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'''Dyshidrosis''' (also known as "Acute vesiculobullous hand eczema,"<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology'' (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref> "Cheiropompholyx,"<ref name="Bolognia" /> "Dyshidrotic eczema,"<ref name="Bolognia" /> "Pompholyx,"<ref name="Bolognia" /> and "Podopompholyx"<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>) is a [[skin condition]] that is characterized by small [[blister]]s on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, |
'''Dyshidrosis''' (also known as "Acute vesiculobullous hand eczema,"<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology'' (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref> "Cheiropompholyx,"<ref name="Bolognia" /> "Dyshidrotic eczema,"<ref name="Bolognia" /> "Pompholyx,"<ref name="Bolognia" /> and "Podopompholyx"<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>) is a [[skin condition]] that is characterized by small [[blister]]s on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated [[itch|pruritic]], clear [[vesicle (dermatology)|vesicles]]; later, scaling, fissures and [[lichenification]] occur. Recurrence is common and for many can be chronic. Incidence/prevalence is said to be 1/5,000 in the [[United States]]. However, many cases of eczema are diagnosed as garden-variety atopic eczema without further investigation, so it is possible that this figure is misleading. |
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It is one of the most misdiagnosed conditions by non specialist doctors, and is more commonly recognized by podiatrists. (15) |
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This condition is not contagious to others, but its unsightly nature can lend to awkward social interaction. The compromised integument can increase susceptibility to infection, and the accompanying pruritus can be a source of psychological duress. |
This condition is not contagious to others, but its unsightly nature can lend to awkward social interaction. The compromised integument can increase susceptibility to infection, and the accompanying pruritus can be a source of psychological duress. |
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The name comes from the word "dyshidrotic," meaning "bad sweating," which was once believed to be the cause, but this association is unproven; there are many cases present that have no history of excessive sweating. There are many different factors that may trigger the outbreak of dyshidrosis such as allergens, stress, or seasonal changes. |
The name comes from the word "dyshidrotic," meaning "bad sweating," which was once believed to be the cause, but this association is unproven; there are many cases present that have no history of excessive sweating. There are many different factors that may trigger the outbreak of dyshidrosis such as allergens, stress, or seasonal changes. Emotional stress may also further aggravate the condition. |
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==Symptoms== |
==Symptoms== |
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Small blisters with the following characteristics: |
Small blisters with the following characteristics: |
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* Blisters are very small (3 mm or less in diameter). They appear on the tips and sides of the fingers, toes, palms, and soles. |
* Blisters are very small (3 mm or less in diameter). They appear on the tips and sides of the fingers, toes, palms, and soles. |
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* Blisters are opaque and deep-seated; they are either flush with the skin or slightly elevated and break easily. |
* Blisters are opaque and deep-seated; they are either flush with the skin or slightly elevated and do not break easily. Eventually, small blisters come together and form large blisters. |
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* Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances. |
* Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances. |
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* Scratching blisters breaks them, releasing the fluid inside, causing the skin to crust and eventually crack. This cracking is painful as well as unsightly and often takes weeks, or even months to heal. The skin is dry and scaly during this period. |
* Scratching blisters breaks them, releasing the fluid inside, causing the skin to crust and eventually crack. This cracking is painful as well as unsightly and often takes weeks, or even months to heal. The skin is dry and scaly during this period. |
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* Fluid from the blisters is |
* Fluid from the blisters is [[serum]] that accumulates between the irritated skin cells. It is not sweat as was previously thought. |
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* In some cases, as the blistering takes place in the palms or finger, lymph node swelling may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps present in the arm pits. |
* In some cases, as the blistering takes place in the palms or finger, lymph node swelling may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps present in the arm pits. |
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* Nails on affected fingers, or toes, may take on a pitted appearance. |
* Nails on affected fingers, or toes, may take on a pitted appearance. |
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==Causes== |
==Causes== |
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Causes of dyshidrosis are unknown. However, a number of triggers to the condition exist: |
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A number of triggers to the condition exist: |
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* Dyshidrosis has been historically linked to excessive sweating during periods of anxiety, stress, and frustration. However, many cases present that have no history of excessive sweating, and the hypothesis of dyshidrosis as a sweating disorder is largely rejected. Some patients reject this link to stress, though as a trigger of vesicular eruption it cannot be overlooked, as with other types of eczema. |
* Dyshidrosis has been historically linked to excessive sweating during periods of anxiety, stress, and frustration. However, many cases present that have no history of excessive sweating, and the hypothesis of dyshidrosis as a sweating disorder is largely rejected. Some patients reject this link to stress, though as a trigger of vesicular eruption it cannot be overlooked, as with other types of eczema. |
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* Vesicular eruption of the hands |
* Vesicular eruption of the hands may also be caused by a local infection, with [[Mycosis|fungal infection]]s, like [[Athlete's foot]] being the most common.<!-- see http://www.emedicine.com/derm/topic608.htm link given in the Infobox disease template above --> Sunlight is thought to bring on attacks: Some patients link outbreaks to prolonged exposure to strong sunlight from late spring through to early autumn.{dyshidrosis yahoogroups.com}. Others have also noted outbreaks occurring in conjunction with exposure to chlorinated pool water or highly treated city tap waters. |
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<!-- see http://www.emedicine.com/derm/topic608.htm link given in the Infobox disease template above --> Some patients link outbreaks to prolonged exposure to strong sunlight from late spring through to early autumn.{dyshidrosis yahoogroups.com}. The seasonal outbreak is more likely to be caused by an increase in molds present in the air during spring and autumn. |
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*Pregnancy is common cause of onset due to a lowering of the immune system during pregnancy. It is possible that normal skin flora increase in this environment, setting up the allergic reaction. (15) |
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When dyshidrosis is exascerbated by food intake, as listed below, this is most probably caused by an overgrowth of candida in the gastrointestinal tract, which pushes the epithelial cells of the gut aside and allows small molecule of undigested food to enter the blood system where it is attacked by antigens. This creates the appearence of a food allergy. (Intestinal Candida is effectively treated by a two week oral course of Nystatin, 100,000 units) |
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* Systemic nickel allergies may be related such as foods with high nickel content - cocoa, chocolate, whole grains, and nuts. |
* Systemic nickel allergies may be related such as foods with high nickel content - cocoa, chocolate, whole grains, and nuts. |
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* Allergic reactions may be attributed to soy, caffeine in coffees, teas, and carbonated beverages. |
* Allergic reactions may be attributed to soy, caffeine in coffees, teas, and carbonated beverages. |
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* Allergic reactions may be attributed to the use of [[Dairy |
* Allergic reactions may be attributed to the use of [[Dairy_product|Dairy products]] - milk, butter, cheese, yoghurt, icecream. |
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* the dehydrating effects of alcohol may exacerbate the severity of the fissures and cracking. |
* Allergic reactions may be caused by ingestion of alcohol; the dehydrating effects of alcohol may exacerbate the severity of the fissures and cracking. |
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* Keeping skin damp will trigger or worsen an outbreak. For this reason, people with dyshidrosis should wear gloves, socks, and shoes made of materials that "breathe well", such as cotton or silk. Certain fabrics may greatly irritate the condition, including wool, nylon, and many synthetic fabrics. {{Citation needed|date=July 2007}} |
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*Citrus fruits may appear to cause the allergy, but this is due to their acid nature and ease of entry into the blood system undigested. |
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* Inherited, not contagious. Often, patients will present with other types of dermatitis, such as [[Seborrhoeic dermatitis]] or [[atopic eczema]]. For this reason, among others, dyshidrosis is often dismissed as atopic eczema or contact dermatitis. |
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All of the above food allergies symptoms are a direct result of 'leaky gut syndrome' qv, which is a manifestation of Candida overgrowth. |
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* |
* Can be the secondary effect of problems in the gut{{Citation needed|date=February 2007}} (or alternatively, it can be the ''cause'' of secondary effects of problems in the gut<ref>Dermatology 1999;199:308-312 (DOI: 10.1159/000018280)</ref><ref>Vol. 140 No. 12, December 2004 Archives of Dermatology |
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Oral Al1itretinoin (9-cis-Retinoic Acid) Therapy for Chronic Hand Dermatitis in Patients Refractory to Standard Therapy |
Oral Al1itretinoin (9-cis-Retinoic Acid) Therapy for Chronic Hand Dermatitis in Patients Refractory to Standard Therapy |
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Results of a Randomized, Double-blind, Placebo-Controlled, Multicenter Trial |
Results of a Randomized, Double-blind, Placebo-Controlled, Multicenter Trial |
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Thomas Ruzicka, MD; Frederik Grønhøj Larsen, MD, PhD; Dorota Galewicz, MD; Attila Horváth, MD; Peter Jan Coenraads, MD; Kristian Thestrup-Pedersen, MD; Jean Paul Ortonne, MD; Christos C. Zouboulis, MD; Martin Harsch, PhD; Thomas C. Brown, PhD; Maurice Zultak</ref>). Some sufferers claim diet can ease symptoms (relieving internal condition of [[Irritable bowel syndrome|IBS]] or intestinal yeast infection).{{Citation needed|date=February 2007}} Also [[Inflammatory bowel disease]]s of [[Ulcerative colitis]] and [[Crohn's disease]]. |
Thomas Ruzicka, MD; Frederik Grønhøj Larsen, MD, PhD; Dorota Galewicz, MD; Attila Horváth, MD; Peter Jan Coenraads, MD; Kristian Thestrup-Pedersen, MD; Jean Paul Ortonne, MD; Christos C. Zouboulis, MD; Martin Harsch, PhD; Thomas C. Brown, PhD; Maurice Zultak</ref>). Some sufferers claim diet can ease symptoms (relieving internal condition of [[Irritable bowel syndrome|IBS]] or intestinal yeast infection).{{Citation needed|date=February 2007}} Also [[Inflammatory bowel disease]]s of [[Ulcerative colitis]] and [[Crohn's disease]]. {{Citation needed|date=February 2007}} |
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* Bandages, plasters or other types of skin-tapes may be irritating to dyshidrosis and should be avoided. If the 'wounds' are raw enough to warrant covering, pure cotton gloves or gauze should be used. Liquid Band-Aid brand bandage may be tolerated and helpful, refer to the Treatment section, below. |
* Bandages, plasters or other types of skin-tapes may be irritating to dyshidrosis and should be avoided. As the skin needs to breathe, anything that encourages [[maceration]] of the palms should be avoided. If the 'wounds' are raw enough to warrant covering, pure cotton gloves or gauze should be used. Liquid Band-Aid brand bandage may be tolerated and helpful, refer to the Treatment section, below. |
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* Latex and vinyl gloves may increase irritation. |
* Latex and vinyl gloves may increase irritation. |
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* [[Multiple chemical sensitivity]] |
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* Allergic reaction to Cr(6+) compounds ([[potassium dichromate]] and other leather preservative) |
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*'' Allergic reaction to a yeast, mold, parasite, fungus or pollen on or in the epithelial layer, the most common being Candida Albicans, T. Rubrum, and S. Aureus. Seasonal molds are the cause when this condition manifests a seasonal cycle. This is by far, the most common base cause of dyshidrosis.''==Diagnosis== |
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Dyshidrosis is one of the most under- and mis- diagnosed conditions by general practitioners. Podiatrists are more likely to recognize it as it is a common foot condition in conjunction with Athlete's foot.(15) |
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* [[Balsam of Peru]] is a common irritant among sufferers of hand eczema, and even more so for people with dyshidrotic eczema. |
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⚫ | [[Allergy testing]] is a contested subject among eczema communities. Some dermatologists posit that, if a sufferer is allergic to a substance, then a general allergy test on the forearm will suffice. However, others believe that, with conditions like dyshidrosis, the suspect substances must be applied to the affected area to induce a reaction. Whole-blood allergy tests (i.e., Alcat) can prove to be more effective in determining an allergy, as the effects of an allergic reaction are often slow and cumulative, not immediate. |
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==Diagnosis== |
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⚫ | [[Allergy testing]] is a contested subject among eczema communities. Some dermatologists posit that, if a sufferer is allergic to a substance, then a general allergy test on the forearm will suffice. However, others believe that, with conditions like dyshidrosis, the suspect substances must be applied to the affected area to induce a reaction. Whole-blood allergy tests (i.e., Alcat) can prove to be more effective in determining an allergy, as the effects of an allergic reaction are often slow and cumulative, not immediate. |
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It is often seen in people already susceptible to allergies and/or asthma. |
It is often seen in people already susceptible to allergies and/or asthma. |
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Atopy. qv. |
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==Treatment== |
==Treatment== |
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There are many treatments available for dyshidrosis. However, few of them have been developed or tested specifically on the condition. |
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Treatment is either to (1) alliviate the condition on the hands and feet or (2) cure the underlying dermatophyte infection. |
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* Cut nails as short as possible, cleaning under and around them daily with baking soda. Apply a paste of baking soda and water to the affected areas, twice a day for three days. After 5 minutes, rinse and carefully pat dry, paying special attention to the area in between the fingers or other possible places where moisture may remain. If rash spreads to a new area, recommence, applying to both old and new areas, leaving a large border around affected areas. Continue to clean hands daily with baking soda for a week, paying special attention to the areas around and under the nails. Avoid scratching, as this will cause rash to spread. For '''severe cases''' that have spread or are resistant: make a paste of baking soda/water and apply to palms, inner fingers and between fingers. Put clear disposable gloves(soft plastic type used in food preparation) on for a duration of 15 minutes before going to sleep allowing for absorbtion. Remove gloves and do not rinse. Repeat for 3-5 days. |
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⚫ | * Topical [[steroids]]<ref>{{cite web |url=http://www.emedicine.com/ped/topic1867.htm |title=eMedicine - Dyshidrotic Eczema : Article by Camila K Janniger |accessdate=2007-07-10 |work=}}</ref> - 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. |
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'''(1) Alliviating treatments:''' |
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* Nutritional deficiencies may be related, so addressing diet and vitamin intake is helpful. |
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⚫ | * Topical [[steroids]]<ref>{{cite web |url=http://www.emedicine.com/ped/topic1867.htm |title=eMedicine - Dyshidrotic Eczema : Article by Camila K Janniger |accessdate=2007-07-10 |work=}}</ref> - 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 |
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* [[Potassium permanganate]] dilute solution soaks - also popular, and used to 'dry out' the vesicles,<ref name="pmid14127384">{{cite journal |author=BIRT AR |title=Drugs for eczema of children |journal=Can Med Assoc J |volume=90 |issue=11 |pages=693–4 |year=1964 |month=March |pmid=14127384 |pmc=1922428 |doi= |url=}}</ref> and kill off superficial ''[[staphylococcus aureus]]'',<ref name="pmid1476027">{{cite journal |author=Stalder JF, Fleury M, Sourisse M, ''et al.'' |title=Comparative effects of two topical antiseptics (chlorhexidine vs KMn04) on bacterial skin flora in atopic dermatitis |journal=Acta Derm Venereol Suppl (Stockh) |volume=176 |issue= |pages=132–4 |year=1992 |pmid=1476027 |doi= |url=}}</ref> but it can also be very painful. Undiluted it may cause significant burning.<ref name="pmid12538301">{{cite journal |author=Baron S, Moss C |title=Caustic burn caused by potassium permanganate |journal=Arch. Dis. Child. |volume=88 |issue=2 |pages=96 |year=2003 |month=February |pmid=12538301 |doi= 10.1136/adc.88.2.96|url=http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=12538301 |pmc=1719457}}</ref> |
* [[Potassium permanganate]] dilute solution soaks - also popular, and used to 'dry out' the vesicles,<ref name="pmid14127384">{{cite journal |author=BIRT AR |title=Drugs for eczema of children |journal=Can Med Assoc J |volume=90 |issue=11 |pages=693–4 |year=1964 |month=March |pmid=14127384 |pmc=1922428 |doi= |url=}}</ref> and kill off superficial ''[[staphylococcus aureus]]'',<ref name="pmid1476027">{{cite journal |author=Stalder JF, Fleury M, Sourisse M, ''et al.'' |title=Comparative effects of two topical antiseptics (chlorhexidine vs KMn04) on bacterial skin flora in atopic dermatitis |journal=Acta Derm Venereol Suppl (Stockh) |volume=176 |issue= |pages=132–4 |year=1992 |pmid=1476027 |doi= |url=}}</ref> but it can also be very painful. Undiluted it may cause significant burning.<ref name="pmid12538301">{{cite journal |author=Baron S, Moss C |title=Caustic burn caused by potassium permanganate |journal=Arch. Dis. Child. |volume=88 |issue=2 |pages=96 |year=2003 |month=February |pmid=12538301 |doi= 10.1136/adc.88.2.96|url=http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=12538301 |pmc=1719457}}</ref> |
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* Domeboro (OTC) helps alleviate itching in the short term, and can help to quicken the natural healing process. The active ingredient in Domeboro is aluminum acetate, also found in Burow's solution, an OTC antistringent available at most drug stores. Either product is effective in helping to dry out the blisters, which leads to faster healing. Affected areas should be soaked in Domeboro or Borow's solution for 20–30 minutes several times a day to be effective. |
* Domeboro (OTC) helps alleviate itching in the short term, and can help to quicken the natural healing process. The active ingredient in Domeboro is aluminum acetate, also found in Burow's solution, an OTC antistringent available at most drug stores. Either product is effective in helping to dry out the blisters, which leads to faster healing. Affected areas should be soaked in Domeboro or Borow's solution for 20–30 minutes several times a day to be effective. |
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* Emollients during the drying/scaling phase of the condition, to prevent cracking and itching. While [[petroleum jelly]] may work well as a barrier cream, it is not absorbed into the skin. |
* Emollients during the drying/scaling phase of the condition, to prevent cracking and itching. While [[petroleum jelly]] may work well as a barrier cream, it is not absorbed into the skin and does not allow it to breathe, so may actually be less helpful. |
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* Salt soaks - maintaining palms for 40 minutes to an hour immersed in a salt solution of 1/4 salt dissolved in water. Repeating treatment for 3–4 days or additionally if required. It is best to soak only the palm and avoid exposing the top of the hand to the saline solution, as salt can severely dry and irritate the skin on the top of the hand. |
* Salt soaks - maintaining palms for 40 minutes to an hour immersed in a salt solution of 1/4 salt dissolved in water. Repeating treatment for 3–4 days or additionally if required. It is best to soak only the palm and avoid exposing the top of the hand to the saline solution, as salt can severely dry and irritate the skin on the top of the hand. |
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* White vinegar soaks |
* White vinegar soaks |
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* Avoidance of known triggers - dyshidrosis sufferers may need to abstain from washing their own hair or bodies, or wearing gloves when they do so, however waterproof gloves are often potential irritants. |
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* Avoidance of known triggers |
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* [[Zinc oxide]] ointment |
* [[Zinc oxide]] ointment |
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* Nickel-free diets |
* Nickel-free diets |
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* Sugar-free, gluten-free, fruit-free diet |
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* Sugar-free, gluten-free, fruit-free diet, which may be particularly useful treating the dermataphyte candida albicans in the gastrointestinal tract. Much original research was conducted by people on the Atkins diet. (atkins and lo-carb friends website) |
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* Alcohol-free, caffeine-free diet |
* Alcohol-free, caffeine-free diet |
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* When in the scaling phase of the condition, the scales may cause deep cracks and fissures in the skin. Filing (as with an emery board) may help to minimize this. |
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* [[Stress management]] counseling |
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* Light treatment: UVA-1, [[PUVA]], [[Grenz rays]], [[Low-Level Light Therapy]] using a Red + NIR (LED) combination |
* Light treatment: UVA-1, [[PUVA]], [[Grenz rays]], [[Low-Level Light Therapy]] using a Red + NIR (LED) combination |
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* [[Ciclosporin]], a strong immunosuppressant drug used to combat dyshidrosis caused by ulcerative colitis |
* [[Ciclosporin]], a strong immunosuppressant drug used to combat dyshidrosis caused by ulcerative colitis |
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* [[Efalizumab]] (Raptiva), a medication used to treat [[psoriasis]] |
* [[Efalizumab]] (Raptiva), a medication used to treat [[psoriasis]] |
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* [[Clobetasol Propionate]] (0.05%), (potent corticosteroid cream or ointment ) has been an effective treatment. |
* [[Clobetasol Propionate]] (0.05%), (potent corticosteroid cream or ointment ) has been an effective treatment. |
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* [[Tacrolimus]] and [[Pimecrolimus]], [[immunomodulators]] often used to prevent [[organ rejection]] in topical, ointment form, may be used in severe cases. |
* [[Tacrolimus]] and [[Pimecrolimus]], [[immunomodulators]] often used to prevent [[organ rejection]] in topical, ointment form, may be used in severe cases. |
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* [[Betamethasone]] Dipropionate, and creams that contain it such as [[Lotrisone]] (which also contains an antifungal [[Clotrimazole]]) has worked in some cases. |
* [[Betamethasone]] Dipropionate, and creams that contain it such as [[Lotrisone]] (which also contains an antifungal [[Clotrimazole]]) has worked in some cases. |
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* [[Dapsone]] (diamino-diphenyl sulfone) is an antibacterial sulfonamide. It has been recommended for the treatment of dyshidrosis in some chronic cases.<ref>http://www.dermnet.org.nz/dermatitis/pompholyx.html</ref> |
* [[Dapsone]] (diamino-diphenyl sulfone) is an antibacterial sulfonamide. It has been recommended for the treatment of dyshidrosis in some chronic cases.<ref>http://www.dermnet.org.nz/dermatitis/pompholyx.html</ref> |
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* Frequent application of a barrier cream can protect against irritants while allowing the skin to breathe. |
* Frequent application of a barrier cream can protect against irritants while allowing the skin to breathe. |
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* Avoid metal computer keyboards and track pads that contain nickel. |
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* When affect area is itchy, apply a mixture of [[hemp oil]] and [[vaseline]], cover with [[finger condom]]. Replace every two hours and leave uncovered for a half-hour between applications. |
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* '''Anti-histamines: fexofenadine up to 180mg then 60mg every 12 hours. This can be used as 'negative diagnosis', in that if the fexofenadine stops the itching and reduces the swelling and redness, the condition is an allergy, and is dyshidrosis. If it does not have any effect then the condition is not an allergy, and not dyshidrosis'''. |
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<ref |
* Anti-histamines: fexofenadine up to 180 mg per day.<ref>MDContact Dermatitis 2007: 57: 203–210 |
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Journal compilation # 2007 Blackwell Munksgaard |
Journal compilation # 2007 Blackwell Munksgaard CONTACT DERMATITIS Management of chronic hand eczema |
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Thomas L. Diepgen, Tove Agner, Werner Aberer, John Berth-Jones, Frédéric Cambazard, Peter Elsner, John McFadden AND Pieter Jan Coenraads |
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THOMAS L. DIEPGEN, TOVE AGNER, WERNER ABERER, JOHN BERTH-JONES, FRE´ DE´ RIC CAMBAZARD, PETER ELSNER, JOHN MCFADDEN AND PIETER JAN COENRAADS |
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1Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg, Heidelberg 69115, Germany, |
1Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg, Heidelberg 69115, Germany, |
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2Department of Dermatology, University of Copenhagen, Roskilde Sygehus, 4000 Roskilde, Denmark, |
2Department of Dermatology, University of Copenhagen, Roskilde Sygehus, 4000 Roskilde, Denmark, |
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7St Thomas Hospital, St Johns Institute of Dermatology, London, UK, and |
7St Thomas Hospital, St Johns Institute of Dermatology, London, UK, and |
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8Department of Dermatology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands</ref> |
8Department of Dermatology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands</ref> |
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Many sufferers of dyshidrosis will find that treatments that were previously suitable for them no longer work or have induced sensitive reactions, which is common in most types of eczema. |
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* It may be prudent to wear light cotton gloves while reading newspapers, books, and magazines. The inks and paper may irritate the condition. |
* It may be prudent to wear light cotton gloves while reading newspapers, books, and magazines. The inks and paper may irritate the condition. |
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* Wash affected hands and feet with cool water and apply a moisturizer as soon as possible. While hot water seems to kill the itch, it may aggravate the condition. |
* Wash affected hands and feet with cool water and apply a moisturizer as soon as possible. While hot water seems to kill the itch, it may aggravate the condition. |
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* Avoid moisturizers that contain water (cremes and lotions). Stick with ointments. Use only thin applications of ointments, as excessive amounts of ointment may restrict breathing of the skin and aggravate the condition. |
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*Use of ointments and lotions, creams is a daily necessity, but read the ingredients carefully and avoid known irritants and perfume. Creams containing zinc and castor oil are particularly soothing. |
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* Aloe Vera may be applied after cleaning hands |
* Aloe Vera may be applied after cleaning hands |
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* When itchy or inflamed, 100% lavender oil can be applied occasionally to soothe and reduce irritation for those not sensitive to the oil, making sure to pat excess oil with a tissue. A patch test on the wrist is recommended before application to the palms. |
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* Saline solution for washing hands may be very useful. |
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* Avoid soaps with [[Sodium laureth sulfate|Sodium Laureth Sulfate]] (SLS). Many pump-style soaps and common shampoos contain SLS. |
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⚫ | * Toctino' alitretinoin 9-cis-retinoic acid has been approved for prescription in the UK. (08/09/2008) This is specifically used for chronic hand eczema.<ref>Ruzicka T, Lynde C, Jemec G et al. Efficacy and safety of oral alitretinoin in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomised, double-blind, placebo-controlled, multicentre trial. British Journal of Dermatology April 2008; 158(4): 808-817.</ref> It is made by Basilea of Switzerland (BAL 4079) |
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'''(2)Treatments to eliminate the underlying dermatophyte infection:''' |
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* Rinsing the affected areas briefly in [[surgical spirit]] is very effective. It will work to clear up the blisters within hours if they have been pricked open first. |
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'Toctino' alitretinoin 9-cis-retinoic acid has been approved for prescription in the UK. (08/09/2008) This is specifically used for chronic hand(and foot) eczema. |
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⚫ | |||
* Nystatin oral is taken for Candida albicans in the gastrointestinal tract. 2 weeks oral at 100,000 units daily. |
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* Feet should be checked for athlete's foot which can be the infecting dermatophyte on the foot and concurrent with dyshidrosis. |
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* Pathology testing nasal yeast infection. |
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* Oral fungicides (Ketoconazole, Clotimiazole, Fluconazole) may be used when the reaction is caused by a fungus, but in general are bad for the liver and should not be used in hepatically or renally compromised/suppressed patients. |
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*Vitamin A is very effective, however, it is toxic in large doses and teratogenic. This is the traditional naturopathic treatment and is effective and less expensive that Toctino, which is a drug derived from vitamin A.(Marcona) |
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==See also== |
==See also== |
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==References== |
==References== |
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{{reflist}} |
{{reflist}} |
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(13)A 3-Year Causative Study of Pompholyx in 120 Patients |
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Marie Hélène Guillet, MD; Ewa Wierzbicka, MD; Stephanie Guillet, MD; Guy Dagregorio, MD; Gerard Guillet, MD |
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Arch Dermatol. 2007;143(12):1504-1508. |
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(14)Long-term, intermittent treatment of chronic hand eczema with mometasone furoate |
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Veien N. K. (1) ; Larsen P. O. (2) ; Thestrup-Pedersen K. (3) ; Schou G.(4) |
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Affiliation(s) du ou des auteurs / Author(s) Affiliation(s) |
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The Dermatology Clinic, Vesterbro 99, DK-9000 Aalborg, Denmark, The Dermatology Clinic, Guldsmedgade 1, Århus, Denmark, Department of Dermatology, Marselisborg Hospital, Århus, Denmark, Geert Schou Konsulenter, Helgesensgade 1, Copenhagen, Denmark |
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(15) Unpublished research by a podiatrist. |
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(16) Marcona Naturopathic website |
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==External links== |
==External links== |
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*[http://www.dermnetnz.org/dermatitis/pompholyx.html Pompholyx] at DermNet NZ (New Zealand Dermatological Society Incorporated) |
*[http://www.dermnetnz.org/dermatitis/pompholyx.html Pompholyx] at DermNet NZ (New Zealand Dermatological Society Incorporated) |
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*[http://www.pompholyx.co.uk Information, advice and shared experiences for Pompholyx sufferers] |
*[http://www.pompholyx.co.uk Information, advice and shared experiences for Pompholyx sufferers] |
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*dyshidrosis@yahoogroups.com |
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{{Diseases of the skin and subcutaneous tissue}} |
{{Diseases of the skin and subcutaneous tissue}} |
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{{Disorders of skin appendages}} |
{{Disorders of skin appendages}} |
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[[Category:Eczema]] |
[[Category:Eczema]] |
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[[ru:Дисгидроз]] |
[[ru:Дисгидроз]] |
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[[tr:Disidroz]] |
[[tr:Disidroz]] |
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[[zh:汗皰疹]] |
Revision as of 19:05, 26 May 2011
Dyshidrosis | |
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Specialty | Dermatology ![]() |
Dyshidrosis (also known as "Acute vesiculobullous hand eczema,"[1] "Cheiropompholyx,"[2] "Dyshidrotic eczema,"[2] "Pompholyx,"[2] and "Podopompholyx"[2]) is a skin condition that is characterized by small blisters on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic, clear vesicles; later, scaling, fissures and lichenification occur. Recurrence is common and for many can be chronic. Incidence/prevalence is said to be 1/5,000 in the United States. However, many cases of eczema are diagnosed as garden-variety atopic eczema without further investigation, so it is possible that this figure is misleading.
This condition is not contagious to others, but its unsightly nature can lend to awkward social interaction. The compromised integument can increase susceptibility to infection, and the accompanying pruritus can be a source of psychological duress.
The name comes from the word "dyshidrotic," meaning "bad sweating," which was once believed to be the cause, but this association is unproven; there are many cases present that have no history of excessive sweating. There are many different factors that may trigger the outbreak of dyshidrosis such as allergens, stress, or seasonal changes. Emotional stress may also further aggravate the condition.
Symptoms
Small blisters with the following characteristics:
- Blisters are very small (3 mm or less in diameter). They appear on the tips and sides of the fingers, toes, palms, and soles.
- Blisters are opaque and deep-seated; they are either flush with the skin or slightly elevated and do not break easily. Eventually, small blisters come together and form large blisters.
- Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances.
- Scratching blisters breaks them, releasing the fluid inside, causing the skin to crust and eventually crack. This cracking is painful as well as unsightly and often takes weeks, or even months to heal. The skin is dry and scaly during this period.
- Fluid from the blisters is serum that accumulates between the irritated skin cells. It is not sweat as was previously thought.
- In some cases, as the blistering takes place in the palms or finger, lymph node swelling may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps present in the arm pits.
- Nails on affected fingers, or toes, may take on a pitted appearance.
-
Advanced stage of dyshidrosis on the palm showing cracked and peeling skin.
-
Dyshidrosis
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Advanced stage of dyshidrosis on the foot.
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Advanced stage of dyshidrosis on the sole.
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Rim of scale on the plantar surface of the thumb from a resolving flare of dyshidrotic eczemaRim of scale on the plantar surface of the thumb from a resolving flare of dyshidrotic eczema
Causes
Causes of dyshidrosis are unknown. However, a number of triggers to the condition exist:
- Dyshidrosis has been historically linked to excessive sweating during periods of anxiety, stress, and frustration. However, many cases present that have no history of excessive sweating, and the hypothesis of dyshidrosis as a sweating disorder is largely rejected. Some patients reject this link to stress, though as a trigger of vesicular eruption it cannot be overlooked, as with other types of eczema.
- Vesicular eruption of the hands may also be caused by a local infection, with fungal infections, like Athlete's foot being the most common. Sunlight is thought to bring on attacks: Some patients link outbreaks to prolonged exposure to strong sunlight from late spring through to early autumn.{dyshidrosis yahoogroups.com}. Others have also noted outbreaks occurring in conjunction with exposure to chlorinated pool water or highly treated city tap waters.
- Antibacterial soaps, fragrances, and contact with fruit juices or fresh meat also can trigger outbreaks of dyshidrosis, as with other types of eczema.
- Systemic nickel allergies may be related such as foods with high nickel content - cocoa, chocolate, whole grains, and nuts.
- Allergic reactions may be attributed to soy, caffeine in coffees, teas, and carbonated beverages.
- Allergic reactions may be attributed to the use of Dairy products - milk, butter, cheese, yoghurt, icecream.
- Allergic reactions may be caused by ingestion of alcohol; the dehydrating effects of alcohol may exacerbate the severity of the fissures and cracking.
- Keeping skin damp will trigger or worsen an outbreak. For this reason, people with dyshidrosis should wear gloves, socks, and shoes made of materials that "breathe well", such as cotton or silk. Certain fabrics may greatly irritate the condition, including wool, nylon, and many synthetic fabrics. [citation needed]
- Inherited, not contagious. Often, patients will present with other types of dermatitis, such as Seborrhoeic dermatitis or atopic eczema. For this reason, among others, dyshidrosis is often dismissed as atopic eczema or contact dermatitis.
- Can be the secondary effect of problems in the gut[citation needed] (or alternatively, it can be the cause of secondary effects of problems in the gut[3][4]). Some sufferers claim diet can ease symptoms (relieving internal condition of IBS or intestinal yeast infection).[citation needed] Also Inflammatory bowel diseases of Ulcerative colitis and Crohn's disease. [citation needed]
- Bandages, plasters or other types of skin-tapes may be irritating to dyshidrosis and should be avoided. As the skin needs to breathe, anything that encourages maceration of the palms should be avoided. If the 'wounds' are raw enough to warrant covering, pure cotton gloves or gauze should be used. Liquid Band-Aid brand bandage may be tolerated and helpful, refer to the Treatment section, below.
- Latex and vinyl gloves may increase irritation.
- Multiple chemical sensitivity
- Allergic reaction to Cr(6+) compounds (potassium dichromate and other leather preservative)
- Dyshidrosis can sometimes even be caused by dust mite allergies, with sufferers having to wash and change bedding weekly, sometimes even every 2 days or even every day, to combat symptoms.
- Balsam of Peru is a common irritant among sufferers of hand eczema, and even more so for people with dyshidrotic eczema.
Diagnosis
Allergy testing is a contested subject among eczema communities. Some dermatologists posit that, if a sufferer is allergic to a substance, then a general allergy test on the forearm will suffice. However, others believe that, with conditions like dyshidrosis, the suspect substances must be applied to the affected area to induce a reaction. Whole-blood allergy tests (i.e., Alcat) can prove to be more effective in determining an allergy, as the effects of an allergic reaction are often slow and cumulative, not immediate. It is often seen in people already susceptible to allergies and/or asthma.
Treatment
There are many treatments available for dyshidrosis. However, few of them have been developed or tested specifically on the condition.
- Cut nails as short as possible, cleaning under and around them daily with baking soda. Apply a paste of baking soda and water to the affected areas, twice a day for three days. After 5 minutes, rinse and carefully pat dry, paying special attention to the area in between the fingers or other possible places where moisture may remain. If rash spreads to a new area, recommence, applying to both old and new areas, leaving a large border around affected areas. Continue to clean hands daily with baking soda for a week, paying special attention to the areas around and under the nails. Avoid scratching, as this will cause rash to spread. For severe cases that have spread or are resistant: make a paste of baking soda/water and apply to palms, inner fingers and between fingers. Put clear disposable gloves(soft plastic type used in food preparation) on for a duration of 15 minutes before going to sleep allowing for absorbtion. Remove gloves and do not rinse. Repeat for 3-5 days.
- Topical steroids[5] - 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.
- Nutritional deficiencies may be related, so addressing diet and vitamin intake is helpful.
- Potassium permanganate dilute solution soaks - also popular, and used to 'dry out' the vesicles,[6] and kill off superficial staphylococcus aureus,[7] but it can also be very painful. Undiluted it may cause significant burning.[8]
- Domeboro (OTC) helps alleviate itching in the short term, and can help to quicken the natural healing process. The active ingredient in Domeboro is aluminum acetate, also found in Burow's solution, an OTC antistringent available at most drug stores. Either product is effective in helping to dry out the blisters, which leads to faster healing. Affected areas should be soaked in Domeboro or Borow's solution for 20–30 minutes several times a day to be effective.
- Emollients during the drying/scaling phase of the condition, to prevent cracking and itching. While petroleum jelly may work well as a barrier cream, it is not absorbed into the skin and does not allow it to breathe, so may actually be less helpful.
- Salt soaks - maintaining palms for 40 minutes to an hour immersed in a salt solution of 1/4 salt dissolved in water. Repeating treatment for 3–4 days or additionally if required. It is best to soak only the palm and avoid exposing the top of the hand to the saline solution, as salt can severely dry and irritate the skin on the top of the hand.
- White vinegar soaks
- Avoidance of known triggers - dyshidrosis sufferers may need to abstain from washing their own hair or bodies, or wearing gloves when they do so, however waterproof gloves are often potential irritants.
- Zinc oxide ointment
- Nickel-free diets
- Sugar-free, gluten-free, fruit-free diet
- Alcohol-free, caffeine-free diet
- When in the scaling phase of the condition, the scales may cause deep cracks and fissures in the skin. Filing (as with an emery board) may help to minimize this.
- Stress management counseling
- Light treatment: UVA-1, PUVA, Grenz rays, Low-Level Light Therapy using a Red + NIR (LED) combination
- Ciclosporin, a strong immunosuppressant drug used to combat dyshidrosis caused by ulcerative colitis
- Efalizumab (Raptiva), a medication used to treat psoriasis
- Clobetasol Propionate (0.05%), (potent corticosteroid cream or ointment ) has been an effective treatment.
- Tacrolimus and Pimecrolimus, immunomodulators often used to prevent organ rejection in topical, ointment form, may be used in severe cases.
- Betamethasone Dipropionate, and creams that contain it such as Lotrisone (which also contains an antifungal Clotrimazole) has worked in some cases.
- Dapsone (diamino-diphenyl sulfone) is an antibacterial sulfonamide. It has been recommended for the treatment of dyshidrosis in some chronic cases.[9]
- Unbleached cotton gloves may be used to cover the hands to prevent scratching and vulnerability of the skin to bacteria
- Plantain (Plantago major) infused in olive or other oil can be soothing.
- Frequent application of a barrier cream can protect against irritants while allowing the skin to breathe.
- Avoid metal computer keyboards and track pads that contain nickel.
- When affect area is itchy, apply a mixture of hemp oil and vaseline, cover with finger condom. Replace every two hours and leave uncovered for a half-hour between applications.
- Ingest 1-4 tablespoons of hemp oil daily. Use straight or mixed with other substances, like a smoothie.
- Anti-histamines: fexofenadine up to 180 mg per day.[10]
Many sufferers of dyshidrosis will find that treatments that were previously suitable for them no longer work or have induced sensitive reactions, which is common in most types of eczema.
- It may be prudent to wear light cotton gloves while reading newspapers, books, and magazines. The inks and paper may irritate the condition.
- Wash affected hands and feet with cool water and apply a moisturizer as soon as possible. While hot water seems to kill the itch, it may aggravate the condition.
- Avoid moisturizers that contain water (cremes and lotions). Stick with ointments. Use only thin applications of ointments, as excessive amounts of ointment may restrict breathing of the skin and aggravate the condition.
- Aloe Vera may be applied after cleaning hands
- When itchy or inflamed, 100% lavender oil can be applied occasionally to soothe and reduce irritation for those not sensitive to the oil, making sure to pat excess oil with a tissue. A patch test on the wrist is recommended before application to the palms.
- Saline solution for washing hands may be very useful.
- Avoid soaps with Sodium Laureth Sulfate (SLS). Many pump-style soaps and common shampoos contain SLS.
- Toctino' alitretinoin 9-cis-retinoic acid has been approved for prescription in the UK. (08/09/2008) This is specifically used for chronic hand eczema.[11] It is made by Basilea of Switzerland (BAL 4079)
- Rinsing the affected areas briefly in surgical spirit is very effective. It will work to clear up the blisters within hours if they have been pricked open first.
See also
- List of skin diseases
- Dermatology
- Epidermolysis bullosa - a genetic disorder that causes similar, but more severe, symptoms to dyshidrosis
References
- ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ^ a b c d Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ^ Dermatology 1999;199:308-312 (DOI: 10.1159/000018280)
- ^ Vol. 140 No. 12, December 2004 Archives of Dermatology Oral Al1itretinoin (9-cis-Retinoic Acid) Therapy for Chronic Hand Dermatitis in Patients Refractory to Standard Therapy Results of a Randomized, Double-blind, Placebo-Controlled, Multicenter Trial Thomas Ruzicka, MD; Frederik Grønhøj Larsen, MD, PhD; Dorota Galewicz, MD; Attila Horváth, MD; Peter Jan Coenraads, MD; Kristian Thestrup-Pedersen, MD; Jean Paul Ortonne, MD; Christos C. Zouboulis, MD; Martin Harsch, PhD; Thomas C. Brown, PhD; Maurice Zultak
- ^ "eMedicine - Dyshidrotic Eczema : Article by Camila K Janniger". Retrieved 2007-07-10.
- ^ BIRT AR (1964). "Drugs for eczema of children". Can Med Assoc J. 90 (11): 693–4. PMC 1922428. PMID 14127384.
{{cite journal}}
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ignored (help) - ^ Stalder JF, Fleury M, Sourisse M; et al. (1992). "Comparative effects of two topical antiseptics (chlorhexidine vs KMn04) on bacterial skin flora in atopic dermatitis". Acta Derm Venereol Suppl (Stockh). 176: 132–4. PMID 1476027.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ Baron S, Moss C (2003). "Caustic burn caused by potassium permanganate". Arch. Dis. Child. 88 (2): 96. doi:10.1136/adc.88.2.96. PMC 1719457. PMID 12538301.
{{cite journal}}
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ignored (help) - ^ http://www.dermnet.org.nz/dermatitis/pompholyx.html
- ^ MDContact Dermatitis 2007: 57: 203–210 Journal compilation # 2007 Blackwell Munksgaard CONTACT DERMATITIS Management of chronic hand eczema THOMAS L. DIEPGEN, TOVE AGNER, WERNER ABERER, JOHN BERTH-JONES, FRE´ DE´ RIC CAMBAZARD, PETER ELSNER, JOHN MCFADDEN AND PIETER JAN COENRAADS 1Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg, Heidelberg 69115, Germany, 2Department of Dermatology, University of Copenhagen, Roskilde Sygehus, 4000 Roskilde, Denmark, 3Department of Dermatology, University of Graz, 8036 Graz, Austria, 4Department of Dermatology, University Hospitals Coventry and Warkwickshire NHS Trust, Coventry CV2 2DX, UK, 5Department of Dermatology, 42055 St Etienne, France, 6Department of Dermatology and Allergology, Friedrich Schiller University Jena, 07740 Jena, Germany, 7St Thomas Hospital, St Johns Institute of Dermatology, London, UK, and 8Department of Dermatology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
- ^ Ruzicka T, Lynde C, Jemec G et al. Efficacy and safety of oral alitretinoin in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomised, double-blind, placebo-controlled, multicentre trial. British Journal of Dermatology April 2008; 158(4): 808-817.
External links
- Dyshidrotic eczema at MedlinePlus
- Images of dyshidrotic eczema at Skinsight
- MedAdvice.com
- Pompholyx at DermNet NZ (New Zealand Dermatological Society Incorporated)
- Information, advice and shared experiences for Pompholyx sufferers