Donate For AAD Members Search

Go to AAD Home
Welcome!
Advertisement
Advertisement

Eczema types: Dyshidrotic eczema diagnosis and treatment


If you frequently get blisters, making an appointment to see a board-certified dermatologist can be helpful. Several different diseases can cause blisters, including dyshidrotic eczema. To get effective treatment, you need an accurate diagnosis.

The following explains how dermatologists diagnose and treat dyshidrotic eczema, which can cause blisters on your hands, feet, or both.

How do dermatologists diagnose dyshidrotic eczema?

If your dermatologist suspects that you have dyshidrotic eczema, your dermatologist will:

  • Look closely at the skin on your hands and feet

  • Take a bit of fluid from a blister if it looks infected

  • Ask you questions about your health, what you do for work and hobbies, and when you usually develop blisters

During your appointment, be sure to tell your dermatologist if you have a metal implant in your body or recently:

  • Noticed that your skin reacts when you wear certain jewelry

  • Smoked tobacco

  • Had an injection of vitamin B12

  • Received intravenous immunoglobulin (IVIG)

  • Worked with cutting oil or cement

  • Took a medication, including aspirin or birth control pills

If your dermatologist thinks that the dyshidrotic eczema could be due to an allergy, an allergy test called patch testing may be recommended. During patch testing, small amounts of substances that you may be allergic to are placed on your skin — often the skin on your back.

That’s often all that’s needed to determine whether you have dyshidrotic eczema. If you do, your dermatologist will create a treatment plan tailored to your needs.

Having an infection can stop dyshidrotic eczema from clearing

In one study, researchers found that about 33% of patients who had dyshidrotic eczema on their hands got rid of the dyshidrotic eczema only after treating an infection on their feet.

Dermatologist using dermatoscope to examine patient’s hand

How do dermatologists treat dyshidrotic eczema?

Your dermatologist will create a treatment plan for you to follow at home. This treatment plan will be tailored to your individual needs and may include the following:

Soaks and cool compresses: Medicated soaks and cool compresses can be very effective for drying blisters. You will apply these two to four times a day for 15 minutes at a time.

Corticosteroid that you apply to your skin: After each soak or cool compress, you’ll likely need to apply a medicated cream or ointment, such as a prescription corticosteroid. This helps to reduce the inflammation and clear the blisters.

Anti-itch medicine: An antihistamine pill or other anti-itch medicine can reduce your discomfort. Anything you can do to reduce scratching is helpful because scratching tends to worsen dyshidrotic eczema. One anti-itch medication that dermatologists frequently include in a treatment plan is pramoxine (pra mox’ een). Available as a cream or lotion, this medication helps to relieve itch and pain.

Moisturizer or a barrier repair cream: Dyshidrotic eczema can make your skin extremely dry. To reduce dryness and decrease flare-ups, your dermatologist will recommend a moisturizer or barrier repair cream.

Be sure to use the moisturizer or barrier repair cream that your dermatologist recommends

You want to apply it when your skin is still damp after every:

  • Bath

  • Shower

  • Handwashing

Medication to treat an infection: Skin with dyshidrotic eczema can be very itchy. Scratching often causes an infection. To clear the infection, your dermatologist will first determine what type of infection you have and then prescribe medication to treat it.

Your treatment plan may need adjustments

If you continue to have flare-ups after following the treatment plan prescribed by your dermatologist, tell your dermatologist. It can take time to find the right treatment for dyshidrotic eczema.

In studying dyshidrotic eczema, dermatologists have found that the following can be effective.

Treatment for excessive sweating: If you sweat profusely where you have blisters, treatment that helps to control the sweating can be effective. To treat the excessive sweating, your dermatologist may prescribe:

  • A prescription antiperspirant that you apply to the area

  • Injections of botulinum toxin where you have dyshidrotic eczema

Most people think of botulinum toxin as a treatment for wrinkles and frown lines. The U.S. Food and Drug Administration (FDA) has also approved it to treat excessive sweating.

Studies suggest that excessive sweating may trigger dyshidrotic eczema. By reducing the profuse sweating, some people are able to reduce flare-ups. If your dermatologist recommends botulinum toxin, protect your health by seeing a board-certified dermatologist for this treatment.

Stronger medication: People who have dyshidrotic eczema likely have a hypersensitivity. It’s believed that this hypersensitivity causes the blisters. Applying corticosteroids to your skin can help lessen this hypersensitivity, but some patients need stronger (or different) medication.

If you need to treat your skin frequently to prevent flare-ups, your dermatologist may prescribe a medication called pimecrolimus cream or tacrolimus ointment. The U.S. Food and Drug Administration (FDA) approved these medications to treat a different type of eczema called atopic dermatitis.

Studies show these medications can effectively treat dyshidrotic eczema. They can be prescribed for a few weeks. If you need long-term treatment, your dermatologist can explain how to use these medications as needed to control flares.

Medication that works throughout your body can be effective when other medication fails to work. Most of these medications help to calm the immune system. Your dermatologist can tell you if one might be an option for you.

Light treatments: This may be an option when stronger treatment is required. If this is an option, you will need to go to your dermatologist’s office or a hospital for treatment. Often a patient needs five treatments a week for three weeks. Do not try to self-treat by spending time outdoors without sun protection or using a tanning bed, as this can damage your skin and increase your risk of getting skin cancer.

Change in diet: Nickel and cobalt are metals found in many foods. If you have a hypersensitivity to either of these metals, a change in diet may help reduce flares-ups.

To reduce the amount of nickel or cobalt in your diet, your dermatologist may recommend a point-based diet. This diet assigns points to foods and beverages. The higher the amount of nickel (or cobalt), the higher the points value for that food or beverage.

To follow this diet plan, your dermatologist will give you information so that you can track your points. You will need to track your points every day. Once you reach a certain number of points, you stop consuming anything that has points.

Patients find it easier to follow a point-based diet than to avoid everything that contains the metal to which they have a sensitivity. Many foods and beverages contain at least small amounts of either nickel or cobalt. Trying to avoid all of them can leave you with few options.

Studies have found that when patients with dyshidrotic eczema who have a metal hypersensitivity follow this point-based diet, they report fewer and less severe flare-ups.

Bed rest, a break from work, or both: If you have painful blisters on your feet, you may need bed rest. Blisters on the hands may require a break from work.

Referral to another doctor: Stress leads to flare-ups for many people with dyshidrotic eczema. If you often feel stressed out or notice that you only get flare-ups when under stress, learning how to manage stress can mean fewer flare-ups.

To help you manage stress effectively, your dermatologist may refer you to a psychologist who can teach you biofeedback therapy or another stress reduction technique.

Seeing an allergist can be helpful if you continue to have flare-ups

Testing can find out if you have any allergies that may be triggering your flare-ups.

Self-care plays a key role in controlling dyshidrotic eczema

While treatment can help clear your skin and calm the itch, dyshidrotic eczema can be a long-term disease. It can be especially active from your 20s through your 40s, with fewer flare-ups later in life.

Self-care can help reduce flare-ups. To find the self-care that dermatologists recommend, go to, Dyshidrotic eczema: Self-care.


Image
Getty Images

References
Amini S, Burdick AE, et al. [chief editor] James WD. “Dyshidrotic eczema (pompholyx).” Medscape. Last updated 4/22/2020. Last accessed 9/30/2020.

Guillet MH, Wierzbicka E. “A 3-year causative study of pompholyx in 120 patients.” Arch Dermatol. 2007;143(12):1504-8.

McGovern TW. “Dermatitis (Eczema).” In: Fitzpatrick JE, et al. Dermatology Secrets. Hanley & Belfus, Inc., USA, 1996:47-48.

Nishizawa A. “Dyshidrotic eczema and its relationship to metal allergy.” Curr Probl Dermatol. 2016;51:80-5.

Petering H, Christine Breuer C, et al. “Comparison of localized high-dose UVA1 irradiation versus topical cream psoralen-UVA for treatment of chronic vesicular dyshidrotic eczema.” J Am Acad Dermatol. 2004 Jan;50(1):68-72.

Reider N, Fritsch PO. “Other eczematous eruptions.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 237-8.

Stuckert J, Nedorost S. “Low-cobalt diet for dyshidrotic eczema patients.” Contact Dermatitis. 2008;59(6):361-5.

Waldman RA, DeWane ME, et al. “Dupilumab for the treatment of dyshidrotic eczema in 15 consecutive patients.” J Am Acad Dermatol. 2020 May;82(5):1251-2.


Written by:
Paula Ludmann, MS

Reviewed by:
Dara D. Spearman, MD, FAAD
Elaine T. Kaye, MD, FAAD
Emily Chu, MD, PhD, FAAD

Last updated: 11/16/20

Advertisement
Advertisement
Advanced search
Advanced search