Dyshidrosis
Overview
Dyshidrosis is a skin condition that causes
small, fluid-filled blisters to form on the palms of the hands and sides of the
fingers. Sometimes the bottoms of the feet are affected too.
The blisters that occur in dyshidrosis
generally last around three weeks and cause intense itching. Once the blisters
of dyshidrosis dry, your skin may appear scaly. The blisters typically recur,
sometimes before your skin heals completely from the previous blisters.
Treatment for dyshidrosis most often includes
creams or ointments that you rub on the affected skin. In severe cases, your
doctor may suggest corticosteroid pills, such as prednisone, or injections.
Dyshidrosis is also called dyshidrotic eczema and pompholyx.
Symptoms
The blisters associated with dyshidrosis occur
most commonly on the sides of the fingers and the palms. Sometimes the soles of
the feet also can be affected. The blisters are usually small — about the width
of a standard pencil lead — and grouped in clusters, with an appearance similar
to tapioca.
In more-severe cases, the small blisters may
merge to form larger blisters. Skin affected by dyshidrosis can be painful and
very itchy. The blisters dry and flake off in about three weeks.
Dyshidrosis tends to recur fairly regularly
for months or years.
When to see a doctor
Call your doctor if you have a rash on your
hands or feet that doesn't go away on its own.
Causes
The exact cause of dyshidrosis isn't known. It
can be associated with a similar skin disorder called atopic dermatitis
(eczema), as well as with allergic conditions, such as hay fever. Eruptions may
be seasonal in people with nasal allergies.
Risk factors
Risk factors for dyshidrosis include:
·
Stress. Dyshidrosis appears to be more common
during times of emotional or physical stress.
·
Exposure
to certain metals. These include
cobalt and nickel — usually in an industrial setting.
·
Sensitive
skin. People who
develop a rash after contact with certain irritants are more likely to
experience dyshidrosis.
·
Atopic
dermatitis. Some people with
atopic dermatitis may develop dyshidrotic eczema.
Complications
For most people with dyshidrosis, it's just an
itchy inconvenience. For others, the pain and itching may limit the use of
their hands or feet. Intense scratching can increase the risk of a bacterial
infection developing in the affected skin.
Prevention
Because the cause of dyshidrosis is generally
unknown, there's no proven way to prevent this condition. You may help prevent
the condition by managing stress and avoiding exposure to metal salts, such as
cobalt and nickel.
Good skin care practices may help protect the
skin as well. These include:
·
Using mild cleansers
and lukewarm water to wash your hands and drying your hands well
·
Moisturizing regularly
·
Wearing gloves
Diagnosis
In most cases, your doctor can diagnose
dyshidrosis based on a physical exam. No lab test can specifically confirm a
diagnosis of dyshidrosis, but your doctor may suggest tests to rule out other
skin problems that have similar symptoms.
For example, a scraping of your skin can be
tested for the type of fungus that causes athlete's foot. Skin allergies and
sensitivities can be revealed by exposing patches of your skin to various substances.
Treatment
Depending on the severity of your signs and
symptoms, treatment options may include:
·
Corticosteroids. High-potency corticosteroid creams and
ointments may help speed the disappearance of the blisters. Wrapping the
treated area in plastic wrap can improve absorption. Moist compresses also may
be applied after the application of a corticosteroid to enhance the absorption
of the medication.
In severe cases, your doctor may prescribe corticosteroid pills,
such as prednisone. Long-term use of steroids can cause serious side effects.
·
Phototherapy. If other treatments aren't effective,
your doctor may recommend a special kind of light therapy that combines
exposure to ultraviolet light with drugs that help make your skin more
receptive to the effects of this type of light.
·
Immune-suppressing
ointments. Medications such
as tacrolimus (Protopic) and pimecrolimus (Elidel) may be helpful for people
who want to limit their exposure to steroids. A side effect of these drugs is
an increased risk of skin infections.
·
Botulinum
toxin injections. Some doctors may
consider recommending botulinum toxin injections to treat severe cases of
dyshidrosis.
Lifestyle and home
remedies
Home treatment might include:
·
Applying
compresses. Wet, cool
compresses may help reduce itching.
·
Taking
anti-itch drugs. Over-the-counter
antihistamine medications such as diphenhydramine (Benadryl) or loratadine
(Claritin, Alavert, others) can help relieve itching.
·
Applying
witch hazel. Soaking the
affected areas in witch hazel may speed healing.
Preparing for your
appointment
You're likely to start by seeing your family
doctor. He or she may refer you to a doctor who specializes in skin disorders
(dermatologist). Here's some information to help you get ready for your
appointment.
What you can do
Before your appointment, you may want to write
a list that answers the following questions:
·
Have you experienced
this problem in the past?
·
Do you have allergies
to certain substances such as rubber, glues, fragrances or nickel?
·
Have your stress
levels worsened recently?
·
What medications and
supplements do you take regularly?
·
Are you exposed to
certain metals or chemicals in the work setting or through hobbies?
What to expect from
your doctor
Your doctor is likely to ask you a number of questions,
such as:
·
When did you first
begin experiencing symptoms?
·
Have your symptoms
been continuous or occasional?
·
How severe are your
symptoms?
·
What, if anything,
seems to improve your symptoms?
·
What, if anything,
appears to worsen your symptoms?
·
Are you exposed to
chemicals or metals in the work setting or through a hobby?
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