Today, I will talk about dyshidrotic eczema, also known as dyshidrosis or pompholyx, a condition that is as common as it is bothersome. It manifests as itchy blisters on the hands and feet. Those who suffer from it know that it can be very disruptive to daily life. It tends to appear especially with changes in the weather (such as spring) or during periods of stress.
WHAT IS Dyshidrotic Eczema or Pompholyx? – Symptoms
We call dyshidrotic eczema, dyshidrosis, or pompholyx the small bubbles, pimples, or blisters that appear on the sides of the fingers and toes. They may also extend to other areas of the palms or soles. The appearance of these vesicles is relatively common and may account for up to 20% of hand eczema cases. It can appear at any age, although it is more common before the age of 40.
It is characteristic that blisters appear on the sides of the fingers that are very itchy.
It may occur only on the hands (most frequently), only on the feet, or on both sites. They are usually small vesicles (which in more severe cases may become blisters) on the sides of the fingers. These may become superinfected (in which case they become more yellowish). The vesicles break with time and gradually flake off. Sometimes small cracks form on the skin, which can be annoying. This rash is notably very itchy.
Outbreaks may last several weeks and recur periodically.
Here you can see more pictures of dyshidrotic eczema.
WHY does Dyshidrotic Eczema or Pompholyx Break Out? – Cause
In my experience with patients with dyshidrotic eczema, in the vast majority of cases, there is no clear cause for its occurrence. Dyshidrotic eczema (like so many other skin diseases) is capricious. It usually appears suddenly and can disappear just as suddenly (although, as we will discuss later, there are treatments available to improve it). However, it is more frequent in people with atopic dermatitis or other types of eczema.
It is known to be more common in warmer climates. It can flare up in times of increased stress and worry, and some cases have been associated with fungal infections, smoking, and some intravenous treatments. In any case, the most common scenario is that the cause is unknown.
Although the exact cause is not known, it has been found that sweating does not influence the appearance of the disease.
Vesicles finger dyshidrotic eczema.
It used to be thought that dyshidrotic eczema was related to sweating of the feet and hands, and that the blisters formed when the sweat glands became occluded. To date, this hypothesis has been discarded, as no evidence or demonstration of this supposed mechanism has been found.
HOW IS Dyshidrotic Eczema or Pompholyx Diagnosed? – Diagnosis
First of all, it is important to differentiate it from other diseases that can cause skin pimples (psoriasis, other eczemas, fungal infection, scabies, etc.). Dyshidrotic eczema can usually be diagnosed with a simple clinical examination. Dermatologists do not usually need specific tests to recognize it. In rare cases, if a good response to treatment is not observed, a biopsy, culture, or certain allergy tests may be necessary.
On the other hand, it is important to confirm in any case that the dyshidrotic eczema is not caused by a contact allergy to some substance or material that the person touches on a daily basis. This is called allergic contact eczema and may be due to metals, fragrances, rubbers, preservatives, or dyes. Dyshidrotic eczema and contact eczema can manifest in very similar ways. To determine if this is the cause, contact tests can be performed, and if sensitization is confirmed, by eliminating the causative factor, the symptoms of eczema will disappear.
HOW IS Dyshidrotic Eczema or Pompholyx Treated? – Treatment
Measures such as using mild soaps, wearing gloves, and avoiding irritating products can help improve dyshidrotic eczema. In many cases, eczema may heal on its own after a few weeks.
First, it is not enough to use moisturizer. Cosmetics alone do not have the ability to control eczema and can even make it worse.
Second, the most commonly used treatment is corticosteroid creams. These, in most cases, reduce itching as well as the appearance of vesicles and desquamation. The treatment may last several days or weeks. In more severe cases, oral corticosteroids or other treatments (such as phototherapy in rare cases) may be necessary.
Dyshidrotic eczema may heal on its own, but in most cases, it is treated with corticosteroid creams. However, it is important to know that, even with proper treatment, eczema may have a tendency to recur. Many times it may be necessary to use the treatment repeatedly or even to use a maintenance treatment. Your dermatologist can advise you on how to do this.
How Does Dyshidrotic Eczema or Pompholyx Evolve? – Prognosis
In my experience, it is really important that sufferers of dyshidrotic eczema understand its recurrent nature. The itchy blisters and pimples that appear on the hands and feet usually reappear periodically. It is also common for outbreaks to occur during times of increased stress or worry.
As I often say in my practice, we do not know how to cure dyshidrotic eczema, but we do know how to manage it. Consequently, it is highly recommended that those suffering from this condition have the necessary tools to control the outbreaks and symptoms caused by dyshidrotic eczema, always with the guidance of their dermatologist. Ultimately, it will be the patient themselves who best controls which treatment cream to apply and at what time it is best to apply it.
Psychological Impact of Dyshidrotic Eczema or Pompholyx
Itching is the worst symptom caused by dyshidrotic eczema. The rupture or erosion of the blisters also causes a lot of discomfort to sufferers. Beyond the purely dermatological symptoms, we know that people with dyshidrotic eczema may feel affected or withdrawn in their personal relationships. Having their hands permanently “bad” together with the frustration of not achieving adequate control means that the psychological repercussions of dyshidrotic eczema can be significant.
In this sense, from my experience as a dermatologist, I believe it is important to understand that dyshidrotic eczema can be controlled and improved. Moisturizing cream alone is not enough (in fact it often makes it worse) and it is necessary to use medicated creams (usually with corticosteroids). Using the right guidelines, it is possible to control it and prevent its reappearance.
Therefore, in my opinion, it makes no sense to resign oneself to outbreaks. The help of a dermatologist who is an expert in pompholyx can alleviate and improve the repercussions on the daily life of the sufferer.
In conclusion…
Dyshidrotic eczema is not a sign of any internal disease, it is not contagious, and it is not related to sweating of the hands or feet. It can be treated with topical corticosteroids, but it may have a tendency to recur, as it follows a “capricious” course. Its exact cause is not known at this time.
