Dyshidrosis
Encyclopedia
Dyshidrosis is a skin condition that is characterized by small blister
s on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic
, clear vesicles; later, scaling, fissures and lichenification occur. Recurrence is common and for many can be chronic. Incidence/prevalence is said to be 1/5,000 in the United States
. However, many cases of eczema are diagnosed as garden-variety atopic eczema without further investigation, so it is possible that this figure is misleading.
This condition is not contagious to others, but its unsightly nature can lend to awkward social interaction. The compromised integument can increase susceptibility to infection, and the accompanying itching can be a source of psychological duress.
The name comes from the word "dyshidrotic," meaning "bad sweating," which was once believed to be the cause, but this association is unproven; there are many cases present that have no history of excessive sweating. There are many different factors that may trigger the outbreak of dyshidrosis such as allergens, stress, or seasonal changes. Emotional stress may also further aggravate the condition.
It is often seen in people already susceptible to allergies and/or asthma.
Blister
A blister is a small pocket of fluid within the upper layers of the skin, typically caused by forceful rubbing , burning, freezing, chemical exposure or infection. Most blisters are filled with a clear fluid called serum or plasma...
s on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic
Itch
Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response...
, clear vesicles; later, scaling, fissures and lichenification occur. Recurrence is common and for many can be chronic. Incidence/prevalence is said to be 1/5,000 in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. However, many cases of eczema are diagnosed as garden-variety atopic eczema without further investigation, so it is possible that this figure is misleading.
This condition is not contagious to others, but its unsightly nature can lend to awkward social interaction. The compromised integument can increase susceptibility to infection, and the accompanying itching can be a source of psychological duress.
The name comes from the word "dyshidrotic," meaning "bad sweating," which was once believed to be the cause, but this association is unproven; there are many cases present that have no history of excessive sweating. There are many different factors that may trigger the outbreak of dyshidrosis such as allergens, stress, or seasonal changes. Emotional stress may also further aggravate the condition.
Symptoms
Small blisters with the following characteristics:- Blisters are very small (3 mm or less in diameter). They appear on the tips and sides of the fingers, toes, palms, and soles.
- Blisters are opaque and deep-seated; they are either flush with the skin or slightly elevated and do not break easily. Eventually, small blisters come together and form large blisters.
- Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances.
- Scratching blisters breaks them, releasing the fluid inside, causing the skin to crust and eventually crack. This cracking is painful as well as unsightly and often takes weeks, or even months to heal. The skin is dry and scaly during this period.
- Fluid from the blisters is serumSerumSerum may refer to:*Blood serum, a component of blood which is collected after coagulation.**Antiserum, blood serum with specific antibodies for passive immunity*Serous fluid, any clear bodily fluid*any drug derived from an animal's blood or serous fluid...
that accumulates between the irritated skin cells. It is not sweat as was previously thought. - In some cases, as the blistering takes place in the palms or finger, lymph node swelling may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps present in the arm pits.
- Nails on affected fingers, or toes, may take on a pitted appearance.
Causes
Causes of dyshidrosis are unknown. However, a number of triggers to the condition exist:- Dyshidrosis has been historically linked to excessive sweating during periods of anxiety, stress, and frustration. However, many cases present that have no history of excessive sweating, and the hypothesis of dyshidrosis as a sweating disorder is largely rejected. Some patients reject this link to stress, though as a trigger of vesicular eruption it cannot be overlooked, as with other types of eczema.
- Vesicular eruption of the hands may also be caused by a local infection, with fungal infectionMycosisA mycosis is a fungal infection of animals, including humans. Mycoses are common, and a variety of environmental and physiological conditions can contribute to the development of fungal diseases...
s, like Athlete's footAthlete's footAthlete's foot is a fungal infection of the skin that causes scaling, flaking, and itch of affected areas. It is caused by fungi in the genus Trichophyton and is typically transmitted in moist areas where people walk barefoot, such as showers or bathhouses...
being the most common. Sunlight is thought to bring on attacks: Some patients link outbreaks to prolonged exposure to strong sunlight from late spring through to early autumn. Others have also noted outbreaks occurring in conjunction with exposure to chlorinated pool water or highly treated city tap waters. - Allergic reactions of various kinds, including allergies to nickel which is present in many foods and vitamins (i.e. oatmeal, canned foods).
- Ingestion of alcohol; the dehydrating effects of alcohol may exacerbate the severity of the fissures and cracking.
- Inherited, not contagious. Often, patients will present with other types of dermatitis, such as Seborrhoeic dermatitisSeborrhoeic dermatitisSeborrhoeic dermatitis is an inflammatory skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceous-gland-rich areas of skin...
or atopic eczema. For this reason, among others, dyshidrosis is often dismissed as atopic eczema or contact dermatitis. - Can be the secondary effect of problems in the gut (or alternatively, it can be the cause of secondary effects of problems in the gut). Some sufferers claim diet can ease symptoms (relieving internal condition of IBSIrritable bowel syndromeIrritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
or intestinal yeast infection). Also Inflammatory bowel diseaseInflammatory bowel diseaseIn medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
s of Ulcerative colitisUlcerative colitisUlcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
and Crohn's diseaseCrohn's diseaseCrohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
. - Bandages, plasters or other types of skin-tapes may be irritating to dyshidrosis and should be avoided. As the skin needs to breathe, anything that encourages maceration (the softening and whitening of skin that is kept constantly wet) of the palms should be avoided.
- Multiple chemical sensitivityMultiple chemical sensitivityMultiple chemical sensitivity is a chronic medical condition characterized by symptoms the affected person attributes to exposure to low levels of chemicals. Commonly suspected substances include smoke, pesticides, plastics, synthetic fabrics, scented products, petroleum products and paints...
Diagnosis
Allergy testing is a contested subject among eczema communities. Some dermatologists posit that, if a sufferer is allergic to a substance, then a general allergy test on the forearm will suffice. However, others believe that, with conditions like dyshidrosis, the suspect substances must be applied to the affected area to induce a reaction.It is often seen in people already susceptible to allergies and/or asthma.
Treatment
There are many treatments available for dyshidrosis. However, few of them have been developed or tested specifically on the condition.- Topical steroids - while useful, can be dangerous long-term due to the skin-thinning side-effects, which are particularly troublesome in the context of hand dyshidrosis, due to the amount of toxins and bacteria the hands typically come in contact with.
- Potassium permanganatePotassium permanganatePotassium permanganate is an inorganic chemical compound with the formula KMnO4. It is a salt consisting of K+ and MnO4− ions. Formerly known as permanganate of potash or Condy's crystals, it is a strong oxidizing agent. It dissolves in water to give intensely purple solutions, the...
dilute solution soaks - also popular, and used to 'dry out' the vesicles, and kill off superficial staphylococcus aureusStaphylococcus aureusStaphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
, but it can also be very painful. Undiluted it may cause significant burning. - DapsoneDapsoneDapsone is a medication most commonly used in combination with rifampicin and clofazimine as multidrug therapy for the treatment of Mycobacterium leprae infections . It is also second-line treatment for prophylaxis against Pneumocystis pneumonia caused by Pneumocystis jiroveci Dapsone...
(diamino-diphenyl sulfone) is an antibacterial sulfonamide. It has been recommended for the treatment of dyshidrosis in some chronic cases. - Anti-histamines: fexofenadine up to 180 mg per day.
- "Toctino" alitretinoin 9-cis-retinoic acid has been approved for prescription in the UK. It is specifically used for chronic hand and foot eczema. It is made by Basilea of Switzerland (BAL 4079).
- In the case of a nickel allergy or sensitivity a low nickel diet may lead to improvement. This includes avoiding high nickel foods like oatmeal and chocolate, canned foods (especially acidic foods like pineapple and tomato that leach metal from the can), and using vitamins the do not contain nickel. In this situation avoiding excessive exposure to environmental nickel may also be helpful, such as not using stainless steel pots and silverware.
See also
- List of skin diseases
- DermatologyDermatologyDermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
- Epidermolysis bullosaEpidermolysis bullosaEpidermolysis bullosa is an inherited connective tissue disease causing blisters in the skin and mucosal membranes, with an incidence of 1/50,000. Its severity ranges from mild to lethal. It is caused by a mutation in the keratin or collagen gene....
- a genetic disorder that causes similar, but more severe, symptoms to dyshidrosis
External links
- Dyshidrotic eczema at MedlinePlusMedlinePlusMedlinePlus is a free Web site that provides consumer health information for patients, families, and Health care providers. The site brings together information from the United States National Library of Medicine, the National Institutes of Health , other U.S. government agencies, and...
- Images of dyshidrotic eczema at Skinsight
- MedAdvice.com
- Pompholyx at DermNet NZ (New Zealand Dermatological Society Incorporated)
- Information, advice and shared experiences for Pompholyx sufferers