What is Dyshidrotic Eczema? Symptoms, Causes, Diagnosis, Treatment, and Prevention
â€œIt is characterized by tiny blisters or vesicles, usually between the digits, and it can be extremely itchy,â€ says Peter Lio, MD, a dermatologist who is a clinical assistant professor in the department of dermatology and pediatrics at Northwestern University's Feinberg School of Medicine in Chicago, as well as a board member and scientific advisory committee member for the National Eczema Association (NEA). â€œCertain triggers can also make it flare, such as contact with irritating chemicals like soaps or detergents or hand sanitizers, sweating, seasonal changes, and sometimes even just stress.â€
Other causes and triggers include allergic skin reactions, atopic dermatitis, fungal and bacterial infections, exposure to nickel or cobalt, and excessive exposure to water, according to Chesahna Kindred, MD, a dermatologist in Columbia, Maryland, who is an assistant professor at Howard University College of Medicine in Washington, DC.
Dyshidrotic eczema is also a side effect of intravenous immunoglobulin infusions (IVIG), which are typically used to treat certain immune system diseases, according to the AAD. Exposure to cement is another risk factor. (2)
The condition is not contagious, according to the Cleveland Clinic. It tends to affect women more than men, perhaps because women are more likely to be exposed to certain skin irritants, such as nickel or cobalt in jewelry. Itâ€™s also most common in people ages 20 to 40. (3)
Dr. Lio says that cleansing measures related to the COVID-19 pandemic are spurring an increase in the cases heâ€™s seeing, because of increased hand- washing, hand sanitizer use, and stress.
Signs and Symptoms of Dyshidrotic Eczema
Common symptoms, according to the AAD, include: (5)
- Small blisters and rashy skin
- Blisters filled with clear fluid
- Blisters that appear in clusters between fingers and toes or on the edges of fingers, toes, palms, or soles of the feet
- Rashy, scaly, red and cracked skin around the blisters
- Blisters that are very itchy and sometimes painful
- Blisters that dry and peel in about three weeks
Causes and Risk Factors of Dyshidrotic Eczema
â€œAs with other forms of eczema, we do not understand what causes it or why it affects some more than others, but there do appear to be genetics involved, as it is more common in some families,â€ says Lio. â€œFrequent hand-washing, sweaty hands and feet, and contact with irritants or chemicals are all the most common [risk factors]. We see it in many healthcare workers, as you can imagine.â€
According to the AAD, dyshidrotic eczema is more likely to occur if you: (2)
- Have sweaty or moist hands
- Are under stress
- Have atopic dermatitis (also known as eczema)
- Have sensitive skin in general
- Have allergies, including hay fever
- Wash your hands frequently or your hands are often in water
- Work with cement
- Expose your hands to metals, such as chromium, cobalt, or nickel
- Receive intravenous immunoglobulin infusions to treat another medical condition
How Is Dyshidrotic Eczema Diagnosed?
Diagnosing the condition usually involves examining the patient, noting the symptoms and taking the patientâ€™s history, says Lio.
â€œIf we suspect that a contact allergen is driving it, we may perform patch testing. Rarely, fungal infection can cause a very similar picture to occur clinically, so we can perform a scraping and a KOH examination to look for fungal forms,â€ he adds. According to U.S. National Library of Medicineâ€™s MedlinePlus guide, a KOH examination involves scraping the problem area of your skin with a needle or scalpel blade and examining the tissue under a microscope on a slide to which KOH (the chemical potassium hydroxide, a form of lye or potash) has been added. (6)
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â€œWe do not have a cure, but we have many good treatments and many more in development. Usually we can help people get their skin much better so that they can be comfortable and return to normal activities,â€ says Lio.
Some people have a single outbreak that clears without treatment, but it is much more common to have recurring flare-ups throughout life, according to the AAD. (7)
Duration of Dyshidrotic Eczema
If you are experiencing a flare-up, the blisters usually clear with within two or three weeks, according to the AAD. (1)
Treatment and Medication Options for Dyshidrotic Eczema
While there is no cure for dyshidrotic eczema, as Lio says, you can manage most of the symptoms on your own with a doctorâ€™s direction.
â€œTypically, we start with gentle skin care and avoiding triggers,â€ he says. â€œI have some favorite gentle cleansers to use instead of harsh soaps, some super- protective moisturizers, and even a gentle hand sanitizer. If that is enough (and it can be for milder cases), then we can get by without any medications at all.â€
Dr. Kindred says that keeping skin moisturized is an important part of treating dyshidrotic eczema. â€œUse lotions containing ceramides and then cover with a barrier ointment, such as petroleum jelly,â€ she says.
The AAD has additional tips for self-care, such as how to cleanse, moisturize, and avoid triggers.
Doctors and Healthcare Providers Who Can Help You Manage Your Eczema
But with more severe dyshidrotic eczema, medication and other treatments are necessary for symptom relief, say both doctors.
â€œWe usually will add either a topical steroid or a nonsteroidal topical such as tacrolimus to cool things down,â€ says Lio.
According to DermNet NZ, these are among the medications that may be prescribed: (8,9)
- Potent topical steroids such as clobetasol, fluocinonide, halobetasol, and triamcinolone
- Protopic (tacrolimus) and Elidel (pimecrolimus), topical medications that suppress your immune systemâ€™s response in order to help quell a flare-up
- Oral steroids such as Deltasone (prednisone), which may be prescribed for two to four weeks if topical medications arenâ€™t effective
- Oral medications that alter your immune response, such as cyclosporine, methotrexate, or azathioprine
â€œIf that is still not enough, we often use phototherapy with narrow band ultraviolet (UVB) light to cool the inflammation with a specialized light,â€ Lio says.
If the problem is specific irritant or allergy, the treatment may even be dietary. â€œSensitivity to nickel is fairly common, and in extreme cases, we can recommend a nickel-free diet which, while onerous, can help some patients with severe sensitivity,â€ says Lio.
Nickel is present in most foods, and depending on the soil that the food is grown in, the concentrations can vary greatly, according to an article in the Indian Journal of Dermatology. A nickel-free diet should avoid cocoa, chocolate, soybeans, oatmeal, nuts, almonds, legumes, drinks and vitamin supplements with nickel; canned food (due to leaching of nickel from cans into food); and fish that show high concentration of nickel, such as tuna, herring, shellfish, salmon, and mackerel. He notes that whole wheat, whole grain, rye, oats, millet, buckwheat, and licorice are high in nickel, as are some vitamin supplements. (10)
Integrative and Complementary Approaches
â€œThere are many natural moisturizers that can be soothing, such as sunflower seed oil and coconut oil,â€ says Lio. He adds that soaking in diluted apple cider vinegar or black tea can help to dry blisters. â€œFor milder cases, these can be enough to get people through, but usually if things are more severe, we often need more powerful treatments.â€
Research into the bathing remedies he mentions have had mixed results on people with related types of eczema.
Prevention of Dyshidrotic Eczema
While you canâ€™t prevent dyshidrotic eczema, you can do a number of things to avoid or minimize flare-ups.
â€œAvoid triggers, wear cotton-lined gloves when washing dishes and doing other wet work, and keep other skin diseases under control,â€ counsels Kindred.
To this list, Lio adds: Wear lightweight clothing and avoid gloves, socks, and shoes that trap moisture and donâ€™t allow your skin to breathe.
Complications of Dyshidrotic Eczema
The complications of this condition can be very painful and disruptive. â€œSometimes the hands are cracked, fissured, and bleeding, and it can cause lots of pain,â€ says Lio. â€œSome people can't work due to the severity. I recently had a surgeon [as a patient] with such bad dyshidrotic eczema that he was on disability. I'm happy to say that we got him better and he is operating again.â€
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The AAD concurs that symptoms range from mild to debilitating. â€œA severe flare on your feet can make walking difficult. Having many blisters on your hands can make it difficult to work and perform everyday tasks like shampooing your hair and washing dishes,â€ according to the organization. (1)
Constant scratching also tears the skin, increasing the risk of skin infection. According to the AAD, a staph infection (caused by the bacteria staphylococcus) may result. Signs of a staph infection include the development of pus in blisters, pain, swelling, and crusting. (5) Usually skin staph infections are mild, but if they are left untreated and the bacteria enter your bloodstream or other organs, life-threatening complications such as sepsis could result, according to Penn Medicine. (13)
Research and Statistics: How Common Is Dyshidrotic Eczema?
The condition tends to affect women more than men, according to the Cleveland Clinic. It is most common in adults between ages 20 and 40. (3)
Mental Health and Dyshidrotic Eczema
In addition to physical anguish, flare-ups of dyshidrotic eczema can lead to mental anguish. For those whose hands are affected, â€œit is in a highly visible area that can't be covered with clothing, so many patients feel ashamed or embarrassed about their skin,â€ notes Lio. Also, severe cases can interfere with a person's ability to work or carry out routine daily tasks involving hands or feet â€” stressful situations brought on by a condition that itself is aggravated by stress.
How Stress Can Trigger Eczema and How to Avoid a Flare-Up
The NEA reports that a survey they conducted about a related condition, atopic dermatitis, found that 30 percent of people with atopic dermatitis were also diagnosed with depression or anxiety. The organization recommends speaking with your healthcare provider or a mental health professional if you are experiencing symptoms of mental illness. Self-care is important too, such as getting adequate sleep, practicing relaxation techniques, and finding a peer support group. (14)
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