Dyshidrotic Eczema (Dyshidrosis)

What is dyshidrotic eczema?

Dyshidrotic eczema is a chronic (long-term) skin condition that causes small blisters and dry, itchy skin. It usually develops on your fingers, hands and feet. Other names for dyshidrotic eczema include dyshidrosis, acute palmoplantar eczema, vesiculobullous dermatitis and pompholyx.

Who does dyshidrotic eczema affect?

Dyshidrotic eczema can affect anyone. However, it most commonly affects people:

• Between the ages of 20 and 40.
• Who are female.
• With a personal or family history of eczema.
• With a personal or family history of contact dermatitis.
• Who develop allergic reactions when they touch an antigen, which is a foreign substance that causes an allergic reaction.
• Who receive immunoglobulin infusions. Intravenous immunoglobulin (IVIG) is an injection of antibodies for people with an immune deficiency.

About 50% of dyshidrotic eczema cases occur in people who have allergic reactions when they touch an antigen. Researchers think that females may be more likely to develop dyshidrotic eczema because they more frequently interact with certain antigens, like nickel and cobalt in jewelry.

How common is dyshidrotic eczema?

In occupational or clinical settings, dyshidrotic eczema accounts for 5% to 20% of all cases of hand dermatitis.

How does dyshidrotic eczema affect my body?

Dyshidrotic eczema affects the skin around the palms of your hands, fingers and soles of your feet.

Your skin may develop bumps or blisters that look like tapioca pearls. These blisters are typically one to two millimeters in diameter. The blisters may come together to form one large blister.

After your blisters have dried out, they may become scaly and cracked.

What are the symptoms of dyshidrotic eczema?

Dyshidrotic eczema causes symptoms that come and go. These symptoms may last for several weeks at a time. The most common symptoms of dyshidrotic eczema include:

• Small, firm blisters on the sides of your palms, fingers and soles.
• Painful blisters.
• Itchy, scaly skin on or around your blisters.
• Increased sweat around your blisters.
• Dry, cracked skin that appears as blisters fade.

The skin on your fingers, hands and feet may thicken if you scratch them frequently. Large blisters or large areas of blisters may become infected.

What triggers dyshidrosis?

Healthcare workers and researchers don’t know exactly what causes dyshidrosis. A combination of triggers can cause dyshidrosis flare-ups, including:

• Immune system activation: If you have dyshidrotic eczema, your immune system reacts to minor irritants or allergens. This overreaction can inflame your skin.
• Allergies: Exposure to certain substances, including cement, nickel, cobalt and chromium, may trigger dyshidrotic eczema. Other allergies, including hay fever (allergic rhinitis) or food allergies, may also cause flare-ups.
• Moisture: Frequently sweaty or wet hands or feet may trigger dyshidrotic eczema.

Can dyshidrosis spread?

In severe cases, dyshidrosis blisters may get bigger and spread to the backs of your fingers, hands and feet. They won’t spread to other parts of your body.

Is dyshidrotic eczema contagious?

Dyshidrotic eczema isn’t contagious. You can’t spread it to another person.

If you scratch your blisters, you may break your skin, which can lead to infections. If your blisters become infected, contact your healthcare provider. They may prescribe antibiotics to clear your infection.

How is dyshidrotic eczema diagnosed?

Your healthcare provider will examine the affected areas on your skin. They may ask if you’re undergoing significant stress or have a personal or family history of dyshidrotic eczema. They may also ask if you’ve recently started using new skin care products, wearing new jewelry or eating new foods.

What tests will be done to diagnose dyshidrotic eczema?

Your healthcare provider may perform several tests to confirm their diagnosis or rule out conditions that look similar to dyshidrotic eczema, including contact dermatitis, bullous pemphigoid and hand, foot and mouth disease. The tests may include:

• Allergy test.
• Biopsy.
• Blood tests.

How do you get rid of dyshidrotic eczema?

For many people, getting rid of dyshidrotic eczema starts with an at-home skin care routine. Home care may include:

• Using warm water instead of hot water when washing your hands.
• Soaking your hands and feet in cool water to improve your symptoms.
• Applying cool compresses as needed to relieve itching and irritation. Soak a clean washcloth with cool water and hold it to your skin for 10 to 15 minutes. Allow the water to partially evaporate (air dry) and then immediately apply moisturizer. Repeat this three to four times per day.
• Applying moisturizers frequently each day to improve dry skin.
• Thoroughly drying your hands and feet after bathing or swimming.
• If possible, don't wear gloves, socks or shoes. If you must, wear gloves that repel or absorb moisture, cotton or wool socks that absorb moisture and loose shoes.

Your healthcare provider may recommend over-the-counter (OTC) medications such as topical corticosteroid creams or ointments that you rub directly on your skin. They may also recommend oral antihistamine pills, including fexofenadine (Allegra®) or cetirizine (Zyrtec®), that you swallow with water. These medications help reduce inflammation and itching.

What prescription medications or treatments are used to treat dyshidrotic eczema?

In more severe cases of dyshidrotic eczema, your healthcare provider may prescribe or recommend the following medications or treatments to help relieve your symptoms:

• System-wide corticosteroids: If corticosteroid creams or ointments don’t relieve your symptoms, your healthcare provider may prescribe an oral corticosteroid, like prednisone (Deltasone®).
• System-wide nonsteroidal immunosuppressive drugs: Long-term use of oral steroids may be unhealthy, so your healthcare provider may prescribe medications such as methotrexate tablets (Rheumatrex®), mychophenolate tablets (CellCept®) or dupilumab injections (Dupixent®).
• Phototherapy: Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps. The ultraviolet light waves in the light can help certain skin disorders, including dyshidrotic eczema. UVB can cause permanent dark spots (hyperpigmentation) in darker skin color, so it’s a good idea to check with your healthcare provider if you have darker skin.

What is the fastest way to get rid of dyshidrotic eczema?

Your body is unique. You may respond well to an at-home skin care routine and OTC medications, or you may require prescription-strength corticosteroid creams or ointments, like clobetasol (Cormax®).

Dyshidrotic eczema usually goes away with treatment, but it may come back later. You may need to follow a specific skin care routine at home or continue using medication to reduce your symptoms.

What can I expect if I have dyshidrotic eczema?

If you have dyshidrotic eczema, you can take action to reduce your likelihood of flare-ups. A good skin care routine and medicines such as antihistamines can help you manage your symptoms. Other therapies, including phototherapy, can help as needed.

How can I prevent dyshidrotic eczema?

You can’t prevent dyshidrotic eczema. It’s a chronic medical condition that may come and go throughout your life.

How do I take care of myself?

Many people live with dyshidrotic eczema, though it can be challenging.

You may have dyshidrotic eczema once and then never have it again, or it may come and go throughout your life. There may be times when your dyshidrotic eczema disappears. These times are called remission periods. A good skin care routine and treatment aim to prevent flare-ups and extend remission periods.

Be sure to avoid anything that triggers dyshidrotic eczema, moisturize your skin, take your medicine and follow your healthcare provider’s recommendations.

You can do a few things to make your blisters more comfortable, including:

• Wash your affected areas gently with a mild soap.
• Apply antibacterial cream or ointment.
• Cover your affected areas with a bandage or gauze.
• Change your bandages at least once a day.

It can be tempting to pop your blisters. However, it’d be best if you didn’t break your blisters or peel them off. The skin on your blisters protects the deeper layers of your skin from infection.

When should I see my healthcare provider?

Call your healthcare provider as soon as you notice blisters on your hands, fingers and feet.

What questions should I ask my doctor?

• How can you tell that I have dyshidrotic eczema?
• If I don’t have dyshidrotic eczema, what other skin condition might I have?
• Is there a cream or ointment that you can prescribe?
• What medications do you recommend?
• What at-home treatments do you recommend?
• Is there a specific brand of moisturizer that you recommend?
• Should I see a dermatologist or another specialist?