Occurring only on the palms of the
hands, sides of the fingers, and soles of the feet, this common
eczema typically causes a burning or itching sensation and a
blistering rash. Some patients say the blisters resemble tapioca
Some medical conditions
increase the risk of developing dyshidrotic dermatitis. This
43-year-old woman had asthma and later developed dyshidrotic
with permission of the American Academy of
National Library of Dermatologic Teaching Slides)
Signs and Symptoms
Small, deep blisters can form on the
palms, sides of the fingers, and/or soles
Intense burning or itching
Inflamed skin (reddish and hot to the
Cracking and peeling skin
Affected areas may sweat excessively
Skin may become infected, causing
oozing blisters and crusts
Skin between the fingers can soften;
skin may feel spongy
Nail changes if dyshidrotic
dermatitis persists for a long time. The fingernails can develop
ridges and pitting. The nails may thicken and discolor.
Sometimes as the skin clears, the
skin peels and a new crop of blisters appear
Extensive peeling and cracking in
Researchers now believe that a
person’s reaction to events occurring within the body (e.g.,
having another medical condition) and factors occurring outside
the body (e.g., the weather) play a role.
Research shows that excessive
sweating — originally believed to be the cause — does not cause
Researchers have identified several factors that can increase
one’s risk of developing dyshidrotic dermatitis and the risk of
Stress. Probably the most
common risk factor, many patients report a stressful period before
Gender. Females tend to
develop dyshidrotic dermatitis more frequently than males.
Weather. Flare-ups are most
frequent in hot humid weather. In fact, the weather is a common
trigger for many patients. A study of 104 patients found that the
following weather conditions triggered flare-ups: heat (29.8% of
patients), humidity (24% of patients), and cold (12.5% of
Pre-existing atopic condition
(e.g., atopic eczema, hay fever, or asthma). Having one or more of
these conditions significantly increases the risk.
Pre-existing contact dermatitis.
Having contact dermatitis significantly increase the risk of
developing dyshidrotic dermatitis.
Pre-existing infection. Having
an infection in another part of the body may increase the risk. A
study found that one-third of the patients saw the dyshidrotic
dermatitis on their hands clear after they received treatment for
their athlete’s foot.
Metal implant, such as a hip
replacement. Studies show a direct correlation between a metal
allergy and developing dyshidrotic dermatitis.
Aspirin, oral contraceptives, and
smoking. One study suggests that smoking as well as taking
aspirin or an oral contraceptive increases the risk.
While some patients experience only one outbreak that clears in 2
or 3 weeks without treatment, others have recurring flare-ups that
can range in frequency from once a month to once a year.
Diagnosis begins with a complete
medical history and visual examination of the skin.
A dermatologist may swab the affected
skin if it looks infected.
A type of testing called “patch
testing” may be scheduled to find out if the patient has
Blood tests may be ordered to find
out if other medical conditions exist.
This condition can be a challenge to treat, and some patients say
dyshidrotic dermatitis seems unresponsive to treatment. To
overcome these obstacles, dermatologists often call upon an array
of treatment options to control the condition:
Topical corticosteroid and cold
compresses are typically used first.
Dermatologists may drain large
blisters to relieve pain.
Prescription antibiotics are used to
treat an infection.
Topical medication, such as pramoxine,
can help relieve pain and itch.
For severe cases that seem resistant
to treatment, dermatologists may prescribe an oral corticosteroid
or another immunosuppressive medication (e.g., methotrexate,
cyclosporine, or mycophenolate mofetil) along with bedrest.
PUVA therapy (a type of light
treatment) helps some patients with chronic dyshidrotic
Topical calcineurin inhibitors (e.g.,
pimecrolimus and tacrolimus), which are used to treat atopic
dermatitis, can effectively reduce inflammation.
Injections of botulinum toxin type A,
a popular wrinkle treatment, have effectively cleared some
patients. While the reason remains unclear, it is believed that
the botulinum toxin type A may relax the muscles or inhibit nerve
Reduce stress. Some patients
find that practicing stress-reduction techniques along with using
medication as directed helps to clear their skin. For information
about stress-reduction techniques that can help patients with
Stress Reduction Techniques.
Avoid allergens and irritants.
A medical test called “patch testing” can identify common
substances to which the person is allergic. Patch testing cannot
identify irritants; however, a dermatologist can ask a number of
questions to help identify anything that is irritating the skin.
Avoiding known allergens and irritants can help reduce flare-ups.
Follow a dermatologist-recommended
skin care plan. Dermatologists often recommend that patients
follow a recommended skin care plan. This can help prevent
Avoid excessive sweating and dry
conditions. Both are believed to be triggers.
Protect the skin from further
injury. Using gloves to protect the hands from irritants and
allergens, wearing socks made of 100% cotton, and avoiding strong
soaps can help protect damaged skin. For more information, see
Edman B. “Palmar eczema: a pathogenetic role for acetylsalicylic
acid, contraceptives and smoking?” Acta Dermato-Venereologica.
(Swedish, translated into English) 1988;68(5):402-407.
Egan CA et at. “Low-dose oral methotrexate treatment for
recalcitrant palmoplantar dyshidrotic dermatitis.” Journal of
the American Academy of Dermatology. 1999.
Janniger CK et al. “Dyshidrotic Eczema.” eMedicine. Last
updated June 26, 2006. Last accessed August 2006.
Klein AW et al. “Treatment of dyshidrotic hand dermatitis with
intradermal botulinum toxin.” Journal of the American Academy
of Dermatology. 2004 January;50(1):153-154.
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Dyshidrotic dermatitis can
Short-lived, resolving on
its own in 2 or 3 weeks.
A disabling condition that
prevents the person from working and performing everyday