Dermatitis, Dyshidrotic

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Overview

Dyshidrotic eczema, also known as dyshidrotic dermatitis, is an itchy rash that occurs on the hands and feet. Dyshidrotic eczema looks like blisters on the skin. Sometimes the blisters are very small, like pinpoints, and sometimes they are larger, covering almost the whole palm or foot. The fluid inside the blister can be clear or white to yellow. It is not known what causes this condition, but it is more common in people with eczema; even in people without sensitive skin, it seems to be triggered by the same things that trigger eczema: cold, dry air or contact with irritants that bother the skin. In other people, a warm, moist climate may be the trigger. Do not pop the blisters of dyshidrotic eczema because of the risk of infection. A doctor may prescribe a cream to help the rash heal.

Who's at risk?

Anyone of any age can develop dyshidrotic eczema, but it is usually seen in teens and adults and rarely in infants and children.

Signs and Symptoms

The most common location of dyshidrotic eczema is on the hands and less commonly the feet.

  • Small, tense, clear fluid-filled blisters are seen on the surfaces of palms and soles and the sides of the fingers and toes.
  • These blisters can appear "deep-seated" (tapioca-like) due to the thickness of the skin on the palms. In severe cases, individual blisters can merge together and present as large blisters (bullae).
  • Redness (erythema) is typically mild or absent.

Self-Care Guidelines

Avoidance of irritants may be helpful.

  • Handwashing with mild soaps and cleansers and frequent application of thick emollient creams and petroleum jelly may be beneficial.

When to Seek Medical Care

Seek medical evaluation for a rash on the hands and/or feet that is unresponsive to self-care measures.

Treatments Your Physician May Prescribe

To manage dyshidrotic eczema, your physician may recommend removal of irritating agents and, if many blisters are present, soaks with drying agents.

  • Medium- and high-potency topical steroids may be prescribed to be used twice daily. Use of a high-potency topical steroid initially that is tapered as allowed may be most beneficial.
  • An oral steroid (prednisone) may be necessary but people often cannot be tapered off this therapy.
  • Chronic, severe disease can be treated with a form of light therapy called PUVA (psoralen and ultraviolet A phototherapy) administered by a dermatologist.

References

Bolognia, Jean L., ed. Dermatology, pp.582. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.32. New York: McGraw-Hill, 2003.