ALL YOU NEED TO KNOW ABOUT DYSHIDROSIS

What is Dyshidrosis?

Dyshidrosis, or otherwise known as Dyshidrotic eczema, is a chronic skin condition that appears as small, itchy blisters on the hands and feet, more common on the lateral sides of fingers and toes. It is common in young adults between the ages of 20 and 40 and is more frequent in women than men. Some cases resolve quickly, but others can persist for long periods.

Causes of Dyshidrosis

The exact cause for dyshidrotic eczema has not yet been identified, but it is hypothesized to have a genetic component. There are a variety of triggers causing the appearance of these lesions. Risk factors include:

• Having another type of eczema, such as atopic dermatitis
• Personal / family history of asthma, allergic rhinitis, eczema
• Nickel or cobalt allergies
• Medications (aspirin, birth control pills)
• Irritants or allergies to ingredients in the skincare products used
• Sweaty hands and/or feet
• Exposure to a lot of wet work such as washing dishes, laundry
• Occupations related to metalwork, mechanics
• Changes in weather
• Hot temperatures
• Stress

Dyshidrotic eczema is not contagious. Flare-ups are often triggered by exposure to nickel, a very common metal. Stressful events and changes in weather are also typical triggers.

Symptoms

Dyshidrotic eczema appears as deep-seated blisters, or what we call vesicles, on the hands and feet. It is most commonly found on the sides of your fingers and toes but can also appear on the palms. Some vesicles group together to form larger blisters. It can be accompanied by intense itching and sometimes, a burning or prickly sensation. Scratching these itchy vesicles can create breaks in the skin and cause secondary bacterial infections with some swelling, redness, and crusting of the lesions.

Dyshidrotic eczema improves in a few weeks. As the blisters clear out, they can leave dark marks (post-inflammatory hyperpigmentation) on the skin. The skin can also appear to be dry and scaly.

Treatment and Management

There is no cure for dyshidrosis, but there are numerous treatment and management options.

Medications:

• Topical corticosteroids - decrease inflammation and calm the red, inflamed skin
• Topical immunomodulators - keep the immune system from overreacting and producing more inflammation
• Oral antihistamines -  address the itch
• Topical or Oral antibiotics - target the secondary bacterial infection, if present
• Topical or Oral antifungals - used if there is a concomitant fungal infection
• Systemic medications such as corticosteroid pills or systemic immunomodulators may be given for severe cases
• Dupilumab - a biologic that may be used in refractory cases

Procedures:

• Phototherapy – used for moderate cases that are not responsive to initial treatment with topical medications. Phototherapy helps reduce the inflammatory response of the skin.
• Botulinum toxin injections – decrease hand/feet sweating which can trigger dyshidrosis

Self-care:

• Proper skin care – includes using mild, hypoallergenic, fragrance-free soaps and moisturizers to protect the skin barrier
• Soaks and cool compresses – can help dry blisters
• Remove rings or any jewelry before washing hands
• Avoid scratching
• Manage stress
• Avoid allergens or irritants that trigger your skin
• Wear gloves. Use cotton gloves if your hands will stay dry throughout the day during work. When doing wet work, use cotton gloves under waterproof gloves or rubber gloves.

Prognosis

Unfortunately, there is no cure yet for dyshidrotic eczema. Lesions usually improve in about 2-3 weeks, but recurrence is highly possible due to its chronic nature. Triggers such as weather changes, stress, or any exposure to irritants may cause new lesions to appear. Some cases are recalcitrant and will need other forms of treatment to address the skin problem.

Take-Home Messages

Dyshidrotic eczema is a constantly recurring skin disorder that can affect the quality of life of those who have it. It can cause emotional distress and problems with social interactions, which can be a debilitating experience. There are several treatment options for this skin condition; improvements will largely depend on treatment compliance. A visit to the dermatologist is recommended for proper treatment and prompt management. Remember that there is no “magic” treatment and that the rate of improvement differs from person to person.

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References:

• Dyshidrotic eczema – Symptoms and causes | National Eczema Association. (n.d.). National Eczema Association; https://www.facebook.com/nationaleczema. Retrieved April 8, 2022, from https://nationaleczema.org/eczema/types-of-eczema/dyshidrotic-eczema/
• Dyshidrotic eczema Information |  Mount Sinai - New York. (n.d.). Mount Sinai Health System. Retrieved April 8, 2022, from https://www.mountsinai.org/health-library/diseases-conditions/dyshidrotic-eczema
• Eczema types: Dyshidrotic eczema overview. (n.d.). American Academy of Dermatology. Retrieved April 8, 2022, from https://www.aad.org/public/diseases/eczema/types/dyshidrotic-eczema
• Pompholyx (dyshidrotic eczema, vesicular hand eczema)  | DermNet NZ. (n.d.). DermNet NZ – All about the Skin  | DermNet NZ. Retrieved April 8, 2022, from https://dermnetnz.org/topics/vesicular-hand-dermatitis

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