What is dyshidrotic eczema?
Dyshidrotic eczema is a form of eczema often seen on the hands and feet where tiny blisters of serum form just below the skin’s surface. I refer to these as “tapioca seed vesicles”. The presence of these blisters signals an acute flare that is accompanied by tremendous itching. Deep, painful cracks in the skin and superficial scaling tend to accompany this condition. Dyshidrotic eczema must be distinguished from an allergic contact dermatitis, and I often patch test patients to
see whether they have a contact dermatitis as the primary, or even a secondary etiology of their disease. Dyshidrotic eczema tends to be a chronic condition that appears periodically throughout adulthood.
Dyshidrotic eczema is a recurrent disease of the palmar and/ or plantar skin characterised by sudden eruptions of clear, mostly pruritic vesicles. Sweat gland dysfunction or sweat retention do not play the pathogenetic role that has been assigned to them in the past, although some degree of hyperhidrosis exists in many of the affected patients. Etiologic factors for dyshidrotic eczema include atopy, contact allergy, constant irritation, primary fungal infections and fungal id-reactions. An idiopathic form is also recognised. Smoking and excessive coffee consumption are believed to play an aggravating role.
The cause of dyshidrotic eczema is not known, but it occasionally appears to be seasonal. Small fluid filled blisters called vesicles appear on the hands and feet. They are most common along the edges of the fingers, toes, palms and soles. The vesicles produce intense itching. Scratching leads to skin changes with thickening. Scratching may also lead to secondary infections. Some individuals with dyshidrotic eczema are atopic (have an allergic predisposition). Some cases may be triggered by contact with substances causing allergic skin reactions. Dyshidrotic eczema may occur in both men and women. Its onset occurs usually before the age of 40. Individuals experiencing emotional stress may be more likely to develop flare-ups of this disease.
The diagnosis is based on the patient history, the clinical picture and on the exclusion of other skin diseases. Patch testing is used to exclude underlying contact allergies. Possible etiologic factors such as atopy, contact allergy, irritation and fungal infections have to be ruled out before settling on the diagnosis idiopathic dyshidrotic eczema. Pustular psoriasis of the palms and soles, epidermolysis bullosa hereditaria, hand-foot-mouth-disease, acrodermatitis enteropathica and scabies in children are possible differential diagnoses for vesicles on the palms and soles.
Corticosteroid creams and ointments play an important role in the treatment of this disorder. Application of corticosteroid under plastic occlusion may increase their effectiveness. Severe attacks may require the use of oral or intramuscular corticosteroid. Oral antihistamines may help to reduce itching. Antibiotics may be necessary if infection is present.
More information on eczema
What is eczema? - Eczema is a heterogeneous group of different non-infectious skin diseases. Eczema occurs in both children and adults, but usually appears during infancy.
What types of eczema are there? - There are various types of eczema, including atopic eczema (atopic dermatitis), contact dermatitis, varicose eczema, discoid eczema, nummular eczema, stasis dermatitis.
What are the symptoms of eczema? - Symptoms of eczema are itching and redness, and may make the skin dry and flaky. Eczema makes the skin more sensitive.
What causes eczema? - The most common cause of eczema is a general allergic over-sensitivity. Other types of eczema arise as a result of causes within the body.
How does eczema affect people? - In eczema, the main problems occur in the epidermis where the keratinocytes become less tightly held together.
How is eczema diagnosed? - Eczema is usually diagnosed through a physical examination. Further tests may include skin biopsy or patch tests.
What are the treatments for eczema? - Avoidance of the aetiological factors is one important therapeutical approach. Symptomatic treatment includes topical and systemic treatment regimens.
How can eczema be prevented? - Eczema flare-ups can be prevented by avoiding exposure to extreme temperatures, dry air, harsh soaps and bubble baths.
How to deal with infant or baby eczema? - For mild to moderate baby eczema, the application of moisturizer on a regular basis can be very helpful. Avoid as many eczema triggers as possible.
What is atopic eczema and its treatment? - Atopic eczema (atopic dermatitis) is the commonest form of eczema and is closely linked with asthma and hayfever.
What is dyshidrotic eczema? - Dyshidrotic eczema is a form of eczema often seen on the hands and feet where tiny blisters of serum form just below the skin's surface.
What is nummular eczema? - Nummular eczema is a chronic eczema characterised by coin-shaped, sharply demarcated lesions. Nummular eczema is more common in males.
What is hand eczema (hand dermatitis)? - Hand eczema, also called hand dermatitis, is a skin condition in which the hands develop a rash and become red, dry, cracked, and inflamed.
What is varicose eczema? - Varicose eczema is due to increased pressure within the veins in the leg. Varicose eczema affects the lower legs people in their middle to late years.
What's seborrhoeic eczema? - Seborrhoeic eczema is a common skin disease affecting any sebum-(natural oil) producing area of the skin.