Dyshidrotic eczema or Pompholyx is an intensely itchy form of eczema that appears as fluid filled vesicles (blisters) on the fingers, palms of the hands and soles of the feet.
The cause of Dyshidrotic eczema is unclear however there are known factors that may trigger or worsen the condition. Stress, atopic characteristics and prolonged exposure to water may all be factors leading to the development of the condition. Some believe it may be caused by abnormal sweating (hyperhydrosis) but this is more likely a trigger than a cause.
In general there are two phases of Dyshidrotic eczema. During the acute phase small itchy bumps will develop into small clear, fluid filled vesicles which are accompanied by a burning sensation with intense itching. This phase usually has a sudden onset of 1 – 3 days.
The chronic phase usually follows the acute phase and is characterised by the presence of scaling, thickening of the skin and painful fissures. The skin may also peel, crack and crust. A secondary staphylococcal infection is not uncommon. The affected area will be red, swollen and painful.
It is not always that the acute phase will be followed by the chronic phase. Some people will only experience the acute phase whilst others will only experience the chronic phase. Some people will be affected by both the acute and chronic phase at the same time.
Similarly it is not always both the hands and feet affected. For some it will be only the hands whilst for others only the feet.
There is no cure for Dyshidrotic eczema however the condition often resolves itself completely. It may reappear after a period of stress or exposure to other trigger factors.
Triggers to Avoid
- Known allergens if you are atopic
- Contact with irritants – soaps, detergent, solvents
- Contact with common metals – chromium, cobalt or especially nickel
- Nervous tension, worry or stress
- Prolonged exposure to water – hand washing, laundering, bathing
- Prolonged exposure to moisture – sweaty socks, wet shoes, wet gloves
- Rubber or latex gloves next to the skin
- Industrial, waterless or antibacterial cleansers as they contain alcohol and other irritating ingredients
- Scratching.
Things to Do
- Wear cotton gloves under unlined, powder-free vinyl or neoprene gloves when exposure to water or chemicals is inevitable
- Wear cotton or leather gloves when doing normal (non wet) household chores to protect the hands
- Dispose of gloves if they develop a hole as this is more damaging than not wearing gloves at all
- Avoid wearing waterproof gloves for more than 15 minutes at a time. If this is unavoidable apply a moisturiser before putting the gloves on
- Avoid jewelry containing metal
- Remove jewelry when washing hands or doing household chores to ensure chemicals, cleansers and water do not get trapped
- Use dishwashers and washing machines in preference to hand washing
- Apply a moisturiser immediately after washing hands
- Change socks regularly and do not wear wet shoes.
- Avoid scratching
- Attempt to control stressful situations
- Do not use soaps with perfumes or preservatives
- Wash your hands in luke warm water with a perfume free cleanser, and then pat them dry and apply a moisturiser
- Avoid woolen gloves and socks as they tend to irritate the skin.
Treating Dyshidrotic Eczema
Use a greasy moisturiser regularly. It has fewer ingredients and provides a natural barrier, locking moisture in and keeping irritants out. Regular and liberal use will help to keep the skin soft and supple. Use an emollient, like Calendulis Plus Cream 3 – 4 times to help control the itchiness and redness.
Soak the hands and feet in a tub of warm water with a few drops of bath oil each evening. This will remove any bacteria as well as soften the skin to help keep it moisturised and supple. Apply treating emollients immediately after soaking as this is when the skin is most receptive to treatment.
Your doctor may prescribe a steroid cream or pills to control the symptoms. These often control the symptoms quickly but there is an increased risk of another flare up as soon as the medication is stopped.
Notify your doctor if you develop a fever or the skin becomes hot and red as oral antibiotics will be required to treat bacterial infections. You may also need antipruritic medication to help control itching (ie Benadryl or Claritin). These are best taken at night if night itching is an issue.