Occurence of Dyshidrotic Eczema

Dyshidrotic (a.k.a. hand-and-foot) eczema appears as intensely itchy blisters on the hands, fingers, and soles of the feet. When it affects the hands it's called cheiropompholyx and when it affects the feet it's called pedopompholyx. It is also known as pompholyx, keratolysis exfoliativa, or vesicular eczema of the hands and/or feet. The term pompholyx (Greek "bubble") is generally reserved for the cases of deep-seated itching blisters which are generally associated with, but not caused by, excessive sweating (hyperhydrosis).

Dyshidrotic dermatitis (pompholyx) is a form of hand eczema, more common in women, which starts on the sides of the fingers as itchy little bumps and then develops into a rash. The condition can also affect only the feet. Some patients have involvement of both the hands and feet.

Hand eczema is the general term used to describe a variety of skin irritations that your hands can develop. You may have itchy, scaly patches of skin that flake constantly. Or your hands may become red, cracked, and painful. In some cases, the rash worsens into weepy bumps. These problems can happen to anyone at any time of life, but they are more likely to occur if:

  • You had similar skin problems, hay fever or other allergies as a child. (Doctors call this set of symptoms "atopy".)
  • Your hands get wet a lot, whether at home, work, or play
  • Your job exposes your hands to irritating chemicals

Dishpan hands is actually a form of hand eczema which occurs because constant wetting and drying breaks down the skin's protective outer barrier. If you already have hand eczema or are recovering from an episode, you need to avoid getting water on your hands so often. Perfumes and preservatives in soaps and irritants in household cleansers can also make symptoms worse.

Unfortunately, there is no quick and easy solution to hand eczema. Clearing up an episode of the condition can take several months, and you'll need to continue babying your hands for as long as a year even though they appear to be eczema-free.

Causes of Dyshidrotic Eczema

Though the exact cause is unknown, there are several factors concerning the cause of dyshidrotic eczema including:

  • Excessive sweating - The original hypothesis of sweat gland dysfunction has been disputed because the type of lesions which form are not associated with sweat ducts. People with this form of eczema do not suffer from excessive sweating (hyperhidrosis).
  • Colds and allergies - Dyshidrotic eczema is sometimes associated with skin conditions resulting from colds and allergies. Of the people with dyshidrosis, one half of them suffer from atopic eczema (cold or allergy induced eczema).
  • Fungal infection - In some patients, a distant fungal infection can cause hand eczema (palmar pompholyx) as an initial reaction. In one study, one third of pompholyx occurrences on the palms resolved after treatment for tinea pedis.
  • Diet - A tiny percentage of individuals with the condition note flares in their condition after ingesting metal salts, specifically chromium, cobalt, and nickel. Diets that eliminate these metal salts may help in some cases.
  • Emotional stress - Dyshidrotic eczema often appears during times of stress, anxiety, or worry.
  • Genetic predisposition - Dyshidrotic eczema tends to run in families.
  • Certain work exposures (e.g., cobalt) and/or recreational exposures
  • Recent exposure to contact allergens (e.g., nickel, balsams, paraphenylenediamine, chromate, sesquiterpene lactones) before condition flares
  • Exposure to contact irritants before condition flares
  • Recent exposure to costume jewelry (patients with palmar pompholyx and allergic to nickel)
  • Recent treatment with intravenous immunoglobulin therapy

Hand eczema occurs most often in people who frequently have their hands immersed in water, such as food preparers, nurses, or florists. wearing protective gloves can help these sufferers to reduce flare ups. The warm, moist conditions in shoes provide an ideal situation in which foot dermatitis may also flourish. These eruptions often become chronic and can be severe. Chronic hand-and-foot eczema is similar to other forms of dermatitis in appearance.

As in other forms of hand eczema, dyshidrotic eczema is aggravated by contact with irritants such as water, detergents, and solvents. Contact with them must be avoided as much as possible and protective gloves worn.

Other possible triggers include:

  • Deodorant soaps and strong detergents
  • Extremely stressful situations
  • Rubber or latex gloves next to the skin. If you must wear gloves, be sure to wear a cotton liner under them.

Dyshidrotic eczema is often a chronic condition, but it may go away for long periods of time. It often reappears after a period of nervous tension, worry, or stress. Unfortunately this form of eczema does not have any quick sure cure.

Symptoms of Dyshidrotic Eczema

Dyshidrotic eczema is characterized by the sudden onset (1-3 days) of deep-seated, clear blisters on the hands specifically on the palms and/or sides of fingers and/or on the feet on the soles and/or sides of the toes. The blisters are often accompanied or precluded by a burning feeling or itching. In the later stages, there is more peeling, cracking, or crusting of the skin along with scaling, thickening, and painful fissuring typically occurring. With long-standing disease, some sufferers' fingernails may reveal dystrophic changes (e.g. irregular transverse ridging, pitting, thickening, discoloration). Occasionally secondary infection with staphylococcus bacteria can occur during a flare up, resulting in pain, redness, swelling, and crusting or pustules.

Some sufferers will have mostly one stage, while others will have mostly the other. Sometimes both stages occur at the same time. In 80% of people who suffer from dyshidrotic eczema, only the hands are affected. In 10%, only the feet are affected and in the remaining 10%, both hands and feet are involved. In many sufferers, the condition worsens during the summer months. Episodes can vary in frequency from once per month to once per year.

Controlling Dyshidrotic Eczema

Once someone has suffered an episode of hand eczema, the risk of having another one increases greatly. For some people, hand eczema becomes chronic. Clearing up hand eczema depends largely on how a sufferer change day-to-day habits. The following tips are useful for controlling dyshidrotic eczema:

  • Wash hands using lukewarm water and a perfume-free cleanser such as Cetaphil® "Moisturizing Gentle Cleansing Bar for Dry Sensitive Skin".
  • Dry hands after washing them by bloting them dry gently and immediately apply a moisturizer. Jojoba oil (100% natural) is very good to use.
  • Use oral antihistamines (such as Benadryl) as a possible way to help relieve the itching.
  • Avoid using waterless or antibacterial hand cleansers for they contain alcohol, solvents, and other ingredients that may make your problem worse.
  • Keep several pairs of cotton gloves around the house to protect hands while doing dry chores. Even folding laundry can irritate tender skin. Wash the gloves if they get dirty. If one's fingertips aren't affected by hand eczema, cut the glove tips off to stay cooler in hot weather. For wet work, put on cotton gloves and then cover them with unlined, powder-free vinyl or neoprene gloves. (Latex in rubber gloves can cause allergies.) Afterward, wash reusable gloves inside and out and let them air dry thoroughly. Toss the cotton gloves in the washer.
  • Wear gloves (such as vinyl ones) when peeling potatoes and when working with meat, onions, peppers, or acidic fruit such as citrus and tomatoes. After preparing these foods, throw the gloves away. If a reusable vinyl glove gets a hole in it, throw the glove away. Wearing a glove with a hole in it is worse than wearing no glove at all. If water gets in the glove, take the glove off immediately.
  • Avoid wearing waterproof gloves more than 15 or 20 minutes at a time. If it is necessary to wear waterproof gloves for longer than that, apply a moisturizer to the hands beforehand.
  • Ask someone else to shampoo one's hair. Or wash one's hair while wearing waterproof/cotton liner glove combination. Use rubber bands on the forearms to keep water out of the gloves.
  • Remove rings when doing housework and before washing and drying one's hands. Also, clean rings regularly by soaking them overnight in 1 tablespoon of ammonia in a pint of water. Rinse and dry the rings before wearing.
  • Use the washing machine and the dishwasher, not one's hands, to do laundry and dishes. If dishes must be washed by hand, do it under running water. Use a long-handled scrubber to minimize hand damage from hot water.
  • For outdoor work, wear unlined leather or thick fabric gloves to protect the hands. Leather gloves also will protect hands in dry, windy, or cool weather. Avoid wool because it may be prickly and irritating.
  • Apply Eczema-Ltd III patented topical skin conditioner disks to the affected areas.

If a sufferer's job is causing hand eczema, the doctor will help determine what irritating chemicals or work practices are contributing to the condition. In addition to modifying those risks, many of the same hand-protective strategies useful at home also can help at work. Here are some ideas:

  • Use heavy-duty vinyl or neoprene gloves and cotton gloves when doing wet work. Wash the cotton gloves regularly, as well as the vinyl gloves if they aren't disposable.
  • Wear leather or clean, heavy-duty fabric gloves for dry work.
  • Avoid using industrial hand cleansers or waterless or antibacterial cleansers that contain irritating ingredients.
  • Keep work clothes, protective clothing, tools, and work surfaces clean. Irritant residues on them can aggravate eczema.
  • Treat all minor wounds on hands and bandage them to avoid giving irritants and allergens an easy route into the skin.
  • Keep hand moisturizer and/or prescription medication readily accessible to prevent problems.

Ironically, the more water there is in a lotion or other moisturizer, the more likely it is to worsen hand eczema. So-called "cream" moisturizers contain more water than oil. When the water evaporates, these moisturizers have a net drying effect on the skin. (They are called cream moisturizers because they are white in color.) The very best moisturizer for hand eczema is a greasy one. It has very few ingredients, holds the skin's natural moisture in and provides a protective barrier to keep irritants out. The following are lotion and moisturizer ingredients to avoid:

  • Methyldibromoglutaronitrile/phenoxyethanol methylchloroisothiazolinone/methylisothiazolinone
  • Botanicals (can cause allergic reactions, even if they are natural)
  • Lanolin
  • Propylene glycol
  • Fragrances
  • Formaldehyde (Formalin, Formol, Methanal, Veracur, etc.)
  • Formaldehyde releasers
  • 2-bromo-2-nitropropane-1, 3-diol (Bronopol)
  • Diazolidinyl urea (Germaben II or Germal II)
  • Imidazolidinyl urea
  • Retinol or vitamin A
  • Citric or fruit acids

In addition to the tips and information provided above, sufferers should also make a point of avoiding contact with substances to which they are allergic or have shown past skin sensitivity. Though there is no cure for eczema, taking steps to control flare ups can enable sufferers to live much more comfortable lives with much less discomfort from the disease.