Dyshidrotic eczema: Diagnosis and treatment
How do dermatologists diagnose dyshidrotic eczema?
When dyshidrotic eczema (DE) flares, a dermatologist can diagnose it by looking at your skin.
Your dermatologist will also ask about your medical history, work, hobbies, and recent stress level.
If your dermatologist thinks that the DE could be due to an allergy, an allergy test called patch testing may be recommended. During patch testing, small amounts of substances that you may be allergic to are placed on your skin — often the skin on your back.
How do dermatologists treat dyshidrotic eczema?
Your treatment plan will be designed to treat your signs and symptoms. You may be responsible for doing much of the treatment at home. It is important to carefully follow your treatment plan, which may include several of the following:
- Soaks and cool compresses: Soaks or cool compresses that you apply 2 to 4 times a day can be very effective for drying blisters. You apply these for 15 minutes at a time.
After each soak or cool compress, you’ll likely need to apply a medicated cream or ointment, such as a corticosteroid.
- Corticosteroid that you apply to your skin: This can reduce the inflammation and clear the blisters.
- Anti-itch medicine: An antihistamine pill or other anti-itch medicine can reduce scratching. Anything you can do to reduce scratching is helpful because scratching tends to worsen DE.
- Pramoxine (pra mox’ een): A cream or lotion containing this can relieve itch and pain.
- Moisturizer or a barrier repair cream: Your dermatologist will recommend a moisturizer or barrier repair cream. These can reduce dryness and flares of DE.
It’s important to apply the product after each shower, bath, and hand washing.
- Medicine to treat an infection: The skin with DE can get infected. Before prescribing this medicine, your dermatologist will first determine what type of infection you have.
Infection may cause dyshidrotic eczema to linger
Having an infection can stop DE from clearing.
In one study, researchers found that about 33% of patients who had DE on their hands got rid of the DE only after treating an infection on their feet.
When treatment fails to clear DE or a patient has severe DE
If the above treatments fail to work or you have severe DE, your dermatologist may recommend one of the following:
- Botulinum toxin: These injections, which are given in a dermatologist’s office, bring some patients relief because botulinum toxin temporarily relaxes the muscles and stops excessive sweating.
Botulinum toxin is FDA approved to treat wrinkles and excessive sweating in the underarms — but not DE. It’s legal to prescribe a medicine for a condition other than its FDA-approved use. This is called “off-label” use, which can be very helpful for some patients.
- Draining large blisters in the office. Draining blisters is safe and effective when performed in a dermatologist’s office, but you should not drain your own blisters. Attempting this at home can lead to an infection, which can worsen DE and prevent clearing.
- Corticosteroid that works throughout the body: For a severe case, a corticosteroid pill or injection may be prescribed.
- Light treatments: This treatment exposes the skin with DE to ultraviolet (UV) light for a prescribed amount of time. Under a dermatologist’s care, light treatment can be a safe and effective treatment for DE. In one study, more than 90% of patients report good to excellent results after 6 to 8 weeks of treatment.
It’s extremely important to get these treatments at a hospital, clinic, or your dermatologist’s office. Trying to treat your skin by using a tanning bed is not recommended.
- Changing your diet: Sometimes, DE continues to flare despite all you do to treat it. If this happens, your dermatologist may recommend a change to your diet.
Eliminating foods that contain nickel or cobalt helps some people.
Many foods contain nickel or cobalt. If you are allergic to either, your dermatologist can tell you how to change your diet.
Other treatments than the ones listed here can also be helpful. Your dermatologist can tell you what treatment may be best for you.
Outcome for people who have dyshidrotic eczema
Some people have one mild outbreak that clears without treatment. It’s much more common to have flares throughout your life. Treatment can help control DE, which cannot be cured.
Egan CA Rallis TM, et al
. “Low-dose oral methotrexate treatment for recalcitrant palmoplantar dyshidrotic dermatitis.” J Am Acad Dermatol
Gerstenblith MR, Antony AK, et al
. “Pompholyx and eczematous reactions associated with intravenous immunoglobulin therapy.” J Am Acad Dermatol
Habif TP, Campbell JL, et al
. “Pompholyx” (card #16). Dermatology DDxDeck
. Mosby 2006.
Klein AW. “Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin.” J Am Acad Dermatol
Miller JL, Hurley HJ. “Diseases of the eccrine and apocrine sweat glands.” In: Bolognia JL, Jorizzo JL, et al
, eds. Dermatology
. Mosby Elsevier 2008. p. 543.
Peterling H, Breuer C, et al
. “Comparison of localized high-dose UVA1 irradiation versus topical cream psoralen-UVA for treatment of chronic vesicular dyshidrotic eczema.” J Am Acad Dermatol
Schnoop C, Remling R, et. al.
“Topical tacrolimus (FK506) and mometasone furoate in treatment of dyshidrotic palmar eczema: A randomized, observer-blinded trial.” J Am Acad Dermatol