prevent it primarily. If you have the disease already, you can try to prevent the recurrence of the active episode by avoiding the triggering factors. The general measures described above will help you a lot.

If you don’t have the disease, but there is a family history of dyshidrotic eczema, you should be aware of the aggravating factors. Be careful to handle cosmetics, soap, detergents, cement etc. Avoid excessive moisture. Try to treat any fungal infections promptly. And don’t use any drugs without consulting your physician.

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