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Dyshidrotic Dermatitis

Written by Megan Kinder, with some information gathered from articles on SkinCarePhysicians.com. [email protected]

Signs and Symptoms of Dyshidrotic Dermatitis

• Small, deep blisters can form on the palms, sides of the fingers, and/or soles

• Intense burning or itching

• Inflamed skin (reddish and hot to the touch)

• Cracking and peeling skin

• Affected areas may sweat excessively

• Skin may become infected, causing oozing blisters and crusts

• Skin between the fingers can soften; skin may feel spongy

• Nail changes if dyshidrotic dermatitis persists for a long time. The fingernails can develop ridges and pitting. The nails may thicken and discolor.

• Sometimes as the skin clears, the skin peels and a new crop of blisters appear

• Extensive peeling and cracking in severe cases

Who is Affected by Dyshidrotic Dermatitis?

• Most frequently begins between 20 and 40 years of age, but can develop earlier or later. Rare in children, but can develop in children who have atopic dermatitis.

• Occurs in all races

Causes of Dyshidrotic Dermatitis

• Unknown

• Researchers now believe that a person’s reaction to events occurring within the body (e.g., having another medical condition) and factors occurring outside the body (e.g., the weather) play a role.

• Research shows that excessive sweating — originally believed to be the cause — does not cause dyshidrotic dermatitis.

Risk Factors of Dyshidrotic Dermatitis

Researchers have identified several factors that can increase one’s risk of developing dyshidrotic dermatitis and the risk of flare-ups:

• Stress. Probably the most common risk factor, many patients report a stressful period before an outbreak.

• Gender. Females tend to develop dyshidrotic dermatitis more frequently than males. 

• Weather. Flare-ups are most frequent in hot humid weather. In fact, the weather is a common trigger for many patients. A study of 104 patients found that the following weather conditions triggered flare-ups: heat (29.8% of patients), humidity (24% of patients), and cold (12.5% of patients). 

• Pre-existing atopic condition (e.g., atopic eczema, hay fever, or asthma). Having one or more of these conditions significantly increases the risk.

• Pre-existing contact dermatitis. Having contact dermatitis significantly increase the risk of developing dyshidrotic dermatitis. 

• Pre-existing infection. Having an infection in another part of the body may increase the risk. A study found that one-third of the patients saw the dyshidrotic dermatitis on their hands clear after they received treatment for their athlete’s foot. 

• Metal implant, such as a hip replacement. Studies show a direct correlation between a metal allergy and developing dyshidrotic dermatitis.

• Aspirin, oral contraceptives, and smoking. One study suggests that smoking as well as taking aspirin or an oral contraceptive increases the risk.

Duration of Dyshidrotic Dermatitis

While some patients experience only one outbreak that clears in 2 or 3 weeks without treatment, others have recurring flare-ups that can range in frequency from once a month to once a year. 

How Dyshidrotic Dermatitis is Diagnosed

• Diagnosis begins with a complete medical history and visual examination of the skin.

• A dermatologist may swab the affected skin if it looks infected. 

• A type of testing called “patch testing” may be scheduled to find out if the patient has allergies. 

• Blood tests may be ordered to find out if other medical conditions exist.

Treatment of Dyshidrotic Dermatitis

This condition can be a challenge to treat, and some patients say dyshidrotic dermatitis seems unresponsive to treatment. To overcome these obstacles, dermatologists often call upon an array of treatment options to control the condition:

Medications for Dyshidrotic Dermatitis

• Topical corticosteroid and cold compresses are typically used first. 

• Dermatologists may drain large blisters to relieve pain.

• Prescription antibiotics are used to treat an infection.

• Topical medication, such as pramoxine, can help relieve pain and itch.

• For severe cases that seem resistant to treatment, dermatologists may prescribe an oral corticosteroid or another immunosuppressive medication (e.g., methotrexate, cyclosporine, or mycophenolate mofetil) along with bedrest. 

• PUVA therapy (a type of light treatment) helps some patients with chronic dyshidrotic dermatitis. 

• Topical calcineurin inhibitors (e.g., pimecrolimus and tacrolimus), which are used to treat atopic dermatitis, can effectively reduce inflammation. 

• Injections of botulinum toxin type A, a popular wrinkle treatment, have effectively cleared some patients. While the reason remains unclear, it is believed that the botulinum toxin type A may relax the muscles or inhibit nerve impulses.

Lifestyle Changes for Dyshidrotic Dermatitis Treatment

• Reduce stress. Some patients find that practicing stress-reduction techniques along with using medication as directed helps to clear their skin. 

• Avoid allergens and irritants. A medical test called “patch testing” can identify common substances to which the person is allergic. Patch testing cannot identify irritants; however, a dermatologist can ask a number of questions to help identify anything that is irritating the skin. Avoiding known allergens and irritants can help reduce flare-ups.

• Follow a dermatologist-recommended skin care plan. Dermatologists often recommend that patients follow a recommended skin care plan. This can help prevent flare-ups.

• Avoid excessive sweating and dry conditions. Both are believed to be triggers. 

• Protect the skin from further injury. Using gloves to protect the hands from irritants and allergens, wearing socks made of 100% cotton, and avoiding strong soaps can help protect damaged skin.

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