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Dyshidrotic Eczema: Symptoms, Causes, and Treatments

Posted on February 11, 2021
Medically reviewed by
Brian S. Kim, M.D.
Article written by
Sarah Winfrey

Dyshidrotic eczema, also called pompholyx or dyshidrosis, is a type of eczema that affects the hands and feet. Because it is possible to have more than one type of eczema, this form of the skin condition can occur alone or alongside other forms of eczema.

Dyshidrotic eczema is most common in adults between the ages of 20 and 40. It can be a one-time problem, recur over a lifetime, or be chronic (persistent and long-lasting).

To learn more about dyshidrotic eczema, including its causes, symptoms, and treatment options, MyEczemaTeam spoke with Dr. Brian Kim. Dr. Kim is an associate professor of dermatology, anesthesiology, pathology, and immunology, and serves as co-director of the Center for the Study of Itch and Sensory Disorders at Washington University School of Medicine in St. Louis, Missouri.

Symptoms of Dyshidrotic Eczema

Dyshidrotic eczema occurs on the hands and the feet. Itching, the characteristic symptom of this condition, usually appears suddenly. This is followed by the appearance of small blisters, called vesicles, which are usually seated deep in the skin. These vesicles may merge together over time to form larger blisters.

The vesicles usually last for a few weeks before they dry up, and the affected skin peels off. This can leave the skin particularly tender for a while, and in some cases, can also lead to cracks, making a person susceptible to skin infections.

Dyshidrotic eczema, like other forms of atopic dermatitis, is particularly persistent, Dr. Kim said. “It's very chronic and relapsing,” he noted.

The itching associated with dyshidrotic eczema is usually intense, to the point where it can interfere with daily life. Dr. Kim referred to itching as “the most bothersome symptom” for people diagnosed with dyshidrotic eczema.

Dr. Kim has focused his research on understanding and preventing itching, which is tied to inflammation. He has studied the itch scratch cycle: Immune responses produce inflammation, which cause proteins (called cytokines) to interact with the nervous system directly. This is part of the immune response that produces itching. When a person scratches, they raise that inflammation level even more, releasing additional cytokines and causing more itching. Simply, “scratching leads to inflammation that leads to itch,” he said.

Diagnosis of Dyshidrotic Eczema

Dyshidrotic eczema is usually diagnosed by a dermatology expert. Your dermatologist will examine your skin, ask about the symptoms you’ve been experiencing, and rule out the possibility of other skin conditions before making a diagnosis.

If you have small, itchy, unexplained blisters, you likely have dyshidrotic eczema, Dr. Kim said. “The reality is there aren't that many infections that lead to blisters,” he noted. However, you will need to see a doctor in order to receive a definitive diagnosis of dyshidrotic eczema.

Causes of Dyshidrotic Eczema

Classic eczema, or atopic dermatitis, “can always evolve into all these different variants” of the skin condition — including dyshidrotic eczema, Dr. Kim noted. Because of this, you may have eczema for years before developing dyshidrotic eczema.

Several factors can contribute to the development of atopic dermatitis and dyshidrotic eczema.

Inflammation

While doctors do not know exactly what causes the various types of eczema, the skin condition has been found to be related to inflammation.

The skin becomes inflamed when certain kinds of immune system cells invade the epidermis, irritating and destroying tissue there. This inflammation causes the burning, itching, and blisters that characterize dyshidrotic eczema.

Exposure To Certain Substances

In some cases, dyshidrotic eczema seems to be caused by exposure to certain metals — especially nickel and cobalt. “There are certain things that will trigger people and set different people off,” Dr. Kim said.

Some people with dyshidrotic eczema have been found to have higher levels of immunoglobulin E (IgE) in their bloodstreams than normal as the result of exposure to allergens. Immunoglobulin proteins are key components of the immune system that attach to foreign substances in the bloodstream and destroy them.

Stress

Stress and emotion have been found to significantly affect inflammatory skin conditions. This may be due to the fact that stress can impact the function of the skin’s antimicrobial barrier.

The complex relationship between stress and the immune system, nervous system, and hormonal system — and their effects on inflammation — are still being investigated.

Weather and Seasonal Changes

Extreme changes in temperature from very hot to very cold, and extremes in outdoor moisture levels, such as very humid or very dry weather, can trigger eczema symptoms. Seasonal allergies have also been found to trigger different forms of eczema.

Damp Skin

Some cases of dyshidrotic eczema are triggered by having consistently wet hands or feet. This moisture could be caused by sweat or may result from a job or hobby that requires frequent hand-washing or other contact with water.

Dr. Kim said he sees many cases of dyshidrotic eczema develop “when people have clammy, sweaty hands.”

Treatments for Dyshidrotic Eczema

There is no cure for dyshidrotic eczema, but finding the right treatment can help reduce itching and prevent future flare-ups. It’s important to find the treatment that works for you. Dr. Kim noted that many of the people he sees who are diagnosed with eczema find successful treatments and say, “I didn’t realize how miserable I was.”

Dr. Kim’s research has produced drugs that “are in phase 3 clinical trials right now, and will be approved shortly, in the next year or two,” he said. These drugs will “anesthetize the nerves,” he explained, so people will not experience the need to itch and will be able to stop the cycle of itching before they damage their skin.

Until those drugs are approved, there are multiple treatment options for people diagnosed with dyshidrotic eczema. Many of these are the same treatments for atopic dermatitis in general. At Dr. Kim’s clinic, the providers “use a lot of the same tools and coach people the same way, regardless of their kind of eczema, for the most part.”

Moisturization

Moisturizing the skin is one of the key treatments Dr. Kim recommends to people diagnosed with eczema. Moisturizers can prevent drying, which can help manage itching. Dr. Kim noted that Vaseline (petroleum jelly), which you can get at your local drug store, “is probably still the best moisturizer in the world.”

Topical Corticosteroids

Another first line of defense against atopic dermatitis is a corticosteroid cream or ointment. This prescription medication, which is applied after moisturizing your skin, can reduce inflammation and help blisters disappear more quickly.

Oral Corticosteroids

Oral steroids, which reduce inflammation throughout the body (including in the skin), may be prescribed if your dyshidrotic eczema is severe or if you experience frequent flares. Dr. Kim noted, “Oral steroids are generally discouraged and only used in very unique, severe, refractory cases.”

Immune System Inhibitors

Your dermatologist may prescribe a cream containing calcineurin inhibitors. These medications affect how the immune system functions, reducing outbreaks of atopic eczema. Examples include Elidel (Pimecrolimus) and Protopic (Tacrolimus).

These creams are generally for short-term use only. They’re also reserved for use by people older than 2 years of age, and you should avoid sunlight when you’re using them.

Light Therapy

If your dyshidrotic eczema is persistent and continues even after other treatments, your dermatologist may recommend phototherapy — a technique that exposes the affected skin to either natural sunlight, ultraviolet A light, or ultraviolet B light.

Many people with dyshidrotic eczema find that light therapy is effective, but that it must be repeated. However, long-term use of phototherapy can age your skin prematurely and raise your risk of skin cancer. You and your dermatologist can weigh the pros and cons of this treatment and decide if it is right for you.

Antibiotics

In some cases, people with dyshidrotic eczema may develop swelling, crusting, or pus-filled blisters as the result of a potential bacterial infection. If this occurs, your dermatologist may prescribe oral antibiotics to help treat the infection.

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, more than 33,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Have you been diagnosed with dyshidrotic eczema? Have you found effective ways to treat this condition? Share your experience in the comments below, or start a conversation by posting on your MyEczemaTeam Activities page.

A MyEczemaTeam Member said:

I have been the same since 2008...........

posted 16 days ago

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Brian S. Kim, M.D. is co-director for the Center for the Study of Itch and Sensory Disorders and associate professor of medicine at Washington University School of Medicine in St. Louis. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeams. Learn more about her here.

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