Dyshidrosis, also called dyshidrotic eczema, dyshidrotic dermatitis, or vesicular eczema, is a type of hand dermatitis that can also affect the feet. According to the Cleveland Clinic, this type accounts for between five and twenty percent of hand dermatitis. Like most forms of eczema, there is no cure for dyshidrosis, but most individuals can manage the condition. In many cases, symptoms are not constant, and certain triggers cause flare-ups.

Dyshidrotic Eczema

Dyshidrosis forms on the palms of the hands and soles of the feet. Small, fluid-filled blisters develop on the edges of the fingers, palms, toes, and soles. The condition may have a link to seasonal allergies and occurs twice as often in women as in men.

Risk Factors

Though dyshidrosis can affect anyone, it occurs most often in women between the ages of 20 and 40. A person with a history of contact or atopic dermatitis or a family history of dyshidrosis is also at increased risk. Finally, people who have received IVIG for immunotherapy are also more likely to develop dyshidrotic eczema.

Symptoms of Dyshidrosis

Symptoms of dyshidrosis come and go, often lasting a few weeks at a time. Small, firm often painful blisters develop on the hands and feet. Many people experience itchy skin surrounding the blisters, increased sweating around the blistered area, and dry, peeling skin as the blisters subside. The skin may thicken after the blisters disappear.

Diagnosis

A dermatologist or general healthcare provider can usually diagnose dyshidrosis. The exam includes a medical history and determining whether or not the patient came in contact with any irritants that could have caused skin irritation. Any other symptoms should be reported to the physician as well.

Testing

Testing for dyshidrotic eczema focuses on ruling out other potential causes, including ringworm, contact dermatitis, and rare autoimmune diseases. A doctor may perform patch skin testing to check for allergic reactions, and blood tests can rule out autoimmune causes. Skin scraping or biopsies can confirm or rule out infection.

Complications

Most of the time, the most common complications of dyshidrosis are itching and pain that can limit the use of the hands and feet. If someone with dyshidrosis scratches the blisters excessively or the skin gets too dry and cracks, a bacterial infection can occur. Swabs of the affected area can diagnose an infection, and the physician will prescribe an antibiotic.

Treatment

There is no known specific cause of dyshidrosis, so treatment generally depends on preventing flare-ups. Managing stress can help, as can avoiding exposure to irritants and mineral salts such as nickel and cobalt. Taking care of the skin helps, too. Dermatologists recommend people with dyshidrosis use mild soap and lukewarm (rather than hot) water for handwashing, and moisturize regularly. Wearing gloves when there is a risk of contact with irritants can prevent flare-ups, as well.

Additional Treatment

For severe cases of dyshidrosis, a doctor may prescribe topical steroid cream or phototherapy to help manage flare-ups. Large blisters can be drained in the doctor’s office if necessary, and injections of botulinum toxin can reduce sweating, which is a common trigger. An in-home treatment that is often effective is soaking the hands in cool water for 15 minutes a few times a day, then applying a thick barrier repair cream.

Common Triggers

While identifying a specific trigger can be difficult, some factors are common causes of flare-ups, including stress, excessive moisture, and pollen. Nickel is a common trigger found in jewelry, keys, and stainless steel, as well as chocolate, oatmeal, nuts, and canned goods. Another common trigger is cobalt, which is in paints and varnishes, jewelry, and metal snaps and buttons as well as fish, leafy green vegetables, milk, and red meat.

Management is Key

Unfortunately, there is no cure for dyshidrosis. People with this form of eczema commonly experience flare-ups when they are under a lot of stress, when their hands or feet stay wet for long periods, or when the weather starts to warm in the spring and summer. Flares can be mild but can also significantly impact the use of the hands and feet. Learning to manage flares, avoid triggers, and prevent infection are key.