Symptoms
So-called dyshidrotic eczema manifests itself in itchy, non-reddened vesicles or blisters (bullae) that may appear on the sides of the fingers, on the palms of the hands, and also on the feet. The rash is often bilateral and symmetrical. The vesicles or blisters are filled with edema fluid (“water blisters”) and are located in the epidermis. They persist for about two to four weeks and may be accompanied by inflammation. Dyshidrotic eczema may recur and may also be chronic. The degree of severity varies. If the symptoms are severe, professional and private activities may be restricted. Superinfections may occur as a complication. The disease was described by Tilbury Fox in 1873. It is also called pompholyx, especially in the presence of large blisters. The name and possible causes are controversial (Storrs, 2007). A renaming to “acute and recurrent vesicular hand dermatitis” has also been recommended.
Causes
Several factors are known to trigger or exacerbate the condition. Many patients have an allergic predisposition (atopy) and atopic dermatitis. Allergic contact dermatitis to various substances such as metals (nickel, chromium, cobalt, see under metal allergy), fragrances, personal care products, cosmetics, and perubalsam may also be a cause. The term dyshidrosis (dyshidrotic) suggests a connection with sweating. This may indeed aggravate the dermatitis in some cases. However, a dysfunction of the eccrine sweat glands is not present! Other possible factors:
- Fungi: dermatophytes, candida.
- Emotional stress
- Temperature changes
- Genetics
- Smoking
- Medication, especially intravenous immunoglobulins (IVIg).
- Minor injuries
- Irritants
Diagnosis
The diagnosis is made in medical treatment based on the patient’s history, physical examination and with an allergy test. Other skin diseases must be excluded.
Nonpharmacologic treatment
- Cold compresses
- Avoiding the triggers (metals)
- Regularly care for the hands with a hand cream
- Use a mild soap
- Modification of risk factors
Drug treatment
Anti-inflammatory and anti-allergic topical glucocorticoids are approved for treatment. In severe cases, oral therapy may also be indicated, for example, with prednisone. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, have anti-inflammatory and immunosuppressive properties like glucocorticoids. They are applied locally as an ointment or cream. Local photochemotherapy with 8-methoxypsoralen or psoralen and long-wave UV-A light is mentioned in the literature. Medications available for self-medication include the following:
- Topical glucocorticoids: hydrocortisone.
- Topical antihistamines
- Topical tanning agents
- Antifungals
- Wound ointments, zinc ointments
- Cardiospermum and witch hazel ointments
- Medicinal baths
