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Dyshidrosis is a disorder of the skin that is characterized by small blisters on the hands and/or feet. It is also known as pompholyx, podopompholyx, cheiropompholyx, acute vesiculobulbous hand eczema, and dyshidrotic eczema.
Most commonly the condition presents on the fingers and toes, in particular it may be present on the lateral sides of the digits. Dyshidrosis is a pruritic, or itchy, condition, particularly when it is located on the sides of the digits. It typically begins as a number of small, tense blisters, which are deep seated in the skin. Over time these small blisters may coalesce into larger blisters, but do not commonly rupture. However, if the vesicles do rupture, this may lead to secondary bacterial infections.
It is commonly accepted now that dyshidrotic eczema is a multifactorial disorder, which is commonly related to other skin conditions and precipitating factors. In particular, atopic diathesis (such as hay fever, eczema, asthma, and allergic sinusitis) has been shown to be present in as many as 50% of patients with Dyshidrosis.
While excessive sweating may not cause it, dyshidrosis has historically been linked to an excessive output of sweat. However, cases reported of dyshidrosis without hyperhidrosis (excessive sweating) dispute the causation. It is possible that dyshidrosis is linked to anxiety, stress, and frustration, which may cause outbreaks or exacerbate the symptoms.
An association with nickel sensitivity has also been reported. Systemic exposure to high levels of nickel may be from foods that are high in nickel, such as cocoa, chocolate, whole grains, and nuts. Diets that restrict intake of these foods have been shown to reduce the number of outbreaks of dyshidrotic eczema.
Chemical and mechanical irritants have also been indicated as a cause of dyshidrotic eczema outbreaks. This may include things such as keeping the hands and feet damp, using strong soaps or detergents on the hands and feet, exposure to latex or other materials that cause documented allergic reactions, such as bandages, skin tapes and plasters. Dyshidrosis may also be seen in correlation with fungal and/or bacterial infections of the feet. There has also been a well-documented inheritance pattern and genetic predisposition to dyshidrotic eczema.
Dyshidrotic eczema is diagnosed by first ruling out a number of other possible diagnoses. This may include infection, allergic reaction, blistering disease such as pemphigus vulgaris, and a number of other dermatological conditions.
Treatment of dyshidrosis is largely symptom based, and many cases will clear spontaneously within several weeks. Topical steroids are often used to reduce itching, and oral steroids are occasionally used in cases of intense outbreak. When blisters are present, draining of the blisters may be appropriate, as well as using compression bandages with drying agents such as Burow solution. A number of other treatments have been used experimentally, such as Botox injections, UV-A light therapy, Nickel chelators, and a number of oral medications.
Other therapies include diet modifications to avoid exacerbating foods, as well as behavioral modifications to avoid irritating substances. Allergy testing may be indicated for patients with a known or suspected allergy to certain substances.
