What Is Dyshidrotic Eczema?

“It is characterized by tiny blisters or vesicles, usually between the digits, and it can be extremely itchy,” says Peter Lio, MD, a dermatologist who is a clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago, as well as a National Eczema Association (NEA) board member. “Certain 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.”

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.

• 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

“As 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,” says Dr. Lio.

• 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

Diagnosing the condition usually involves examining the patient, noting the symptoms, and taking the patient’s history, says Lio. “If we suspect that a contact allergen is driving it, we may perform patch testing,” he adds.

While there is no cure for dyshidrotic eczema, as Lio says, you can manage most of the symptoms on your own with a doctor’s direction.

“Typically, we start with gentle skin care and avoiding triggers,” he says. “I 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.”

Dr. Kindred says that keeping skin moisturized is an important part of treating dyshidrotic eczema. “Use lotions containing ceramides and then cover with a barrier ointment, such as petroleum jelly,” she says.

• Take rings off before you wash your hands, put on lotion, and go to bed.
• Use warm, not hot water.
• Gently pat dry.
• Try not to scratch.

Medication Options

With more severe dyshidrotic eczema, medication and other treatments are necessary for symptom relief. “We usually will add either a topical steroid or a nonsteroidal topical such as tacrolimus (Protopic) to cool things down,” says Lio.

• A topical anesthetic such as pramoxine, which comes in prescription and over-the-counter forms
• Oral antihistamines
• Over-the-counter steroid creams
• Prescription topical steroids
• Tacrolimus and pimecrolimus (Elidel), topical medications that suppress your immune system’s response in order to help calm a flare-up
• Oral steroids, which may be prescribed for two to four weeks if topical medications aren’t effective
• Oral medications that alter your immune response, such as cyclosporine (Neoral), methotrexate, or azathioprine (Imuran)

Other Treatments

“If that is still not enough, we often use phototherapy with narrow band ultraviolet (UVB) light to cool the inflammation with a specialized light,” Lio says.

If the problem is a specific irritant or allergy, the treatment may even be dietary. “Sensitivity 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,” says Lio.

While you can’t prevent dyshidrotic eczema, you can do a number of things to avoid or minimize flare-ups.

“Avoid triggers, wear cotton-lined gloves when washing dishes and doing other wet work, and keep other skin diseases under control,” counsels Kindred.

To this list, Lio adds: Wear lightweight clothing and avoid gloves, socks, and shoes that trap moisture and don’t allow your skin to breathe.

Dyshidrotic Eczema Prognosis

“We do not have a cure, but we have many good treatments and many more in development,” says Lio. “Usually we can help people get their skin much better so that they can be comfortable and return to normal activities.”

The complications of this condition can be very painful and disruptive. “Sometimes the hands are cracked, fissured, and bleeding, and it can cause lots of pain,” says Lio. “Some 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.”

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, “it is in a highly visible area that can’t be covered with clothing, so many patients feel ashamed or embarrassed about their skin,” notes Lio. Also, severe cases can interfere with a person’s ability to work or carry out routine daily tasks involving hands or feet — stressful situations brought on by a condition that itself is aggravated by stress.

As mentioned, atopic dermatitis or contact dermatitis, especially when related to a nickel allergy, can increase your risk of having dyshidrotic eczema.

• Atopic Dermatitis Also simply known as eczema, atopic dermatitis is chronic and is the most common type of eczema.

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• Contact Dermatitis This happens when physical contact with an irritating substance or allergen triggers an irritation or inflammation reaction of the skin.

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Differentiating between the conditions can be a challenge, and sometimes they are related anyway, says Kindred. “Atopic dermatitis prefers skin folds, such as the insides of the elbows and the knees. Contact dermatitis is usually within the location that the skin was in contact with the trigger. The confusing part is that both atopic dermatitis and contact dermatitis may be associated with dyshidrotic eczema.”

• Dyshidrotic eczema is a skin condition that mainly affects the palms of your hands and the soles of your feet.
• It appears as clusters of small, fluid-filled blisters and causes intense itching.
• You’re more likely to get it if you have another form of eczema, if your hands are often wet, or if you have unusually sweaty palms or feet.
• Most cases are treated by keeping your skin moisturized and avoiding harsh chemicals and other triggers. Some people need topical or oral medications.