Dyshidrotic eczema: Effective management strategies

Dry, cracked, or itchy hands are a common occurrence when the outer layer of your skin is damaged. When this itching is accompanied by small, fluid-filled blisters on the sides of the fingers — and occasionally the feet — it may indicate a skin condition called dyshidrotic eczema. In fact, the condition accounts for 5% to 20% of cases of hand eczema.

What is dyshidrotic eczema?

Dyshidrotic eczema, also known as pompholyx, is a skin condition that causes extremely itchy bumps and watery blisters to form on the hands and feet. Dyshidrotic eczema is a subset of eczema. The skin eruption can occur in those with a history of eczema, or in response to irritants on the skin.

Signs and symptoms of dyshidrotic eczema

Symptoms of dyshidrotic eczema develop on the palms of the hands, soles of the feet, sides of fingers or toes, and often affect both sides of the body. Common signs and symptoms include:

• small fluid-filled bumps known as vesicles, often described as having a "tapioca-like" appearance
• blisters
• intense itching or a prickling sensation, often occurring before the rash appears
• peeling skin and discoloration after the blisters have popped and dried out.

Symptoms often appear suddenly, and recurrence is common. With time the affected skin can become red, thickened, and cracked. Skin infections can also occur, typically presenting as weeping skin with yellow-colored crusting.

Common triggers of dyshidrotic eczema

The cause of dyshidrotic eczema is unknown. It's often seen in people with a history of eczema, and in relation to certain triggers.

Factors often associated with dyshidrotic eczema include:

• exposure to metals, such as nickel or cobalt
• exposure to irritating chemicals, such as with certain occupations (for example, metalworkers and hairdressers)
• excessive sweating
• smoking
• exposure to ultraviolet light
• warm weather
• stress.

Dyshidrotic eczema treatment options

There are both over-the-counter and prescription medications available for the treatment of dyshidrotic eczema. First-line therapy usually involves topical eczema creams or ointments that are applied to the skin. Your dermatologist may prescribe oral and injectable medications in severe cases.

Treatment options include:

• topical corticosteroids such as betamethasone and clobetasol
• topical calcinurin inhibitors such as pimecrolimus and tacrolimus
• short courses of oral corticosteroids
• oral Janus kinase (JAK) inhibitors such as upadacitinib and baricitinib
• dupilumab, an injectable medication used for the treatment of eczema
• oral immunosuppressive medications such as methotrexate
• phototherapy.

Your doctor may prescribe an antibiotic if he or she suspects a skin infection.

Episodes of dyshidrotic eczema usually resolve over the course of a few weeks, even with no treatment. For most people, the condition improves with time and eventually stops.

Preventing and managing dyshidrotic eczema flare-ups: Practical tips

While treatment options can help manage the episodic flares of dyshidrotic eczema, there is no cure for the skin condition. You can manage your symptoms and prevent flares through certain lifestyle changes and adopting good skin habits. Practical tips include:

• Keep skin clean, dry, and moisturized. Gently clean your hands and feet and dry them thoroughly. Apply moisturizers (emollients) daily and after every hand wash.
• Learn proper handwashing techniques. Prior to washing your hands, remove all jewelry and rings. Soap and water can become trapped beneath jewelry and cause irritation. Wash hands in lukewarm water using a non-fragranced, non-soap cleanser. Hot water, excessive handwashing, and harsh soaps can dry out the skin, as can alcohol-based hand sanitizers.
• Identify and avoid triggers. Direct exposure to allergens and irritants on your skin can trigger flares. Avoid these when possible, or wear gloves to prevent direct contact with your hands.
• Keep your hands protected with gloves. When performing tasks such as dishwashing, wear cotton gloves under water-resistant gloves (such as vinyl gloves). Wear protective gloves while cooking, cleaning, gardening, and outside during cold weather.
• Manage stress. Emotional stress can cause flare-ups. Try stress management techniques such as breathing exercises, meditation, or exercise. Or talk to a therapist.

Home remedies for dyshidrotic eczema relief

Flares of dyshidrotic eczema can recur despite preventive strategies. You can try various home remedies and natural treatments for relief. For example:

• Vaseline (white petrolatum): Apply a thin layer to hands nightly, then cover with cotton gloves.
• Aloe vera: Aloe vera helps to moisturize and soothe the skin, while also providing antibacterial benefits. But avoid gels containing aloe vera, because gels often contain other ingredients that may flare eczema. Pure aloe vera and creams containing aloe vera are a better choice.
• Colloidal oatmeal: Available in both pure powder form, which can be added to warm baths, or as a main ingredient in moisturizers, colloidal oatmeal can help protect the skin barrier and the balance of bacteria on your skin.
• Virgin coconut oil: Provides both moisturizing and anti-inflammatory benefits, which can improve eczema.
• Diluted bleach soaks: Diluted warm water bleach baths or soaks can help treat and prevent bacterial infections and reduce eczema flares. Soak affected areas for five to 10 minutes twice weekly, using one teaspoon of 6% bleach for every gallon of warm water.
• Wet wraps: In cases of extreme itching, moisturizers can be applied to the skin and then wrapped in a damp cotton cloth, followed by a dry cotton garment. Change the wet wrap every few hours or leave it on overnight.

Dyshidrotic eczema on feet: Specific considerations

While it's more common for dyshidrotic eczema to occur on the hands, it's estimated that up to 25% of people are affected by dyshidrotic eczema on the feet. Common factors that contribute to dyshidrotic eczema flares on the feet include:

• excessive sweat and moisture
• excessive friction on the feet, such as from wearing tight-fitting shoes
• shoe materials such as leather, rubber, glues, and adhesives
• certain chemicals used in leather processing.

Practical tips to help with dyshidrotic eczema on the feet include:

• Wear socks and shoes made with breathable materials that allow for air circulation, such as cotton, mesh, hemp, or canvas.
• Change socks throughout the day if they become damp.
• Opt for shoes with minimal seams and an open toe box to prevent friction and rubbing.
• Avoid tight-fitting shoes. Consider those with adjustable closures, which can help you control how tightly they fit.
• If possible, look for shoes with moisture-wicking inserts, or wear sandals.

If you cannot identify your triggers, or your symptoms are worsening despite treatment, see a dermatologist. Your doctor may test for fungal infection, or perform allergy testing to pinpoint specific triggers.