Dyshidrotic Eczema - Causes, Symptoms & Treatment

Dyshidrotic eczema is a recurrent or chronic relapsing form of vesicular palmoplantar dermatitis. The condition affects teenagers and adults and may be acute, recurrent, or chronic. A more appropriate term for this vesicular eruption is pompholyx, which means bubble. Genetic component to the development of pompholyx may be involved in some patients. Pompholyx has been described in few large families, so no gene or locus had been identified (Chen, 2006). A genome-wide search in a large Chinese family identified a locus at chromosome 18q22.1-18q22.3, with a maximum 2-point logarithm of the odds. 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.

Small fluid filled blisters called vesicles appear on the hands and feet. Dyshidrotic eczema can affect people of any age but appears to be more common in men between the ages of 20 and 50. There may be a genetic component to the disorder. It has also been suggested that it could be caused by an allergic response to something in the environment. Experts suspect that nickel, balsam, and cobalt may cause the allergic response. Nickel is found in costume jewelry, while the other substances are used in manufacturing. 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. Dyshidrotic eczema may occur in both men and women Dyshidrotic eczema was once thought to be due to trapping of sweat beneath thick skin of the palms and soles. The skin of the palms, sides of the fingers, and soles of the feet react to something in the environment by forming itchy blisters.

Causes of Dyshidrotic Eczema

Common causes of Dyshidrotic Eczema

• Genetic factors (Monozygotic twins).
• Atopy( allergic over-sensitivity)
• Nickel sensitivity.
• Low-nickel diets.
• Small fluid-filled blisters(Vesicles).
• Irritant dermatitis
•  Id reaction.
• Stress.

Symptoms of Dyshidrotic Eczema

Common Symptoms of Dyshidrotic Eczema

• Itching.
• Redness.
• Thickening.
• Blisters.
• Crusts.
• Pain.
• Anxiety.
• Asthma.
• Sinusitis.
• Fever.

Treatment of Dyshidrotic Eczema

Common Treatment of Dyshidrotic Eczema

• Use compresses with Burow solution (10% aluminum acetate).
• Apply in a 1:40 dilution bid/tid until bullae resolve (usually, within a few days).
• Drain large bullae with a sterile syringe, and leave the roof intact.
• Prescribe systemic antibiotics( Clobetasol propionate, Prednisone ,Betamethasone ,Triamcinolone and Methotrexate ) that cover Staphylococcus aureus.
• Seborrhea in adults is best treated with dandruff shampoo, and, occasionally, with prescription antifungal facial creams or rinses.
• Phototherapy uses ultraviolet light, either ultraviolet A (UVA) or ultraviolet B (UVB), from special lamps to treat people with severe eczema.
• Topical immunomodulators (TIMs) is a new class of drugs for the treatment of eczema. One drug in this class—tacrolimus—has been approved by the Food and Drug Administration (FDA) for treatment of moderately severe eczema.
• Avoiding excessive sweating and excessive dryness.
• Avoiding jewelry and other objects made of nickel.
• Avoiding unnecessary exposure to soapy water.

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