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Definition

Dyshidrotic eczema is refers to a number of different skin conditions in which the skin is red and irritated. It can occur at any age, but it is more common in adults. Typically it appears as tiny water blisters on the hands and sometimes the feet. The hands are affected in isolation in 80% of cases, the feet solely (sic) in 10% of cases and both the hands and feet in the remaining 10% of cases. Dyshidrotic eczema can be extremely itchy. In the United States, up to 20 percent of all people with eczema affecting the hands may have dyshidrotic eczema. The condition tends to occur more frequently in areas with a warmer climate.

Causes

The cause of dyshidrotic eczema is not known, but it occasionally appears to be seasonal.  The stress may also be a cause of this disease. Although it may not directly contribute in causing this disease but it creates other situations which lead to this disease. Very often it is seen in association with those that are atopic.

Symptoms

The first (acute) stage shows tiny blisters (vesicles) deep in the skin of the palms, fingers, instep or toes. The blisters are often intensely itchy or have a burning feeling. Usually the first symptom of eczema is intense itching; this itching can be very uncomfortable and individuals may tend to scratch the skin. The rash looks like crops of clear, deep-seated, tapioca-like vesicles and is very itchy. The vesicles resolve in 3 to 4 weeks and are replaced by 1- to 3-mm rings of scale.

Common symptoms of dyshidrotic eczema include:

  • Cracks and fissures in the skin
  • Excessive sweating
  • Pain and swelling at the rash site
  • Severe itching
  • Tiny, deep-seated blisters
  • Weeping and crusting skin lesions

Treatment

Your physician may often diagnose dyshidrotic eczema based upon the appearance of your skin. Occasionally, a skin biopsy or skin scraping may be needed to rule out other causes.

Soaks or compresses using weak solutions of Condy's crystals (potassium permanganate), aluminium acetate, or vinegar in water, are applied for 15 minutes four times a day. This will dry up blisters. Compresses are not suitable for dry eczema.

Corticosteroid creams and ointments play an important role in the treatment of this disorder. Application of corticosteroid under plastic occlusion may increase their effectiveness.

Pustular psoriasis of the palms and soles, epidermolysis bullosa hereditaria, hand-foot-mouth-disease, acrodermatitis enteropathica and scabies in children are possible differential diagnoses for vesicles on the palms and soles.

In severe cases oral prednisolone can be used in short courses. In the most severe and recalcitrant cases other immunosuppressants like Azathioprine, Methotrexate and even Cyclosporine have been used.

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