Dyshidrotic dermatitis, also referred to as pompholyx, is a type of eczema. This condition is common and typically affects the hands, but can affect the feet too. This condition tends to come and go and the episodes associated with this condition occur more often in warm weather. The cause is unknown, but emotional stress can worsen this condition. Ingesting chromate, quinoline, neomycin, nickel, or other allergens, may be responsible for some cases.
Signs and Symptoms
The hands are most often affected, but some patients also experience this condition on their feet. Signs or symptoms include:
- Because the skin on the palms is thick, the blisters can look deep-seated. When this condition is severe, the lesions can become one, merging into one large blister, or multiple large blisters
- Tense, small, clear fluid-filled blisters on the palm's surface, the soles of the feet, and on the sides of the toes and fingers
- Mild redness
In most cases, diagnosis is made based on the signs and symptoms. Doctors may do blood work to rule out other possible conditions.
The stage of dyshidrotic dermatitis will determine the treatment. Most episodes will spontaneously resolve within one to three weeks, but treatments are available to help control the itching and increase healing time.
Cold compresses that use weak solutions of aluminum acetate, potassium permanganate, or vinegar in water, can be applied up to four times a day for 15 minutes at a time. This will help in drying up any blisters.
To keep the skin soft, hand creams or emollients, such as dimeticone barrier cream, should be applied frequently and liberally.
Flucloxacillin, and certain other antibiotics, are used when a secondary infection is present.
Steroids may be useful in treating this condition. Topical steroids are applied every night directly to the affected area. They help in relieving the itching and inflammation. Unless a doctor says otherwise, these are generally not used for longer than two weeks. When the skin is weeping or blistering steroids creams are used. When a patient is experiencing the chronic dry stage, steroid ointments are used. Systemic steroids, such as cortisone preparations, are used in severe cases, in either their injectable or oral form.
Other medications may be beneficial in treating this condition, such as botulinum toxin to help prevent sweating, methotrexate, azathioprine, and dapsone.
PUVA therapy is helpful for some patients. This therapy includes using a special ultraviolet light. Several times a week, the affected areas will be soaked in psoralen and then they will be exposed to long wave ultraviolet light. This treatment typically goes on for several months. This therapy is not effective for all patients.
A secondary infection due to staphylococcal bacteria is possible and happens more often than thought. This infection causes pain, swelling, crusting, redness, or pustules.
New Zealand Dermatological Society. (2009). Pompholyx. Retrieved on January 30, 2011 from the New Zealand Dermatological Society: https://www.dermnetnz.org/dermatitis/pompholyx.html
Skinsight. (2008). Dyshidrotic Eczema. Retrieved on January 30, 2011 from Skinsight: https://www.skinsight.com/adult/dyshidroticDermatitis.htm