Dyshidrosis: Symptoms, Causes & Treatment

Dyshidrosis is a skin condition that causes small, fluid-filled blisters on the hands, fingers, or feet. These blisters can be very itchy and may lead to peeling, dry, or cracked skin as they heal.

The exact cause of dyshidrosis is not known, but it may be linked to allergies, stress, excessive sweating, or frequent exposure to water and skin irritants. Dyshidrosis is not contagious and is usually diagnosed by a dermatologist based on symptoms and a skin exam.

Treatment for dyshidrosis may include skin care measures, medications, phototherapy, or Botox injections in more severe cases. Although dyshidrosis has no cure, treatment can help control symptoms and reduce future flare-ups.

Dyshidrosis symptoms

According to the National Eczema Association, dyshidrotic eczema causes small, itchy blisters that typically appear on the fingers, hands, and feet.

The main symptoms of dyshidrosis include:

• Small water blisters on the skin

• Itching on the hands, feet, or sides of the fingers

• Peeling skin

• Pain in or around the blisters

• Excess moisture around the affected area

• Dry or cracked skin after the blisters heal

The blisters usually dry out and begin to peel within about three weeks.

Confirming a diagnosis

Dyshidrosis is usually diagnosed by a dermatologist based on your symptoms and a physical examination of the skin. According to the American Academy of Dermatology, an accurate diagnosis is important because several different skin conditions can cause blisters on the hands, feet, or both. The doctor will evaluate signs such as redness, peeling, itching, and blister formation, as well as the extent of the affected area.

Additional testing is not usually needed to diagnose dyshidrosis. However, the doctor may recommend tests to rule out other conditions with similar symptoms, such as a skin scraping to check for a fungal infection (tinea) or patch testing to identify possible contact allergies.

Possible causes

The exact cause of dyshidrosis is unknown. However, it is more common during the summer.

Some factors that may contribute to dyshidrosis include:

• Family history of dyshidrotic eczema

• Increased emotional or physical stress

• Allergies, such as allergic rhinitis

• Atopic dermatitis or contact dermatitis

• Frequent hand washing

• Jobs that require frequent contact with water or products that can irritate the skin

• Exposure or contact allergy to metals such as cobalt, chromium, or nickel

• Use of intravenous (IV) immunoglobulin

Some studies also report that excessive and persistent sweating of the hands or feet, known as hyperhidrosis, may increase the risk of developing dyshidrosis.

Is dyshidrosis contagious?

Dyshidrosis, also known as dyshidrotic eczema, is not contagious. This means there is no risk of transmission, even with direct contact with another person’s skin.

Main types

The main types of dyshidrosis are:

1. Dyshidrosis on the hands

Dyshidrosis on the hands causes blisters to appear on the palms or sides of the fingers. This is the most common type of dyshidrosis.

2. Dyshidrosis on the feet

Dyshidrosis on the feet mainly affects the soles of the feet, but it can also appear on the sides of the toes. It can cause intense itching and small blisters on the feet.

3. Emotional dyshidrosis

Emotional dyshidrosis can affect the hands and/or feet. It is triggered or worsened by emotional factors, such as stress or anxiety attacks.

Dyshidrosis treatments

The main treatments for dyshidrosis include:

1. Skin care

Skin care can help prevent new blisters and lower the risk of irritation or infection. Recommended dyshidrosis self-care measures include:

• Applying cold compresses 2 to 4 times per day for up to 15 minutes at a time, or soaking the hands or feet in cold water to reduce discomfort or itching

• Using lukewarm water when washing the hands

• Applying moisturizers recommended by the doctor to help restore the skin’s protective barrier, which should be used daily

• Avoiding contact with substances that may cause skin allergies or irritation

If skin care routines are not enough to improve symptoms, the doctor may recommend medication.

2. Medications

Medication may be recommended when skin care is not enough to improve symptoms or in more severe cases of dyshidrosis.

The main medications used for dyshidrosis are:

• Antihistamines in tablet form, such as diphenhydramine or loratadine, to help relieve itching and redness in the affected skin

• Corticosteroid creams or ointments, such as mometasone or betamethasone, to help reduce inflammation and dry out the blisters

• Topical immunosuppressants, such as tacrolimus or pimecrolimus, prescribed when corticosteroid ointments have not been effective or for people who are allergic to corticosteroids

• Oral corticosteroids, such as prednisone, when corticosteroid or immunosuppressant ointments have not been effective

During treatment, the doctor may also recommend potassium permanganate compresses or soaks 2 to 3 times per day until the skin lesions improve.

For severe dyshidrosis that does not respond to previous treatments, the doctor may recommend other medications, such as azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, or etanercept.

3. Phototherapy

Phototherapy is a treatment performed by a doctor in a hospital or specialized clinic. It uses ultraviolet (UV) light on the affected skin and may be recommended when other treatments have not been effective in controlling symptoms.

Ultraviolet light may be used together with a medication called psoralen, taken by mouth or applied to the skin. This treatment is called PUVA therapy and involves taking or applying psoralen before exposing the treatment area to ultraviolet radiation.

4. Botox

In more severe cases, the doctor may recommend botulinum toxin injections, commonly known as Botox. This helps reduce sweat gland activity and decrease excessive sweating, which is one of the factors linked to dyshidrosis.

5. Natural remedies

A home remedy that may help soothe dyshidrosis symptoms is using calendula compresses as a complement to medical treatment.

Calendula is a medicinal plant with soothing and skin-healing properties that may help relieve intense itching and dry out the blisters.

Can dyshidrosis be cured?

Dyshidrosis has no cure. However, symptoms and new flare-ups can be controlled with treatment recommended by a doctor.