Dyshidrotic Eczema

What causes dyshidrotic eczema?
Dyshidrotic eczema symptoms
Dyshidrotic eczema treatment
Preventing flares

Dyshidrotic eczema, also called dyshidrosis, is a type of eczema that causes itchy little blisters on fingers and toes, or elsewhere on the hands or feet. Your dermatologist can prescribe dyshidrotic eczema treatment to get the symptoms under control. They can also help you identify your triggers so you can avoid them if possible.

What causes dyshidrotic eczema?

As with other types of eczema, dyshidrotic eczema is often triggered by exposure to an allergen or something in the environment. The root cause is not known, but genes probably play a role, since eczema runs in families. Dyshidrosis is most common in people ages 20 to 40, especially women.

Dyshidrotic eczema triggers

Common triggers include irritants, excess moisture and flare-ups of other allergic conditions. Your dyshidrotic eczema could be brought on by:

Certain metals, particularly nickel (commonly found in jewelry) and cobalt
Cement and cutting oil
Certain shampoos or soaps
Prolonged or repeated moisture exposure from sweaty hands, handwashing or jobs that involve getting your hands wet
Weather, including hot, humid weather and cold, dry weather
Food allergens and foods that contain nickel, which include tuna, cocoa, chocolate, soybeans, oatmeal, nuts, almonds and legumes
Flare-ups of other conditions such as hay fever and other types of eczema
A skin infection such as athlete’s foot
Skin irritants including perfume, laundry detergent and other strong chemicals
Prolonged or intense stress, which causes the release of excess cortisol (the “stress hormone”), triggering skin inflammation

People who think they have stress-related eczema on their hands probably have dyshidrotic eczema, though stress doesn’t cause eczema unless you’re already prone to it.

Dyshidrotic eczema symptoms

Symptoms start with a burning sensation, a prickly feeling or itching. Soon afterward, small, fluid-filled blisters appear on the fingers, toes, palms of the hands or soles of the feet. The blisters are firm and intensely itchy. They can be limited to one area or appear in scattered clusters.

As the blisters clear, the skin around them dries out and becomes red and sore. In severe cases, the skin may bleed or crack open. Blisters may become infected, especially if they merge to form a large blister or you have large clusters of blisters and you keep scratching them. If you have blisters on your feet, wearing shoes may be painful.

Dyshidrosis can be embarrassing, especially if occurs on the hands, which are hard to hide. For some people, eczema on the hands contributes to anxiety and stress, which can in turn make the condition worse. If it continues over time, the skin may become thick and itch constantly.

Dyshidrotic eczema treatment

Your dermatology provider will diagnose your eczema by looking at your skin and asking questions. In some cases, they may take a sample of the blister fluid or order a blood test or allergy test. They will also help you identify your triggers. Treatment is aimed at managing the symptoms and reducing future flares.

At-home treatment is often sufficient for mild cases. Applying a cool compress (a wet washcloth will do) can temporarily ease the burn or itch. Applying an over-the-counter corticosteroid cream or ointment and taking an antihistamine can also help.

If your symptoms warrant stronger treatment, your dermatologist may recommend a prescription-strength corticosteroid cream or ointment, an immune-suppressing drug such as methotrexate, or phototherapy. Phototherapy involves exposing the skin to a specific wavelength of UVA or UVB light during multiple visits. If other treatments don’t work, another treatment option is a biologic drug called dupilumab.

During a flare, you can avoid making the symptoms worse with these strategies.

Keep the area clean and dry.
Avoid excess friction on blisters or open sores. You may need to avoid wearing shoes, or at least closed shoes, if you have blisters on your feet.
Use warm or cool water, not hot, in the shower and while washing dishes.
Resist the urge to scratch or pick at the blisters. Doing so can irritate the skin, prolong the symptoms and potentially lead to infection. If the temptation is strong, trim your fingernails. If you can’t resist scratching at night, wrap the hand or foot with a bandage or gauze before going to bed.

Preventing flares

Some people experience dyshidrotic eczema once and never again, but for most people, it comes and goes. To keep your next flare at bay, follow these tips.

Avoid your triggers when possible.
Minimize stress. Try practicing a stress management technique such as deep breathing, meditation or yoga, or work with a counselor or other mental health professional who can help you manage the stress in your life.
Moisturize regularly. Apply a thick moisturizing cream or an ointment after washing your hands or touching potential irritants.
Remove sweaty socks and gloves quickly. After you exercise or sweat, change your socks. If your hands sweat in gloves, take the gloves off as soon as you can. Choose moisture-wicking socks and gloves.