Dyshidrotic eczema can be a really persistent and uncomfortable problem, coming and going in waves, with no apparent reason why it’s flaring up again. In this blog we look closely at the various options for treating the condition.
Dyshidrotic eczema, also known as dyshidrosis, palmoplantar eczema, foot-and-hand eczema, vesicular eczema or pompholyx, is a bit of a mysterious condition, as well as a mouthful!
What is dyshidrotic eczema?
It manifests as tiny, intensely itchy blisters on the hands or feet. Often affecting the fingers and toes, the blisters can swell, multiply, and spread across palms and soles, before drying up and leaving skin painfully cracked and sore. In this phase, broken skin is vulnerable to infection, so it’s important to get the condition under control as soon as possible.
Treatment is limited
But that’s easier said than done. Dyshidrosis can be a frustrating and persistent problem, often with no clear trigger, and no obvious reason why it flares up in one person and not another. Treatment for any kind of eczema is a case of managing symptoms, rather than curing the condition - there are no equivalent of bug-killing antibiotics for inflammatory conditions - and that’s the case with dyshidrotic eczema too.
The three-part strategy for getting rid of a pompholyx flare consists of:
- Avoiding irritants that can trigger or worsen an attack
- Managing symptoms to make yourself more comfortable
- Looking after your skin so that it can heal
Although it may not be obvious what sets off an attack of DE, there are things that we know make it worse. These include household chemicals, soap, detergents, perfumes, preservatives, dyes and other ingredients in cosmetics and skincare, swimming pool chemicals, nickel, balsam, sweat, stress, microbe overload/infection, and hot or humid weather.
Just to make things even more complicated, it seems that people’s triggers can change over time, so that what affects them one year is fine the next. It might be worthwhile keeping a trigger diary over the course of weeks or months, to check what might be affecting your skin.
Even if you’re not sure exactly what flares up your dyshidrosis, it’s sensible not to risk inflaming it further; swap soap out for a PH-neutral, SLS-free wash; wearing thin cotton gloves if possible; steering clear of fragranced cosmetics and toiletries; moisturising after washing; and putting some stress-busting strategies in place.
Managing your symptoms
If you’re unlucky enough to be suffering from pompholyx, then alongside avoiding anything that might make it worse, it’s important to find ways to make life more comfortable for yourself, especially if the itch is unbearable.
- Try not to burst the blisters in case they get infected
- Keep your hands/feet clean, dry and cool
- Wear thin cotton dermatological gloves to minimise irritation
- Wear hypoallergenic waterproof gloves for any cleaning or washing your hair
- Take antihistamines to reduce the itchiness
- Apply cool compresses to the area
- Soak hands in potassium permanganate solution
- Remove metal jewellery from affected hands
- Keep your fingernails short and filed to prevent damage
- Moisturise your skin immediately after bathing
Looking after your skin
Caring for itchy or damaged skin during (and after) a flare is a vital step in the process of getting rid of pompholyx. The skin needs nutrients, hydration and protection in order to regenerate itself after an attack. The skin’s natural cycle of repair and regeneration can take up to a month, so anything you can do to help it on its way will be useful!
Here are some tips to pick appropriate skincare for pompholyx:
- Pick unscented products to reduce irritation.
- Use oil-based balms rather than water-based creams if the skin is broken or stinging
- Choose products with naturally nourishing oils to provide skin with the nutrients it needs to repair
- Natural oils can support the healthy functioning of the skin barrier
If this three-part management plan doesn’t improve your skin, or the pompholyx worsens, then go see your doctor. There are further options you might want to consider, including phototherapy, topical steroids and immunosuppressants.
Topical steroids are a short term treatment only: they may help calm the inflammation and itching in the moment, but they should not be used long term to manage the condition. Sometimes a strong steroid cream will dampen the itch quickly and strongly enough to prevent damage from scratching, and the flare can be stopped in its tracks, but they are potent medicines that can have long term consequences, and should only be used under professional guidance.
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If you require medical advice we recommend you always contact your healthcare professional.
If you or someone you are caring for seems very unwell, is getting worse or you think there's something seriously wrong, call for emergency services straight away. For general medical advice, please contact your healthcare professional, this article does not contain or replace medical advice.
Do not delay getting help if you're worried. Trust your instincts.