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What Triggers Dyshidrotic Eczema?

Reviewed on 6/5/2020

What Is Dyshidrotic Eczema?

Itchy blisters on the soles of the feet are a sign of dyshidrotic eczema.
Itchy blisters on the soles of the feet are a sign of dyshidrotic eczema.

Dyshidrotic eczema (also called pompholyx or acute and recurrent vesicular hand dermatitis) is a skin condition characterized by small, intensely itchy blisters on the edges of the fingers, toes, palms of the hands, and soles of the feet.

Dyshidrotic eczema may be acute, recurrent, or chronic. It affects teenagers and adults, and it is twice as common in women as in men.

What Are Signs and Symptoms of Dyshidrotic Eczema?

The severity of dyshidrotic eczema (pompholyx) symptoms can vary widely from minor to debilitating. The condition tends to be chronic and intermittent, and episodes occur less frequently with age.

Symptoms and signs of dyshidrotic eczema include the following:

  • Small, symmetrical blisters may form on the edges of the fingers, toes, palms of the hands, and soles of the feet. The blisters have the following characteristics:
    • Itch intensely
    • May become large, fluid-filled, and join together
    • In chronic disease, fingernails may reveal degenerative changes such as ridges, thickening, discoloration, and pitting.
    • Blisters typically heal on their own without rupturing, followed by skin peeling.
  • Skin redness
  • Flaking
  • Scaly, cracked skin
  • Pain

Atopic dermatitis and contact dermatitis may look like dyshidrotic eczema.

What Causes Dyshidrotic Eczema?

The cause of dyshidrotic eczema (pompholyx) is unknown, but it is most likely due to several factors. A history of atopic dermatitis is a risk factor for developing dyshidrotic eczema.

Common triggers for dyshidrotic eczema include the following:

How Do Doctors Diagnose Dyshidrotic Eczema?

Doctors make a diagnosis of dyshidrotic eczema (pompholyx) following a history and physical exam. Blood tests usually are not necessary. Tests to confirm a diagnosis or rule out other conditions may include

  • bacterial culture and sensitivity,
  • patch testing,
  • KOH wet mount, and
  • punch biopsy for direct immunofluorescence.

What Is the Treatment for Dyshidrotic Eczema?

Dyshidrotic eczema (pompholyx) is typically chronic and recurrent, though episodes occur less frequently with age and most patients eventually go into complete remission. Dyshidrotic eczema may become infected.

Treatment aims to relieve symptoms and signs and includes the following:

Home treatments for dyshidrotic eczema include the following:

  • Cold compresses applied for 15 minutes to affected areas two to four times a day followed by a rich moisturizer or a skin barrier repair cream
  • Soak hands and feet in cool water
  • Compresses with Burow solution or 1:10.000 solution of potassium permanganate for blisters
  • Bed rest if there are large blisters on the feet
  • Avoid dietary sources of nickel and cobalt in the for nickel- and cobalt-sensitive patient
    • Food sources of nickel include chocolate, cocoa, oatmeal, nuts, almonds, soy beans, fresh and dried legumes, and canned foods.
    • Food sources of cobalt include fish, clams, oysters, liver, leafy green vegetables, milk, nuts, and red meat.

Stress-reduction techniques and counseling or biofeedback may help some patients cope with symptoms and signs.

QUESTION

Eczema (also atopic eczema or atopic dermatitis) is a general medical term for many types of skin inflammation. See Answer

What Are Complications of Dyshidrotic Eczema?

Complications of dyshidrotic eczema (pompholyx) include secondary bacterial infection of the blisters, which may result in cellulitis, lymphangitis, and septicemia (rare).

Degenerative nail changes may occur such as transverse ridging, thickening, discoloration, and pitting.

If large blisters develop on the hands, patients may not be able to work or perform other daily activities.

In severe cases, dyshidrotic eczema can become debilitating.

How Do You Prevent Dyshidrotic Eczema?

For the most part, it's not possible to prevent dyshidrotic eczema (pompholyx). If there are known triggers, avoid them. Consistent and proper skin care with moisturizing may help keep skin healthy and minimize flares.

Consultation with an allergist may be helpful if triggers are due to allergies to nickel, cobalt, or chromium salts.

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Reviewed on 6/5/2020
References
Amini, Sadegh. "Dyshidrotic Eczema (Pompholyx)." Apr. 22, 2020. Medscape.com. <https://emedicine.medscape.com/article/1122527-overview>.

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