A characteristic sign of dyshidrosis is the appearance of small blisters on the palms of the hands, on the sides of the fingers and on the soles of the feet. As a rule, the blisters remain 3-4 weeks; in this "period of time, they dry out and" come off ", leaving the underlying skin red and extremely sensitive.
Corticosteroid medications (in the form of creams, ointments, or oral tablets), photodynamic therapy, and some immunosuppressive drugs can help to treat dyshidrotic eczema.
EPIDEMIOLOGY
Dyshidrosis has an "unknown incidence, since, appearing in association with other skin disorders, it is very often underdiagnosed.
According to some research, it seems to have a seasonal pattern (as it is more frequent in the period between spring and summer) and a preference for people between 30 and 40 years old.
In some cases, the appearance of blisters is linked to allergic colds (allergic rhinitis), typical of the spring / summer season.
RISK FACTORS
The onset of dyshidrosis is favored by certain factors, such as stress, exposure to certain metals, contact with certain irritants and atopic eczema.
- Stress. It has been observed that people with recurrent / chronic dyshidrotic eczema are more prone to new episodes of dyshidrosis at times of increased stress.
- Exposure to certain metals. According to some laboratory tests, exposure to chromium, cobalt and nickel favors the onset of dyshidrotic eczema.
- Contact with certain irritants. Some individuals have extremely sensitive skin, which, in contact with certain irritants, develops the classic blisters of dehidrosis.
- Atopic eczema. Some individuals prone to atopic eczema are also involved in episodes of dyshidrosis.
Dyshidrosis is characterized by the formation of small blisters on the palms of the hands, on the sides of the fingers, and sometimes on the soles of the feet. In medicine, the appearance of such blisters is called a vesicular rash.
CHARACTERISTICS OF THE VESICULAR ESANTHEMA
The small blisters (1-2 mm in diameter) of dyshidrotic eczema are fluid-filled and in close contact with each other; in some individuals, they are so close to each other that they appear to form a single large blister.
They can cause itching and / or pain and take about 3-4 weeks to dry out spontaneously.
After they have dried and flaked from the formation area, the underlying skin remains red and becomes, for a few days, more sensitive than normal.
The sites of appearance of the vesicular rash are: the center of the palm of both hands, the sides of the fingers and the soles of both feet. Hands and fingers are affected in most patients; the feet, on the other hand, are affected only in some individuals.
WHEN TO SEE THE DOCTOR?
Patients with dyshidrosis should contact their physician if the vesicular rash, rather than healing spontaneously, continues to recur without interruption.
COMPLICATIONS
Complications of dyshidrosis are related to itching and pain caused by blisters. In fact, these two sensations:
- They prevent you from moving your hands freely and gripping objects
- They induce scratching, to the point of damaging the skin and favoring the onset of bacterial infections
If the doctor uses any particular laboratory tests, he does it as a precautionary measure, to make sure that the rash has not been caused by other skin diseases with symptoms similar to dyshidrotic eczema (differential diagnosis).
DIFFERENTIAL DIAGNOSIS
If the doctor is concerned that the blisters on the feet are due to fungi (in this case, athlete's foot fungus), he can take a small sample of skin cells and have them analyzed in the laboratory. the outcome of an allergic reaction not linked to dyshidrosis subjects the patient to various allergic tests.
WHAT TO DO IN CASE OF INFECTION?
If the patient is injured by scratching, the skin lesions can be attacked by bacteria and become infected, with sometimes very serious consequences.
If the doctor fears an "infection in progress, he can perform a culture test on a skin swab (or skin swab), appropriately taken from the affected area. A culture test that is positive (confirming the presence of bacteria in the skin lesions) it would require the planning of antibiotic therapy.
CORTICOSTEROID DRUGS FOR TOPICAL (OR LOCAL) USE
What are corticosteroids? Corticosteroids are powerful anti-inflammatory drugs, belonging to the steroid family (steroids are hormones also naturally present in the human body).
Types of corticosteroids for topical use (for topical or local use, it means that the preparation is applied directly to the affected area). form of ointments or creams. For example, ointments are indicated for very severe dyshidrotic eczema, characterized by a large number of blisters; creams, on the other hand, are suitable for moderate dyshidrotic eczema, characterized by a limited number of blisters.
How are corticosteroids applied? Before using any corticosteroid drug, you should contact your doctor to be informed on how to administer. In general, these medicines should not be applied more than twice a day and for more than 3-4 weeks. Before applying to the affected area, it is recommended to soften the skin with an emollient, in order to favor the absorption of the corticosteroid preparation.
Side effects. At the first administration, the patient may feel a slight discomfort, which, however, gets used to in a short time. The main side effects are: telangiectasias and thinning of the skin. Their occurrence is usually due to prolonged use of the corticosteroid.
ORAL CORTICOSTEROID DRUGS
Main side effects of oral corticosteroids:
- Hypertension
- Weight gain
- Osteoporosis
Oral corticosteroids differ from topical corticosteroids only in the route of administration, which is by mouth, and in the type of side effects.
The most widely used oral corticosteroid is prednisone.
PHOTODYNAMIC THERAPY
Photodynamic therapy involves the use of a photosensitizing drug, for topical use, and a source of light radiation. The photosensitizing drug is a kind of cream, which, applied to the area affected by the vesicular rash, makes the latter more susceptible to light; the light source, on the other hand, emits the ultraviolet rays necessary to destroy the abnormal skin cells, which have become hyper-photosensitive after the application of the drug.
Photodynamic therapy is minimally invasive, but its long-term effects are not known; therefore, it is only used if corticosteroids have not been effective (or if drug therapy needs to be stopped).
IMMUNE-BASED THERAPY
Immunosuppressive drugs reduce inflammation by acting against the patient's immune system (N.B: the immune system is the defensive barrier against threats from the external environment, such as viruses and bacteria).
In case of dyshidrosis, they are prescribed to limit the dosage of corticosteroids or when the latter are contraindicated.
The medicines used in these situations are tacrolimus and pimecrolimus, which are also indicated in the treatment of atopic eczema.
Attention: the intake of immunosuppressants makes the body more fragile, exposing it to a greater risk of infections.
OTHER REMEDIES
To relieve the itchy sensation (especially when it is very intense), it may be useful to make cold / wet compresses on the affected area and take antihistamines (such as diphenhydramine).
To speed up healing, creams based on witch hazel, a plant with anti-inflammatory and antioxidant powers, seem to have excellent effects.
