Dyshidrotic eczema is a skin disease characterized by blisters on the palms, sides of fingers and soles of feet. Its exact causes have not yet been fully elucidated, but there is a connection with medications and other substances, fungi, bacteria, viruses, and psychological factors. Therapy focuses predominantly on individual triggers and treatment of the skin change.
What is dyshidrotic eczema?
Dyshidrotic eczema is a dermatological condition that leads to the development of small blisters on the palms of the hands and soles of the feet. The clinical picture represents a specific form of eczema and as such belongs to the inflammatory skin diseases. Other names for dyshidrotic eczema are dyshidrosis or dyshidrosis, pompholyx or dyshidrotic eczema. Two variants can occur in this skin disease: In dyshidrosis lamellosa sicca shows up only as a faint change in the skin. In the short course of the acute phase, the vesicles dry out on their own, leaving behind their empty envelope. This also dries out and gradually detaches from the skin in scales with the regrowth of new skin cells. In the variant cheiropompholyx or podopompholyx, on the other hand, the vesicles are larger, partially merge into each other and form a larger attack surface for infections.
Causes
Originally, researchers considered a malfunction of the sweat glands to be the cause of dyshidrotic eczema. The name of the disease, meaning “bad sweat,” can be traced back to this erroneous conclusion. Today, however, it is known that this cause is not true; the exact factors that cause dyshidrotic eczema are not known. The literature discusses, among other things, the relationship between dyshidrotic eczema and various medications, other chemical substances, bacteria and fungi. Psychological factors such as stress may also play a role in the onset of the condition. For people who suffer from contact allergy or atopy, the likelihood of developing dyshidrotic eczema is increased. In these cases, however, the skin change must not be completely due to one of the two skin diseases, but must be present independently of it; otherwise, despite a similar appearance, it is not dyshidrotic eczema but contact allergy or atopy, respectively. In this context, good differential diagnosis is significant.
Symptoms, complaints, and signs
Itching often occurs on the affected areas of the skin and is typical of eczema of all types. On the palms of the hands, sides of the fingers, and soles of the feet, small blisters form under the skin in dyshidrotic eczema, which are filled with fluid and can cause the overlying tissue to tighten. The fluid inside is yellowish or colorless. Redness of the skin around the blisters is also one of the typical symptoms. In eczema that persists for a longer period of time, the skin may thicken, begin to flake or form a leathery surface. As a result, the skin loses its elasticity, increasing the susceptibility to bleeding cracks. These so-called rhagades usually heal without scarring. Since the skin on the hands and soles of the feet, where the blisters usually form in dyshidrotic eczema, is constantly in motion, the healing process can be protracted. Often, the affected areas tear again and again, especially without the use of ointments.
Diagnosis and course
The external appearance of the skin lesions is usually sufficient for diagnosis. Because allergic reactions can cause similar symptoms, diagnosis often includes allergy testing for contact allergies. In the patch test, the most common allergens that are possible triggers are applied to the skin and covered with a large patch. After 48 and 72 hours, sometimes additionally after 96 hours, the diagnostician checks whether there is a change in the treated skin. A positive reaction means that there is an allergy. In addition to contact allergy, atopy also receives differential diagnostic attention. It can cause atopic eczema, which is similar to dyshidrotic eczema. In the course of the skin disease, the vesicles of the dyshidrotic eczema can flow together; medicine calls this process confluent.In some cases, dyshidrotic eczema is accompanied by an infection, for which viruses and fungi are the main possible causes. The pathogens can penetrate the tissue in particular via burst or scratched blisters. The large blisters in the cheiropompholyx and podopompholyx variants are particularly susceptible to this complication.
Complications
In the disease, discomfort occurs mainly on the skin. Vesicles form, which in most cases are also associated with itching. Often, there is also increased sweating on the skin, which many patients find uncomfortable. The blisters can also burst open, causing a fluid to ooze out. The itching tempts many sufferers to scratch, which usually only intensifies the itching. The quality of life decreases considerably due to the disease. Certain activities are also no longer possible for the patient, as contact with the skin would otherwise lead to pain. The treatment of the symptom is carried out with the help of creams, ointments and medications and in most cases leads relatively quickly to success. There are no further complications. In the case of allergies, the patient must refrain from the respective triggering substance so that the symptoms do not occur. As a rule, the disease can be relatively well contained if attention is paid to a healthy diet. Life expectancy is not limited.
When should you go to the doctor?
If an unusual itching is suddenly noticed, a general practitioner should be consulted. At the latest when the characteristic blisters form under the skin, dyshidrotic eczema must be clarified and treated. In the further course, redness and skin cracks may occur, which should be observed first – in case of bleeding or infection, the doctor must be informed. People who suffer from atopy or a contact allergy are particularly likely to develop dyshidrotic eczema. Likewise, people who regularly take certain medications or chemical substances. Psychological factors such as stress can also favor the skin disease. Anyone who belongs to these risk groups should consult a doctor if symptoms are mentioned. The physician will either be able to clarify the disease beyond doubt or refer the patient to an allergist. In any case, several visits to the doctor are necessary until the dyshidrotic eczema can be diagnosed beyond doubt. If the eczema becomes inflamed, a dermatologist is consulted directly in the best case. In case of major complications, emergency medical services should be contacted.
Treatment and therapy
For external treatment, various ointments, creams and lotions are used. They often contain glucocorticoids, a specific type of corticosteroid. The aim of the active substance is to inhibit the inflammatory reaction. Corresponding ointments are particularly suitable for shorter applications, as they can cause increased side effects if used regularly over a period of weeks or months. Medications containing 9-cis-retinoic acid (alitretinoin) are a treatment option even if glucocorticoid therapy is unsuccessful. Tanning agents may accelerate drying of the blisters on the hands and feet, and zinc ointment may also have an anti-inflammatory effect. Proper hygienic measures can help reduce the risk of complications arising from infection. However, gloves and too frequent hand washing and disinfection – even at work – are considered problematic. Which treatment option is appropriate varies from individual to individual. A decisive factor is the specific cause of the dyshidrotic eczema: provided that a causal treatment is possible, further therapeutic measures can take effect.
Outlook and prognosis
The prognosis of dyshidrotic eczema is good. Although the exact cause is not yet complete, the individual triggers can be treated and therapized with current medical options. In addition, there are various risk factors that promote its occurrence. If the patient manages to avoid these, he favors the further course. As soon as the active ingredients of prescribed medicines develop their anti-inflammatory effect, the symptoms are alleviated. The treatment plan is worked out according to the patient’s individual complaints. In many cases, the patient can actively influence the improvement of his symptoms through his hygiene and cleanliness behavior.The prospect of relief from the skin lesions worsens as soon as the itching of the rash is indulged in. In these cases, the patient is at risk of further pathogens entering the organism. In severe cases, this can lead to blood poisoning. There is a life-threatening situation for the affected person. If psychosomatic reasons lead to the outbreak of the disease, the healing process may take several years. In the case of seasonal causes, the patient experiences phases of complete freedom from symptoms. A return of the eczema is lifelong and possible at any time. The affected person should avoid stress and coordinate the use of skin care products with the doctor to avoid using ingredients that lead to an increase in symptoms.
Prevention
Prevention can target typical triggers in dyshidrotic eczema: Patients can avoid substances that act as triggers in them individually. Patients can also counteract psychological factors such as stress as a preventive measure, for example with relaxation techniques and stress management training.
Aftercare
In the first place, the affected person is in any case dependent on direct treatment by a doctor for this disease. In this context, the measures or possibilities of aftercare are usually very limited, so that the focus is on early detection and further treatment by a doctor. It is also not possible for the disease to heal itself, so that the affected person is always dependent on a visit to a doctor. In the case of this disease, the affected person should avoid infections as far as possible. A high standard of hygiene should be maintained, and the patient should wash frequently. In the event of an infection, a doctor should be consulted first and foremost in order to treat it. Furthermore, most patients are dependent on taking medication. The patient should always ensure that the medication is taken regularly and in the correct dosage in order to alleviate the symptoms permanently and correctly. If the medication causes severe side effects, a doctor should also be consulted before the medication is discontinued. In most cases, this disease does not reduce the life expectancy of the affected person.
What you can do yourself
In dyshidrotic eczema, small blisters form on the hands and feet. The cause of this disorder was previously attributed to a malfunction of the sweat glands, but this is not the case. The trigger for the disease is considered unexplained, but a connection with medications, contact allergies, excessive hygiene and psychological stress is suspected. Affected persons should in any case consult a doctor so that an allergy can be ruled out and the symptoms can be treated professionally. Due to the mostly unknown causes, an important contribution to self-help is to keep a diary to check whether there is a statistical correlation between certain activities and acute episodes of the disease. If more new blisters form a few days after stressful situations, for example an exam or an argument with a superior or family member, psychological factors should be considered as triggers. Those affected can then learn relaxation techniques to better cope with negative stress. A food diary can also be used to determine whether a food allergy may be a contributory cause. In these cases, the affected person may have to change his or her eating habits. The blisters should not be scratched open under any circumstances. Antihistamines in drop form, which are available over-the-counter in pharmacies, help against severe itching. The healing process can also be accelerated in many cases by applying zinc ointment thickly to the affected areas in the evening. Cotton gloves or socks should be worn to allow the ointment to work overnight.
