Dyshidrosis, also known as dyshidrotic eczema, is a skin condition that causes small, fluid-filled blisters to appear on the palms of the hands, the sides of the fingers and the soles of the feet. These blisters usually cause intense itching and can last for up to 3 weeks.

Although the exact cause of dyshidrosis is not known, it is typically associated with skin allergies, excessive palm or foot sweat, increased physical activity or excess stress.

Dyshidrotic eczema is not contagious and there is no risk of transmission after direct contact with someone who has it. All cases should be assessed by a dermatologist, who will likely recommend a skin care routine or medication. Phototherapy or botox may also be effective in some cases.

Common symptoms

Fluid-filled blister are the characteristic symptom of dyshidrosis. In more serious cases, these blisters tunnel deep into the skin and become wider in diameter.

Other common symptoms of dyshidrosis are:

Small blisters found on the sides of the fingers, the palms of the hands or the soles of the feet
Intense itching and peeling of the blisters
Pain to the blisters and surrounding area
Excessive sweating in the affected areas
Dry or cracked skin once the blisters are gone

Generally, the blisters dry up and peel about 3 weeks after they appear.

Possible causes

The exact cause of dyshidrosis is not known, however, it is most commonly seen in the summer. The following factors may contribute to its emergence:

Family history of dyshidrotic eczema
Increased stress of physical activity
Allergies (e.g. to hay fever)
Atopic or contact dermatitis
Frequently washing your hands
Working in a job that requires frequent contact with water or with products that can cause skin irritation
Exposure or skin allergy to certain metals like cobalt, chromium or nickel
Administration of IV immunoglobulin

In addition, some studies have shown that excessive sweating in the hands and feet (also known as hyperhidrosis) is linked to the development of dyshidrosis.

Confirming a diagnosis

Diagnosis for dyshidrosis is confirmed following an assessment by the dermatologist. He or she will evaluate the symptoms you have (like redness, peeling or itching), as well the amount of blisters you have and where they have spread to.

Generally, lab tests are not needed to diagnose dyshidrotic eczema. However, the doctor may order testing to rule out other health problems (e.g. sending a scraping of the skin for testing of fungus, allergy testing, etc.).

Treatment options

The dermatologist will likely indicate the following types of treatment:

1. Skin care routine

A regular skin care routine can help to prevent the blisters from forming, as well as prevent any worsening or infection. This routine can include:

Applying cold compresses 2 to 4 times per day for up to 15 minutes, or soaking feet in cold water, to reduce discomfort or itching.
Using warm water to wash your hands.
Applying moisturizer as directed by your doctor, as they can help to build-up of a protective barrier layer on your skin. Moisturizers should be used frequently throughout the day to help with dry skin.
Avoid contact with any substances that can irritate or cause allergy to your skin.

If your symptoms do not improve with these interventions, the doctor may opt to prescribe medications,

2. Use of medication

Medication is usually prescribed in more serious cases, or when a skin care routine was insufficient in treating dyshidrotic eczema. Medications that are commonly prescribed include:

Oral allergy medication, like diphenhydramine or loratadine, to help alleviate itching and redness in the affected skin
Corticosteroid creams, like mometasone or betamethasone, which are applied as a thin layer to the affected skin. These can help to reduce inflammation and dry-up the blisters, which help the skin to heal faster. Treatment with corticosteroid creams is usually done for up 6 weeks, unless otherwise directed by the doctor (depending on the severity).
Immunosuppressant creams, like tacrolimus ir pimecrolimus, which are prescribed when patients have a corticosteroid allergy, or when corticosteroid creams were not effective in improving symptoms.
Oral corticosteroids, like prednisone, which are prescribed when the above-mentioned creams are not effective

To compliment treatment, you can also try soaking the skin or applying wet compresses soaked in potassium permanganate or weak boric acid (2%). These can be done 2 to 3 times per day, until blisters start to improve. In addition, you should cleanse the affected skin with soap and water to ensure it is clean, and apply moisturizer 2 to 3 times per day. This protects the skin from other irritants, like cleaning products.

If more serious cases of dyshidrosis do not respond to the above treatment, the doctor may prescribe other medication like azathioprine, methotrexate, mycophenolate mofetil, cyclosprine or etanercept.

3. Light therapy

Light therapy, or phototherapy, is a type of treatment completed under the supervision of a doctor. UV rays are applied directly to skin affected by dyshidrosis. This is usually recommended when other treatments were not effective.

UV light can be used in conjunction with oral or topical psoralen. This combination treatment is often called PUVA (psoralen with UV-A) and it consists of applying the psoralen on the skin and then exposing the skin to UV rays 2 hours later.

4. Botox

In more serious cases, Botulinum toxin, or botox, injections may be recommended to decrease activity in the sweat glands, which contribute to dyshidrotic eczema.

5. A natural home remedy

A good way to treat and relieve the symptoms of dyshidrosis is to apply calendula, or field marigold, compresses to the affected skin. This should be used to complement the treatment indicated by your dermatologist. Field marigolds contain medicinal properties that help to heal skin and reduce irritation, which will help with itching and drying-up of the blisters.

Ingredients

2 tablespoons of field marigold flower petals
200 mL (or about 6.5oz) of hot water

How to prepare

Place the flower petals in a pot of boiling water and allow them to sit for 10 minutes. Then, strain the infusion through a mesh sieve and soak your clean gauze in the liquid. Apply these compresses directly to affected skin for 5 to 10 minutes.