How Dyshidrotic Eczema Is Treated

Dyshidrotic eczema (DE) is a chronic skin condition that causes small blisters on the palms of the hands, soles of the feet, and the edges of fingers and toes. The blistering rash from DE is itchy and can cause a burning sensation. Symptoms can range from mild to severe.

DE flare-ups can be due to a number of triggers. Common ones include seasonal allergies, hot and humid weather, sweaty palms, some metals (particularly nickel), stress, and working at a job in which your hands are frequently wet (such as hairdressing).

DE can develop at any age, but it is most commonly found in people in their 20s to 40s.

For some people, DE goes away on its own without treatment or by using moisturizers. More severe or persistent DE can be treated with a skin care regimen, identifying and avoiding triggers, using topical medication, taking oral medication, and/or undergoing light therapy.

This article will discuss how dyshidrotic eczema can be treated and ways to help prevent flare-ups.

Home Remedies and Lifestyle

Much of the treatment for and prevention of DE flare-ups involves developing skin-friendly routines and practices at home.

Identifying Triggers

It isn't always possible to know what is causing your DE flare-ups, but if you are able to identify your triggers, avoiding them can help manage your symptoms.

Common triggers for DE include:

• Irritants, such as detergents, cleaners, or hair products
• Certain metals, like nickel or cobalt
• Extreme hot, cold, or dry weather conditions
• Wet palms from sweat or working in a job that requires your hands to get wet frequently

If you are hypersensitive to nickel or cobalt, removing or limiting foods and beverages that contain these metals may help reduce flare-ups.

Some healthcare providers suggest using a point system, in which foods that are higher in one or both of these metals has a higher point value. By tracking your points, you can stop consuming anything that contains these metals once you reach a set number of total points for the day.

Stress can also contribute to DE flare-ups. Using measures to lower your stress levels could help your skin. Some small studies have shown that biofeedback therapy can help clear skin and keep flare-ups at bay by reducing stress.

Skin Care Regimen

Taking care of your skin is important if you have eczema, including DE.

When washing your hands:

• Remove your rings first to avoid water being trapped underneath them.
• Use lukewarm water, not hot.
• Use mild, fragrance-free cleansers (avoid antibacterial and deodorant soaps).
• Dry your hands gently but thoroughly (pat, don't rub).
• Apply a moisturizer, such as a heavy cream with ingredients like ceramides, or petroleum jelly, to help protect and repair the skin barrier.
  

Moisturize your skin every day, particularly your hands, and your feet, if they also get DE flares.

Make sure to wash your hands or feet and apply moisturizer after coming into contact with a potential trigger.

Medicated soaks and cool compresses can be applied for 15 minutes, two to four times daily, to help dry blisters and reduce itching.

Protecting Your Skin

Preventing your hands from irritation can help your skin heal and reduce potential flare-ups.

You can protect your skin by:

• Removing your rings before washing your hands (or getting them wet), applying moisturizers or topical treatments, or going to bed
• Wearing latex-free gloves when doing the dishes or other wet work (wearing 100% cotton gloves underneath waterproof gloves helps to prevent irritation)
• Wearing 100% cotton gloves when your hands will stay dry but may be in contact with irritants
• Wearing gloves during cold or wet weather
• Wearing moisture-wicking socks
• Avoiding scratching as much as possible (keeping your nails short can help prevent scratching from breaking the skin)
• Taking a break from work or other commitments to allow painful blisters to heal

Over-the-Counter (OTC) Therapies

There are a variety of options for OTC treatments for DE, both medicated and unmedicated.

Topical OTC Options

An effective moisturizer or barrier repair cream is an important part of DE skin care. Look for a cream or an ointment rather than a lotion. Lotions have a higher water content and may worsen DE. Your healthcare provider may recommend petroleum jelly or products that contain the ingredient dimethicone.

Apply moisturizer or barrier repair cream regularly throughout the day, particularly after washing your hands, after bathing or showering, or when your skin feels dry. Unless the product info or your healthcare provider says otherwise, these can generally be applied as often as you need.

Applying them to skin that is still damp (such as patting the skin dry after washing and then applying the moisturizer immediately) can help trap moisture and be more effective.

Look for products that do not contain:

• Scents or fragrances
• Alcohol
• Dyes
• Other irritating substances
  

OTC Oral Medications

Antihistamines may help you get a better night's sleep if itching is keeping you awake, but this may be more due to their drowsiness-inducing factor than their itch-reduction ability. Antihistamines that are non-drowsy, such as Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine), are less effective for itch relief.

Check with your healthcare provider before taking antihistamines regularly to ensure they are safe for long-term use.

If you are taking an antihistamine that makes you sleepy, take it at bedtime and be mindful of activities you should avoid doing while drowsy.

Prescriptions

If your DE is more severe, or is not responding to other treatments, your healthcare provider may prescribe topical, oral, or injectable medication.

Steroid Medications

Topical steroid ointment can be prescribed to help reduce inflammation and clear up blisters. Make sure to check the dosage prescribed and don't apply more than you are supposed to.

In some serious cases, oral steroids such as prednisone may be prescribed. These are usually taken short-term as long-term use can have significant side effects.

Anti-Itch Medications

Your healthcare provider may prescribe medications such as Tronolane (pramoxine), which comes as a cream or lotion, to help soothe both itch and pain.

Immunomodulators

These medications help calm the immune system and prevent it from reacting too strongly.

Immune-suppressing topical treatments that may be prescribed include:

• Protopic (tacrolimus)
• Elidel (pimecrolimus)

These ointments are generally used for a few weeks. Your healthcare provider may suggest a plan for using them to manage flare-ups if longer use is needed. These medications may cause an increased risk of skin infections.

Systemic (works through the whole body) medication that calms the immune system may be prescribed if other medication isn't working.

Dupixent (dupilumab), an injectable biologic medicine, has been approved for the treatment of eczema and early data suggest it may also be helpful in treating DE. It helps calm the immune system, but is not an immunosuppressant.

Anti-Infection Medications

DE can make skin prone to infection, especially with scratching. This can cause swelling, pain, crusting, or pus-filled blisters, all of which hinder healing. Depending on the type of infection, your healthcare provider may prescribe topical or oral antibiotics or antifungal medication.

Surgeries and Specialist-Driven Procedures

If blisters are very large, they may need to be drained to help reduce pain.

People with chronic, severe symptoms that aren't responding to other treatments may benefit from a type of phototherapy (light therapy). This treatment uses psoralen and ultraviolet light (PUVA). Psoralen drugs make the skin more receptive to the healing effects of the ultraviolet light.

This treatment is performed in a dermatologist's office or a hospital. It often requires five treatments a week for three weeks.

Never try to give yourself ultraviolet treatment through sun exposure or a tanning bed. This is damaging to your skin and increases your risk for skin cancer.

Summary

Sometimes dyshidrotic eczema will go away on its own without treatment or with a good skin care routine that includes moisturizing.

Medications such as steroids, immune modifiers, anti-itch medication, and anti-infection agents may be needed in cases that are more severe or persistent, are not responding to milder treatments, or when an infection is present.

In some serious cases, DE may be treated with ultraviolet light therapy.