Dyshidrotic Hand Eczema – Causes, Symptoms and Treatment

Itchy blisters on the palms of the hands and finger sides are the typical symptoms of this skin disease. A dyshidrotic hand eczema can be caused by different factors. The chances of recovery are very good, but require a precise diagnosis. This professional article informs you about everything worth knowing. An online assessment and therapy recommendation for your individual skin problem can also be made by board-certified dermatologists via our Online-Dermatologist-Service.

Itching hands with many blisters and small blisters are typical symptoms of dyshidrotic hand eczema.

What is hand eczema?

What exactly is dyshidrotic hand eczema?

It is annoying if these small bubbles form on the palms or sides of the fingers, which is typical for dyshidrotic hand eczema: The itching is unpleasant, the vesicles can open and thus promote infection – a fatal cycle begins. The more you scratch, the more blisters appear, which in turn increase the itching. So far, the causes have not been fully identified, which makes treatment all the more difficult. Obviously there are connections between different substances and medicines on the one hand and bacteria, viruses, fungi and above all psychological aspects on the other. Dyshidrotic hand eczema must therefore be treated individually, as Dr. Titus Brinker, dermatologist from Heidelberg, explains – here are the most important points about this skin disease.

Dyshidrotic eczema occurs as a dermatological disease preferably on the palms of the hands and the sides of the fingers in the form of small blisters. As a specific variant of eczema this clinical picture is attributed to inflammatory skin diseases and is also referred to as dyshidrosis, dishydrosiform eczema or pompholyx. Two variants are typical:

  • Dyshidrosis lamellosa sicca

    The skin changes little, the acute phase is short. The vesicles dry out on their own and remain as empty sheaths, which then gradually separate into scales as soon as new skin cells have regrown.

  • Cheiropompholyx or Podopompholyx

    The vesicles are larger and can merge into each other, so that the target area for possible infections increases significantly.

Causes: Dyshidrotic hand eczema as inflammatory skin disease

The original and name-giving assumption that dyshidrotic hand eczema is due to a malfunction of the sweat glands is outdated in the meantime – but the term, which can be translated as “bad sweat”, has remained. Even though this derivation can now be ruled out, it is still unclear what the concrete reasons for this skin disease are. The technical literature discusses the connection with some drugs and various substances, fungi and bacteria. Probably psychological factors, primarily stress, play an important role. However, it was found that the probability of a disease is higher in people with contact allergies or atopy. The demarcation is naturally difficult, because the skin diseases mentioned show a similar appearance as a dyshidrotic hand eczema. Therefore, a differential diagnosis is necessary here.

The essential symptoms

Typical for dyshidrotic hand eczema is itching at the relevant skin areas: Small vesicles filled with a colourless to yellowish liquid form under the skin, causing tension in the tissue above. The surrounding skin is reddened, may thicken over time and tend to flake. The leathery skin surface which develops during the course of the disease is dry and less elastic, it tends to painful cracks which can bleed. However, these rhagades usually heal without leaving any scars. The fact that the affected areas of the skin are permanently in motion makes the healing process more difficult. If the areas are not treated with ointments, tears can occur again and again.

The detailed diagnosis

In general, examination of the external appearance of this skin disease is sufficient to detect dyshidrotic hand eczema. However, it should be distinguished from allergic reactions as these can cause similar symptoms. Therefore, a dermatologist will usually perform a test for contact allergies: The common allergens are applied to the skin and covered by a patch or lapping test. Based on the reaction after 48, 72 or, if necessary, 96 hours, the diagnostician can determine whether the skin responds to a specific allergen. Alternatively, atopia is considered, because atopic eczema is also similar to dyshidrotic eczema.

If the vesicles that have formed flow together during the course of the infection, which is referred to by the technical term “confluent”, the risk of infection increases. Viruses and fungi in particular can penetrate the tissue via the blisters that have burst as a result of movement or scratching and cause complications. As a rule, two forms of dyshidrotic hand eczema, namely Cheiropompholyx and Podopompholyx, are particularly susceptible.

Possible Complications of Diyshidrotic Hand Eczema

The itching caused by the formation of blisters is unpleasant anyway, especially if the affected skin sweats more, as is often the case with dyshidrotic hand eczema. The itching becomes even more intense, the affected persons give in to the strong urge to scratch, the blisters can burst and wet. Already against this background it becomes clear that the quality of life is impaired by this skin disease. In addition, the changes in the skin, especially the tendency to tear open painfully, significantly limit the activities. This makes targeted treatment with creams and ointments, which as a rule quickly alleviate the symptoms and reduce the likelihood of further complications, all the more important.

Important to know:

If you experience excessive itching on relevant areas of the skin, you should consult a general practitioner. If the typical blisters are already formed, it is best to consult a specialist to determine whether it is a dyshidrotic eczema. The specialist will then also determine the treatment, as any redness or cracking that may occur will first be observed. As soon as bleeding and subsequent infections occur, please inform your doctor.

If you suffer from contact allergy or atopy, the likelihood of developing dyshidrotic eczema increases as much as if you were taking certain chemical substances or medications. Even if you are exposed to excessive stress, this disease is also aggravated. If the symptoms occur, please consult your doctor and have the skin condition clarified. You will have to reckon with a few visits to the doctor, as allergists in particular should be consulted. If you already have an inflammation, please contact a dermatologist directly and, in an emergency, the emergency medical service.

The possibilities of therapy

Dyshidrotic hand eczema is regularly treated externally with creams, ointments or lotions. Primarily preparations with glucocorticoids, which belong to the corticosteroids, are used. This active ingredient inhibits inflammatory reactions and provides a pleasant relief of symptoms, but should only be used for a shorter period of time. The side effects are not to be rejected with regular and long-term application from the hand.

Alternatively, capsules containing 9-cis-retinoic acid (alitretinoin) may be prescribed if glucocorticoid therapy does not lead to the desired result. In addition, tanning agents dry out the vesicles, and zinc ointment is also recommended as an anti-inflammatory. In order to reduce the risk of complications caused by infections, some hygienic measures are recommended. However, the correct measure must be determined individually, as frequent hand washing, disinfection and wearing of gloves can prove counterproductive. Dermatologists will therefore coordinate the treatment on the basis of the specific sensitivities and, if possible, tailor it to a specific cause.

The prognosis

Even if the causes for a dyshidrotic hand eczema are not beyond doubt, the triggers can be treated quite well – the prognosis is therefore good. It is important to determine the risk factors in question in detail and then to avoid them. The anti-inflammatory drugs can alleviate the symptoms well, which facilitates further treatment. The dermatologist will draw up a treatment plan that takes up the individual complaints and takes them into account. With the appropriate hygiene measures you can directly influence the symptoms and support the healing.

It becomes more difficult if the triggers are psychosomatic in nature. In this case, healing can take several years. If the disease is triggered seasonally, patients experience completely symptom-free phases in between, but eczema can break out again and again at any time. Then it is important to select the appropriate skin care products together with the specialist and to avoid stress.

Important to know:

As soon as you give in to the really annoying itching, the chances of relief decrease. At the same time, there is a risk of infection, which can even lead to life-threatening blood poisoning, as pathogens can penetrate. If necessary, you can buy antihistamines as drops in the pharmacy and apply thick zinc ointment to the skin in the evening. In this case it is best to wear special cotton gloves so that the ointment can take effect. Alternatively, you can simply pull a cotton sock over the creamed hand.

Aftercare in dyshidrotic eczema

Naturally, diagnosis and treatment by a specialist are important to achieve successful healing. It is a fact that self-healing is not possible, you cannot avoid consulting a doctor. The possibilities of aftercare are also limited. In principle, you can only ensure that you avoid infections by, for example, adapting your hygiene standards to suit your needs. As a rule, however, frequent washing is sufficient, but individual requirements are quite different.

If you need to take medication, please make sure that it is taken regularly and in the correct dosage in order to achieve lasting relief from your symptoms. If you notice any side effects, please consult your doctor. It is not advisable to stop taking the medication on your own. Apart from the restrictions in everyday life, you usually do not have to fear any further impairments – not even with regard to life expectancy.

Important to know:

Since the causes of dyshidrotic hand eczema are still not known, you can support the diagnosis: Maintain a diary in order to identify any connections between activities, food, medication and life situation on the one hand and disease episodes on the other. For example, certain stress situations may be relevant that you will be able to deal with in the future using suitable relaxation techniques. Your diet is just as important, because a food allergy can also contribute to the onset of dyshidrotic hand eczema.

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