Understanding Dyshidrotic Eczema
Dyshidrotic eczema, also known as pompholyx or vesicular eczema of the hands and feet, can be seen either as a specific disease or as a clinical pattern caused by various conditions. In this article, we'll treat Dyshidrotic eczema as a reaction pattern with multiple possible causes.
This condition typically affects the sides of the fingers and toes, though it can also appear on the palms of the hands or soles of the feet. In 80% of cases, only the hands are affected; in 10%, only the feet; and in the remaining 10%, both hands and feet are involved. Dyshidrotic eczema can be intensely itchy.
The rash consists of small, closely packed blisters (vesicles) less than 5mm in size, filled with clear fluid and located in the upper skin layer (epidermis). In severe cases, these vesicles can merge to form larger, tense blisters (bullae).
Causes of Dyshidrotic Eczema:
Dyshidrotic eczema (as a specific disease with an unknown cause)
Atopic dermatitis
Allergic contact dermatitis (e.g., from nickel)
Irritant dermatitis
Id reaction (eczema due to an infection elsewhere, such as the feet or scalp)
Stress, which may contribute to the above factors
Given the various potential causes, the first step in treatment is identifying the underlying condition. A diagnosis of Dyshidrotic eczema as a specific disease is only made after excluding other causes.
Testing and Treatment:
Allergic contact dermatitis can be diagnosed through patch testing, where substances are applied to the back for 2 days to check for allergic reactions.
Id reactions are eczema responses to fungal or bacterial infections elsewhere on the skin. For example, a fungal infection in the feet might cause Dyshidrotic eczema on the hands. Treatment involves addressing the underlying infection.
Irritant dermatitis occurs from excessive exposure to skin irritants like soap or washing powder.
The primary treatment for Dyshidrotic eczema is to remove the cause, if possible. When the cause can't be identified, treatment focuses on symptom relief.
Common treatments include potent topical corticosteroids combined with frequent use of moisturizers. Other options include light therapy (PUVA) and, in severe cases, short courses of oral prednisolone. In the most resistant cases, immunosuppressants like Azathioprine, Methotrexate, or Cyclosporine may be used.
