Definition

Dyshidrosis is a skin condition characterized by the presence of tiny, fluid-filled blisters that frequently manifest on the palms and fingers. Occasionally, it may also manifest on the plantar surface of the feet. Dyshidrosis, alternatively referred to as dyshidrotic eczema or pompholyx, often has a duration of approximately three to four weeks and induces intense pruritus.

After drying the blisters, the skin typically exhibits a flaky appearance. Dyshidrosis may occasionally resurface before the complete resolution of the previous dyshidrosis. It is commonly managed with lotions or creams. In severe cases, patients could be prescribed oral or intravenous corticosteroids.

Causes

The precise etiology of dyshidrosis remains unclear. There seem to be correlations between this illness and other skin disorders, such as atopic dermatitis, and allergic conditions like urticaria, which are characterized by the presence of allergic skin rashes. Dyshidrosis is believed to be linked to seasonal allergies.

Individuals suffering from dyshidrosis typically exhibit hypersensitivity or excessive sensitivity to certain substances, including:

• Metals, especially cobalt and nickel
• Certain ingredients in soaps or moisturizers
• Certain medicines, such as oral contraceptives or aspirin
• Cigarettes
• Skin infections, such as athlete's foot (tinea pedis)
• Certain therapy, such as IVIG

Stress can also cause dyshidrosis, particularly during seasonal changes. Certain individuals may experience relapses during high temperatures and humidity periods when UVA radiation is most potent. Meanwhile, others may experience a relapse when exposed to low temperatures. 

Risk factor

Risk factors associated with dyshidrosis include:

• Hereditary or genetic factors. Individuals with a family member with dyshidrosis are at an increased risk of developing this condition
• Age 20-40 years
• Stress. Stress is typically associated with a higher incidence of dyshidrosis
• Exposure to certain metals in industrial settings, such as cobalt and nickel
• Exposure to certain cement (potentially contain cobalt and nickel)
• Sensitive skin, individuals who easily develop skin rashes after they are exposed with irritant agents, are more at risk of developing dyshidrosis
• Other types of dermatitis, some individuals with atopic dermatitis for example, are more susceptible to developing dyshidrotic eczema
• Seasonal allergies
• Asthma
• Medical history of allergic sinusitis

Dyshidrosis in children

Eczema, or atopic dermatitis, is more prevalent in babies and children than in adults. Approximately 10-20% of children exhibit an alternative form of eczema. It is common for individuals to experience both atopic dermatitis and eczema from childhood to adulthood. In contrast, dyshidrosis can also occur in children, although it is infrequent.

Symptoms

The initial symptoms of dyshidrosis typically manifest as pruritus and stinging sensations, with no apparent rash yet. Subsequently, fluid-filled blisters may manifest on the palms of the hands, spaces among fingers, or feet. Severe cases may result in blisters distributing to the hands, body, and feet.

In more severe cases, small blisters may merge to form larger blisters. The symptoms are characterized by pain, intense itching, and reddish lesions. In the event of a bacterial infection, the blisters will feel painful with pus discharge. Dyshidrosis typically recurs in several months or even years.

Dyshidrosis typically resolves spontaneously over a span of 3–4 weeks. Nevertheless, upon the disappearance of the blisters, the skin typically exhibits signs of dryness and flakiness. Dark patches may form in individuals with darker skin tones following the healing of blisters.  

Diagnosis

Many skin conditions can result in blisters, so if you have been having blisters, redness, and itching for more than a week, you should see a doctor or dermatologist.

The doctor will examine your skin and inquire about any lifestyle changes that may have contributed to the development of blisters. For example, the doctor may want to know if you are using new products that differ from your usual routine, if you are experiencing high levels of stress right now, or if your job or hobbies require you to touch or come into contact with metal.

The majority of cases can be diagnosed through the patient's symptoms and the skin lesions observed in physical examination. There are no specific laboratory tests to confirm the diagnosis of dyshidrosis.

However, in some cases, diagnostic tests could be recommended to exclude other skin conditions that exhibit similar symptoms. For instance, a skin scraping test could be done to identify the specific fungi responsible for an athlete's foot. The assessment of allergies and skin sensitivity can be checked with a skin prick test, wherein different allergenic substances are applied to the skin to see whether the patients have allergy reactions or not.

Management

The severity of your signs and symptoms will determine the treatment that you will receive. Among the available treatments are:

• High-potency topical corticosteroids have the potential to accelerate the healing process of blisters. Covering clear plastic wrap to the affected area applied with steroids facilitates the absorption of the medication to the skin. Additionally, you might also use a moist bandage. Doctors may prescribe oral corticosteroids in severe cases. Nevertheless, prolonged use of steroids can result in severe adverse reactions, thus it is imperative to adhere to the doctor's instructions when consuming these medications.
• Phototherapy. In cases where alternative treatments prove to be ineffective, doctors may suggest specialized light therapy, which involves the integration of ultraviolet light and medication to enhance the skin's absorption of the light therapy.
• Topical immunosuppressants. Tacrolimus and pimecrolimus are effective medications for individuals seeking to reduce their steroid use. These medicines still have adverse effects, and they could elevate susceptibility to skin infections.
• Injection of botulinum toxin. Certain physicians may contemplate using botulinum toxin injections as a treatment for severe cases of dyshidrosis.

Home Remedies

Remedies that you can do at home are:

• Compress. Applying cold compresses can help in relieving itchiness.
• Antihistamine medicine. You can use over-the-counter (OTC) antihistamines like diphenhydramine or loratadine to relieve itchiness.
• Dietary adjustments. Nickel and cobalt are natural elements that are commonly present in many food sources. Brazil nuts, flaxseed, and chickpeas are sources of cobalt. Cereals, tea, and dried fruits contain nickel. If a physician believes that an allergy to nickel or cobalt is the cause of dyshidrosis, they may recommend a point-based diet low in cobalt and nickel. The point value of a food or drink increases proportionally with the quantity of nickel or cobalt present. Participants will be required to calculate their food points. Nevertheless, due to the abundance of nutritious foods that contain these natural elements, it is advisable to get guidance from a medical professional before starting this point-based diet alone.

Complications

For most people with dyshidrosis, the only complications are discomfort from itchiness. For some individuals, the sensation of pain and itchiness might restrict them from using their hands or feet and disrupt their sleep patterns. Persistent scratching resulting from itchiness will heighten the susceptibility to bacterial infection in the affected skin.

Prevention

As the cause of dyshidrosis is generally unknown, no established method exists to prevent this condition. Several strategies can be taken to decrease the likelihood of dyshidrosis, namely managing stress and avoiding exposure to metals, such as cobalt and nickel. Effective skin care practices are essential to protect the skin. Examples of these include:

• It is recommended to use a gentle cleanser and warm water for washing your hands, followed by thorough drying
• Regularly moisturizing the skin
• Putting on gloves, particularly if you'll be touching substances or objects that typically trigger allergies

When to see a doctor? 

Seek medical advice if you experience persistent rashes, blisters, or lesions on your hands or feet that do not heal.

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