“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 in the department of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago, as well as a board member and scientific advisory committee member for the National Eczema Association (NEA). “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. Dyshidrotic eczema is also a side effect of intravenous immunoglobulin infusions (IVIG), which are typically used to treat certain immune system diseases. Exposure to cement is another risk factor. (2) The condition is not contagious. It tends to affect women more than men, perhaps because women are more likely to be exposed to certain skin irritants, such as nickel or cobalt in jewelry. It’s also most common in people ages 20 to 40. (3) Dyshidrotic eczema is the fifth-most common cause of hand eczema, according to a 2015 study. (4) Dr. Lio says that cleansing measures related to the COVID-19 pandemic also spurred an increase in the cases he saw because of increased hand-washing, hand sanitizer use, and stress.
Small blisters and rashy skinBlisters filled with clear fluidBlisters that appear in clusters between fingers and toes or on the edges of fingers, toes, palms, or soles of the feetRashy, scaly, red and cracked skin around the blistersBlisters that are very itchy and sometimes painfulBlisters that dry and peel in about three weeks
According to the AAD, dyshidrotic eczema is more likely to occur if you: (2)
Have sweaty or moist handsAre under stressHave atopic dermatitis (also known as eczema)Have sensitive skin in generalHave allergies, including hay feverWash your hands frequently or your hands are often in waterWork with cementExpose your hands to metals, such as chromium, cobalt, or nickelReceive intravenous immunoglobulin infusions to treat another medical condition
“If we suspect that a contact allergen is driving it, we may perform patch testing. Rarely, fungal infection can cause a very similar picture to occur clinically, so we can perform a scraping and a KOH examination to look for fungal forms,” he adds. A KOH examination involves scraping the problem area of your skin with a needle or scalpel blade and examining the tissue under a microscope on a slide to which KOH (the chemical potassium hydroxide, a form of lye or potash) has been added. (6)
Prognosis of Dyshidrotic Eczema
“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.” Some people have a single outbreak that clears without treatment, but it is much more common for people to have recurring flare-ups throughout life. (7) “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. The AAD has additional tips for self-care, such as how to cleanse, moisturize, and avoid triggers. But with more severe dyshidrotic eczema, medication and other treatments are necessary for symptom relief, say both doctors.
Medication Options
“We usually will add either a topical steroid or a nonsteroidal topical such as tacrolimus (Protopic) to cool things down,” says Lio. These are among the medications that may be prescribed: (8,9)
Potent topical steroids such as clobetasol, fluocinonide (Lidex), halobetasol (Bryhali), and triamcinolone (Kenalog)Tacrolimus and pimecrolimus (Elidel), topical medications that suppress your immune system’s response in order to help quell a flare-upOral steroids such as prednisone (Deltasone), which may be prescribed for two to four weeks if topical medications aren’t effectiveOral medications that alter your immune response, such as cyclosporine (Neoral), methotrexate, or azathioprine (Imuran)
“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. It may also be worth asking your doctor about patch testing on your skin to determine whether your dyshidrotic eczema has some type of allergic component. Patch testing can determine potential irritants, such as nickel. Note, though, that while patch testing may uncover a trigger, it may not be the only culprit causing your dyshidrotic eczema. Nickel is present in most foods, and depending on the soil that the food is grown in, the concentrations can vary greatly. (10) A nickel-free diet should avoid cocoa, chocolate, soybeans, oatmeal, nuts, almonds, legumes, drinks and vitamin supplements with nickel; canned food (due to leaching of nickel from cans into food); and fish that show high concentration of nickel, such as tuna, herring, shellfish, salmon, and mackerel. He notes that whole wheat, whole grain, rye, oats, millet, buckwheat, and licorice are high in nickel, as are some vitamin supplements. (10)
Integrative and Complementary Approaches
“There are many natural moisturizers that can be soothing, such as sunflower seed oil and coconut oil,” says Lio. He adds that soaking in diluted apple cider vinegar or black tea can help to dry blisters. “For milder cases, these can be enough to get people through, but usually if things are more severe, we often need more powerful treatments.” Research into the bathing remedies he mentions have had mixed results on people with related types of eczema. A study from 2019 followed 22 German people with facial eczema who received treatment with gauze compresses soaked in black tea, followed by cold cream, for six days. Though small, the study suggests this remedy led to significant decreases in itchiness and other symptoms, the researchers write. (11) On the other hand, another small study, also from 2019, found that soaking skin in diluted apple cider vinegar (0.5 percent acetic acid solution) up to the forearms led to irritation in 73 percent of the treated participants with atopic dermatitis and did not improve the condition of the skin barrier. (12) “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. The AAD concurs that symptoms range from mild to debilitating. “A severe flare on your feet can make walking difficult. Having many blisters on your hands can make it difficult to work and perform everyday tasks like shampooing your hair and washing dishes,” according to the organization. (1) Constant scratching also tears the skin, increasing the risk of skin infection. According to the AAD, a staph infection (caused by the bacteria staphylococcus) may result. Signs of a staph infection include the development of pus in blisters, pain, swelling, and crusting. (5) Usually skin staph infections are mild, but if they are left untreated and the bacteria enter your bloodstream or other organs, life-threatening complications such as sepsis could result. (13) The condition tends to affect women more than men, and it is most common in adults between ages 20 and 40. (3)
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. The NEA reports that a survey they conducted about a related condition, atopic dermatitis, found that 30 percent of people with atopic dermatitis were also diagnosed with depression or anxiety. The organization recommends speaking with your healthcare provider or a mental health professional if you are experiencing symptoms of mental illness. Self-care is important too, such as getting adequate sleep, practicing relaxation techniques, and finding a peer support group. (14) 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, confusing the picture.” Learn more about these conditions from the NEA:
Atopic Dermatitis Also simply known as eczema, atopic dermatitis is chronic and is the most common type of eczema. (15)Contact Dermatitis This happens when physical contact with an irritating substance or allergen triggers an irritation or inflammation reaction of the skin. (16)
Favorite Organizations for Essential Dyshidrotic Eczema Information
National Eczema Association (NEA) The NEA is a great first stop, being the most prominent U.S.-based nonprofit devoted to education, research, patient support, and advocacy relating to the various forms of skin disease that fall under the eczema umbrella, including dyshidrotic eczema. Check out their dyshidrotic eczema page before you peruse their fact sheets, glossary of skin-care terms, and webinars. We also recommend Lio’s video on hand hygiene for people with hand eczema in the COVID-19 era. DermNet NZ This well-regarded library of information “all about the skin” is affiliated with the New Zealand Dermatological Society. The jargon is aimed at professionals, but there’s plenty of information for laypeople to use as well. Take a look at their page on vesicular hand dermatitis (another name for dyshidrotic eczema), or try out their DermDiag tool for narrowing down possible causes for your symptoms (which is not intended to replace a doctor’s advice). American Academy of Dermatology (AAD) The AAD lays claim to being the largest professional dermatological association, with more than 20,500 physician members around the globe. They publish guides to a variety of skin conditions, including a robust section about dyshidrotic eczema. Mayo Clinic Page on Nickel Allergies One of the foremost networks of medical institutions in the United States has an extensive library of information on health conditions, including this page about a common trigger for dyshidrotic eczema: nickel sensitivity.
Favorite Online Support Networks for Dyshidrotic Eczema
It’s an Itchy Little World This blog is for families who are managing allergies, asthma, and eczema in their household, with a focus on natural remedies and periodic contributions by medical professionals and other guest bloggers. Check with your doctor before trying any new remedies or products, but consider this site a resource for what your peers may be exploring and finding success with. Inspire The NEA hosts this message-board-driven online forum for sharing support and advice about living with eczema. A keyword search for members’ posts about “hand eczema” brings up more than 1,000 posts going back over several years. Registration is free.
Favorite Site for Dyshidrotic Eczema Management Products
NEA Store The National Eczema Association hosts an online store of eczema-friendly products bearing the NEA Seal of Acceptance, which means they are made for people with moderate-to-severe symptoms. Find cotton gloves, moisturizers, cleansers, and household cleaning products that are designed to protect and not irritate your skin.
Favorite App for Managing Dyshidrotic Eczema
Eczema Tracker When you’re in the middle of a flare-up, it’s easy to forget how it developed. Eczema Tracker allows you to keep track of triggers and symptoms, and get useful advice for managing the condition. Take a photo of your skin on good days and flare-up days, so you can better gauge the state of your skin today. Local reports on weather and humidity can help you to anticipate future symptoms, and the app analyzes your data to help you find trends that tend to lead to flare-ups. Additional reporting by Anne L. Fritz.
