I had a referral from a doctor last week; the patient had a dermatological condition on the feet. Naturally, based on its presentation, the patient was quite concerned, if this is what it was. Dyshidrosis or pompholyx, is a skin condition in which very small, fluid-filled blisters appear on the soles of the feet, and around the toes. It can also occur on the palms of your hands and the sides of your fingers.

Symptoms

The small, itchy blisters are the most noticeable sign. These usually pop up in clusters, and you may itch or feel a burning pain before they appear. The skin around the blisters might sweat more than usual, and your nails might thicken, and change colours too.

The blisters are usually about the width of the lead in a standard pencil,  and grouped in clusters. In more severe cases, the small blisters may merge to form larger blisters. Once the blisters dry and flake off, which occurs in about three weeks, the underlying skin may be red and tender. Dyshidrosis can recur fairly regularly for months or years, sometimes before your skin heals completely from the previous blisters.

Causes

The cause of dyshidrosis is unknown. It can be associated with a similar skin disorder called atopic dermatitis, as well as with allergic conditions, such as hay fever. Eruptions may be seasonal in people with nasal allergies. Other potential causes are:

• Sweaty or wet hands and feet
• Warm, humid weather
• HIV infection
• Certain treatments for a weak immune system (immunoglobulin)

This condition isn’t contagious, so you can’t catch it from touching someone who has it.

Sex- and age-related Demographics

The male-to-female ratio for dyshidrotic eczema has variably been reported as 1:1 and 1:2. It tends to affect individuals aged 4-76 years, with the mean age being 38 years. The peak incidence of the condition occurs in patients aged 20-40 years. After middle age, the frequency of episodes tends to decrease.

Risk factors

These include:

• Stress –it appears to be more common during times of emotional or physical stress.
• Exposure to certain metals – these include cobalt and nickel, usually in an industrial
• Sensitive skin –people who develop a rash after contact with certain irritants are more likely to experience dyshidrosis.
• Atopic eczema –some people with atopic eczema may develop dyshidrotic eczema.

Complications

For most people with dyshidrosis, it’s just an itchy inconvenience. For others, the pain and itching may limit the use of their hands or feet. Intense scratching can increase the risk of a bacterial infection developing in the affected skin.

Prevention

Because the cause of dyshidrosis is generally unknown, there’s no proven way to prevent this condition. You may help prevent it by managing stress and avoiding exposure to metal salts, such as cobalt and nickel.

Good skin care practices may help protect the skin as well. These include:

• Using mild cleansers and lukewarm water to wash your hands and feet, and drying them well.
• Moisturising regularly.

Diagnosis

In most cases, your health provider can diagnose dyshidrosis based on a physical exam. No lab test can specifically confirm a diagnosis of dyshidrosis, but tests may be suggested to rule out other skin problems that have similar symptoms.

For example, a scraping of your skin can be tested for the type of fungus that causes problems such as athlete’s foot. Skin allergies and sensitivities can be revealed by exposing patches of your skin to various substances.

Treatment

Depending on the severity of your signs and symptoms, treatment options may include:

• Corticosteroids –High-potency corticosteroid creams and ointments may help speed the disappearance of the blisters. In severe cases, corticosteroid pills may be prescribed, such as prednisone. Long-term use of steroids can cause serious side effects though.
• Botulinum toxin injections.Some doctors may consider recommending botulinum toxin injections to treat severe cases of dyshidrosis.

Lifestyle and home remedies

Home treatment could include:

• Applying compresses –Wet, cool compresses may help reduce itching.
• Taking anti-itch drugs –Over-the-counter antihistamine medications such as benadryl or claritin can help relieve itching.

You are likely to start by seeing your family doctor. He or she may then refer you to a dermatologist or podiatrist.

 

Your feet mirror your general health . . . cherish them!