Dyshidrosis is a type of

dermatitis Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can ...

that is characterized by itchy blisters on the palms of the hands and bottoms of the feet. Blisters are generally one to two

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in size and heal over three weeks. However, they often recur. Redness is not usually present. Repeated attacks may result in fissures and skin thickening. The cause is unknown. Triggers may include allergens, physical or mental

stress Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...

, frequent hand washing, or metals. Diagnosis is typically based on what it looks like and the symptoms.

Allergy testing Allergy testing can help confirm or rule out allergies and consequently reduce adverse reactions and limit unnecessary avoidance and medications.Boyce, J ''et al''., "Guidelines for the Diagnosis and Management of Food Allergy in the United States: ...

and

culture Culture () is an umbrella term which encompasses the social behavior, institutions, and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups ...

may be done to rule out other problems. Other conditions that produce similar symptoms include pustular psoriasis and scabies. Avoiding triggers may be useful, as may a

barrier cream A barrier cream is a topical formulation used in industrial applications and as a cosmetic to place a physical barrier between the skin and contaminants that may irritate the skin (contact dermatitis or occupational dermatitis). There are many o ...

. Treatment is generally with steroid cream. High strength steroid creams may be required for the first week or two.

Antihistamines Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides re ...

may be used to help with the itch. If this is not effective steroid pills,

tacrolimus Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After allogeneic organ transplant, the risk of organ rejection is moderate. To lower the risk of organ rejection, tacrolimus is given. The drug can also ...

, or psoralen plus ultraviolet A (PUVA) may be tried. About 1 in 2,000 people are affected in Sweden. Males and females appear to be affected equally. It explains about one in five cases of hand dermatitis. The first description was in 1873. The name comes from the word "dyshidrotic", meaning "difficult sweating", as problems with sweating was once believed to be the cause.

Signs and symptoms

Dyshidrosis has been described as having the following characteristics: * Itchiness of the palms or soles, followed by the sudden development of intensely itchy small blisters on the sides of the fingers, the palms or the feet. * These blisters are often described as having a "

tapioca pudding Tapioca pudding (similar to sago pudding) is a sweet pudding made with tapioca and either milk or cream. Coconut milk is also used in cases in which the flavor is preferred or in areas in which it is a commonplace ingredient for cooking. It is ...

" appearance. * After a few weeks, the small blisters eventually disappear as the top layer of skin falls off. * These eruptions do not occur elsewhere on the body. * The eruptions may be symmetrical. File:DyshidroticDermatitisOnHandsLateStage.jpg, Advanced stage of dyshidrosis on the fingers File:Dyshidrosis.JPG, Palmar dyshidrosis File:Palmar dyshidrosis peeling stage.JPG, Advanced stage of palmar dyshidrosis on the palm showing cracked and peeling skin File:Dyshidrosis late stage.jpg, Advanced stage of dyshidrosis on the foot. File:Rim of scale on plantar surface of thumb.jpg, Rim of scale on the palmar surface of the thumb from a resolving dyshidrotic flare

Causes

The exact causes of dyshidrosis are unknown. Food allergens may be involved in certain cases. Cases studies have implicated a wide range of foods including

tuna A tuna is a saltwater fish that belongs to the tribe Thunnini, a subgrouping of the Scombridae ( mackerel) family. The Thunnini comprise 15 species across five genera, the sizes of which vary greatly, ranging from the bullet tuna (max len ...

tomato The tomato is the edible berry of the plant ''Solanum lycopersicum'', commonly known as the tomato plant. The species originated in western South America, Mexico, and Central America. The Mexican Nahuatl word gave rise to the Spanish word ...

pineapple The pineapple (''Ananas comosus'') is a tropical plant with an edible fruit; it is the most economically significant plant in the family Bromeliaceae. The pineapple is indigenous to South America, where it has been cultivated for many centuri ...

chocolate Chocolate is a food made from roasted and ground cacao seed kernels that is available as a liquid, solid, or paste, either on its own or as a flavoring agent in other foods. Cacao has been consumed in some form since at least the Olmec civ ...

coffee Coffee is a drink prepared from roasted coffee beans. Darkly colored, bitter, and slightly acidic, coffee has a stimulating effect on humans, primarily due to its caffeine content. It is the most popular hot drink in the world. Seeds of ...

, and

spices A spice is a seed, fruit, root, bark, or other plant substance primarily used for flavoring or coloring food. Spices are distinguished from herbs, which are the leaves, flowers, or stems of plants used for flavoring or as a garnish. Spices are ...

among others. A number of studies have implicated

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. A 2013 study found that dyshydrosis on the hands increased among those allergic to

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, following inhalation of house dust mite allergen.

Id reaction Id reactions (also known as "disseminated eczema," and "generalized eczema") are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalis ...

and

irritant contact dermatitis Irritant contact dermatitis is a form of contact dermatitis that can be divided into forms caused by chemical irritants and those caused by physical irritants. Chemical Chemical irritant contact dermatitis is either acute or chronic, which is u ...

are possible causes.

Diagnosis

Dyshidrosis is diagnosed clinically, by gathering a patient's history and making careful observations (see signs and symptoms section). Severity of symptoms can also be assessed using the dyshidrotic eczema area and severity index (DASI). The DASI has been designed for clinical trials and is not typically used in practice.

Treatment

There are many treatments available for dyshidrosis. However, few of them have been developed or tested specifically on the condition. * Barriers to moisture and irritants, including

s and gloves. * 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 permanganate Potassium permanganate is an inorganic compound with the chemical formula KMnO4. It is a purplish-black crystalline salt, that dissolves in water as K+ and , an intensely pink to purple solution. Potassium permanganate is widely used in the c ...

dilute solution soaks – also popular, and used to 'dry out' the vesicles, and kill off superficial '' Staphylococcus aureus'', but it can also be very painful. Undiluted it may cause significant burning. * Dapsone (diamino-diphenyl sulfone), an

antibacterial An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention ...

, has been recommended for the treatment of dyshidrosis in some chronic cases. *

Fexofenadine Fexofenadine, sold under the brand name Allegra among others, is an antihistamine pharmaceutical drug used in the treatment of allergy symptoms, such as hay fever and urticaria. Therapeutically, fexofenadine is a selective peripheral H1 block ...

up to 180 mg per day. *

Alitretinoin Alitretinoin, or 9-cis-retinoic acid, is a form of vitamin A. It is also used in medicine as an antineoplastic (anti-cancer) agent developed by Ligand Pharmaceuticals. It is a first generation retinoid. Ligand gained Food and Drug Administration ...

(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

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of Switzerland (BAL 4079). * Systemic steroids can be taken orally to treat especially acute and severe cases of dyshidrosis.

Epidemiology

About 1 in 2,000 people are affected in Sweden. Males and females appear to be affected equally.

Synonyms

Dyshidrosis is also known as pompholyx, a term originating from the Greek word for "bubble".

References

External links

Images of dyshidrotic eczema
at Skinsight

at DermNet NZ (New Zealand Dermatological Society Incorporated) {{Disorders of skin appendages Eczema Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate