Dyshidrosis, also known as Dyshidrotic eczema or Pompholyx, is a type of eczema that causes a blistering rash on the hands or feet, especially the fingers, palms, and soles. It is a form of vesicular dermatitis of hands and feet, also called vesicular endogenous eczema, and may be the same condition as dyshidrotic eczema. It is sometimes subclassified as cheiropompholyx (hands) and pedopompholyx (feet).
The blisters that occur in dyshidrosis generally last around three weeks and cause intense itching. Once the blisters of dyshidrosis dry, the skin may appear scaly. The blisters typically recur, sometimes before the skin heals completely from the previous blisters.
Usually the condition starts on the interdigital skin and spreads to the glabeous skin of the palms and the soles. This special skin has more sweat glands, more pressure receptors, and histamine receptors. It is not unknown for ordinary skin on the arms and other parts of the body to have the vesicles. When it is on parts of the body other than the hands and feet it is usually, though not always caused by contact with a substance that excites, irritates and annoys the body’s immune system and usually appears within minutes of contact. This is Contact Dermatitis.
Causes
If it is dyshidrosis, the root cause in all cases is the ‘Id reaction’ . The ‘id’ is short for ‘dermatiphid’ or ‘dermatophyte’ and the reaction is a histamine reaction (or allergic reaction) to the dermatophyte. The problem is finding the dermatophyte, which is usually a fungus or a yeast or a mold. It may be a bacterium or a virus, which are technically NOT dermatophytes. If a person has Athlete’s foot, caused by any one of a number of tineas, which are fungi, then curing the Athlete’s foot will cure the dyshidrosis.
The greatest cause of dyshidrosis is Candida Albicans. C. Kusai, and C.Tropicalis. This is unproven and difficult to prove. Everybody has Candida in their body, in their gastrointestinal tract and other parts. It is the cause of Thrush in babies and vaginal infections in women. Candida is present in most people as a commensal yeast so it is difficult to say Candida must be the cause of dyshidrosis, since so many people with Candida have no dyshidrosis. The test for Candida does not differentiate between Candida Albicans in its yeast form or in its fungal form.
As in other forms of hand eczema, Dyshidrosis is aggravated by contact with irritants such as soapy water, detergents and solvents. Contact with them must be avoided as much as possible and protective gloves worn. Some people with this condition are found to be allergic to nickel, a common metal. Nickel allergy can be detected by patch testing. These patients must try not to touch nickel items.
Risk Factors
Patients with dyshidrosis eczema may report a variety of factors that possibly are related to eruptions, as follows –
- It is more common in females than males.
- Many of the patients report palmoplantar hyperhidrosis.
- There is a personal or family history of atopic eczema in 50%.
- Emotional stress
- Personal or familial atopic diathesis (eg, asthma, hay fever, sinusitis)
- Certain work exposures (eg, cobalt) and/or recreational exposures
- Recent exposure to contact allergens (eg, nickel, balsams, paraphenylenediamine, chromate, sesquiterpene lactones) before condition flares
- Exposure to contact irritants before condition flares
- Recent exposure to costume jewelry (patients with palmar pompholyx and allergy to nickel)
- Recent treatment with intravenous immunoglobulin therapy
- Human immunodeficiency virus (HIV) infection
Symptoms
The blisters associated with dyshidrosis occur most commonly on the sides of the fingers and the palms, although the soles of the feet also can be affected. The blisters are usually small — about the width of a standard pencil lead — and typically appear in clusters, with an appearance similar to tapioca.
In more-severe cases, the small blisters may merge together to form larger blisters. Skin affected by dyshidrosis can be very itchy or even painful. Once the blisters dry and flake off, which occurs in about three weeks, the underlying skin may be red and tender.
Dyshidrosis tends to recur fairly regularly for months or years.
Treatment
Medications –
- Ultrapotent topical corticosteroid creams applied to new blisters under occlusion, and ointments applied during the inflamed dry phase
- Short courses of systemic corticosteroids, eg prednisone or prednisolone, for flare-ups
- Oral antistaphylococcal antibiotics for secondary infection
- Topical and oral antifungal agents for confirmed dermatophyte infection
- In patients with hyperhidrosis, probanthine or oxybutynin is worth trying.
- In severe cases, immune modulating medicines are indicated. These include: methotrexate, mycophenolate mofetil, azathioprine and ciclosporin.
Phototherapy – If other treatments aren’t effective, the doctor may recommend a special kind of light therapy that combines exposure to ultraviolet light with drugs that help make the skin more receptive to the effects of this type of light.
Immune-suppressing ointments – Medications such as tacrolimus (Protopic) and pimecrolimus (Elidel) may be helpful for people who want to limit their exposure to steroids. However, these drugs can increase the risk of skin infections.
Botulinum toxin injections – Some doctors may consider recommending botulinum toxin injections to treat severe cases of dyshidrosis. However, this is a relatively new treatment option that has not yet gained general acceptance.
Alternative Treatment
Fish oil – In one study people taking fish oil equal to 1.8 g of EPA (one of the omega-3 fatty acids found in fish oil) experienced significant reduction in symptoms of Dyshidrosis after 12 weeks.
Probiotics (bifidobacteria and lactobacillus) may boost the immune system and control allergies, especially in children.
Evening primrose oil (EPO) – In some studies, EPO helps reduce the itching of Dyshidrosis.
Borage oil, like EPO, contains the essential fatty acid gamma-linolenic acid (GLA), which acts as an anti-inflammatory
Vitamin C can act as an antihistamine. In one study, it helped reduce symptoms of eczema.
Bromelain, an enzyme derived from pineapple, helps reduce inflammation. Bromelain may increase the risk of bleeding, particularly in people who take blood-thinning medications, such as warfarin (Coumadin) and aspirin, among others.
Flavonoids, antioxidants found in dark berries and some plants, have anti-inflammatory properties, strengthen connective tissue, and may help reduce allergic reactions.
Vitamin D – Preliminary studies suggest that low vitamin D status during pregnancy may be a risk factor for developing Dyshidrosis in the first year of life.
Topical creams and salves containing one or more of the following herbs may help relieve itching and burning, and promote healing.
Witch hazel (Hamamelis virginiana) cream can relieve itching. Liquid witch hazel can help with Dyshidrosis.
St. John’s wort (Hypericum perforatum), used as a topical cream, has shown promise in one study.
Traditional Chinese medicine (TCM), which uses a variety of herbs often combined with acupuncture, seems to be effective for treating eczema in children and adults.
Exercise – In one clinical study, participating in regular group sporting activities for 3 weeks improved symptoms. Exercise may improve symptoms because of the positive impact it has on emotions. Sports should be avoided during the worst stages of an outbreak.
Climatotherapy – Climatotherapy uses sunlight and water (such as the ocean) as therapy. The Dead Sea in Israel is known for its healing properties, and many people with eczema go there to sit in the sun and swim in the water. Scientific studies support the benefits.
Reference –
http://www.nytimes.com/health/guides/disease/dyshidrotic-eczema/overview.html
http://www.curezone.org/forums/am.asp?i=1467982
http://www.icd10data.com/ICD10CM/Codes/L00-L99/L20-L30/L30-/L30.1
http://www.icd10data.com/ICD10CM/Codes/L00-L99/L20-L30/L30-/L30.1
http://www.healthline.com/health/dyshidrotic-eczema
http://www.mayoclinic.org/diseases-conditions/dyshidrosis/basics/definition/con-20026887
http://emedicine.medscape.com/article/1122527-overview
http://www.everydayhealth.com/dyshidrotic-eczema/
http://www.nhs.uk/Conditions/pompholyx/Pages/Introduction.aspx
http://www.dermnetnz.org/dermatitis/pompholyx.html