What happens to the skin
On the palms and soles the stratum corneum is very thick. When inflammation begins in the skin, fluid accumulates between the cells and cannot escape - this is how small, tense blisters, located deep, form. The name “dyshidrosis” appeared when the cause was considered to be blockage of the sweat glands, but modern data do not confirm this. We are talking about a variant of eczema in people with sensitive skin and a damaged protective barrier. Sometimes rashes on the hands become a reflected reaction to a fungal infection of the feet.
- Bubbles deep in the thick stratum corneum
- Undulating course with exacerbations
- Often associated with atopic dermatitis
- Could be a reaction to foot fungus
- Not contagious
What provokes an exacerbation
Most people can find recurring triggers. Classic ones - emotional stress and lack of sleep, hot weather and sweaty hands, frequent washing and working with household chemicals, wearing rubber gloves for a long time. Contact allergies to nickel and cobalt play a significant role: they are contained in jewelry, buckles, coins, and tools. In some patients, exacerbations are associated with smoking and chronic foci of infection. Understanding your provocateurs often gives more than any ointment.
- Stress and sleep disturbance
- Heat, sweaty palms and feet
- Detergents, solvents, cement
- Nickel and cobalt in jewelry and tools
- Fungal infection of feet and nails
- Prolonged wearing of impervious gloves
Symptoms and stages
An exacerbation usually begins with itching and a burning sensation, followed by blisters the size of a pinhead within a day. They sit in groups on the lateral surfaces of the fingers, palms, and less often on the soles, the skin between them looks normal. After a few days, the blisters dry out, and the peeling stage begins: the stratum corneum comes off in layers, exposing thin pink skin. Painful cracks appear, especially in the folds of the fingers. With frequent exacerbations, the skin thickens, the pattern intensifies, and the nails may become wavy.
- Itching and burning until a rash appears
- Dense bubbles that do not burst when pressed
- Symmetrical arrangement on the hands and feet
- Peeling in layers after drying
- Cracks and soreness
- Changes in nails over a long period of time
Survey
The diagnosis is mainly clinical: the doctor evaluates the type and location of the rashes, their connection with work and everyday life. A mandatory step is scraping the skin and nails for fungi, because a fungal infection masquerades as dyshidrosis and triggers it. If a contact allergy is suspected, patch tests are prescribed, which help identify a reaction to nickel, cobalt, chromium and cosmetic components. A complete blood count and total IgE level are needed if atopy or concomitant infection is suspected. If the picture is atypical, a skin biopsy is performed.
- Examination by a dermatologist, dermatoscopy if necessary
- Scraping skin and nails for fungi
- Patch tests for contact allergens
- Complete blood count, total IgE
- Culture from the lesion if suppuration is suspected
- Skin biopsy in unclear cases
Treatment and care
The goal is to relieve inflammation during exacerbation and lengthen the period of remission. In the acute period, the doctor prescribes external anti-inflammatory drugs, most often hormonal creams in short courses or non-steroidal anti-inflammatory external drugs; When it gets wet, add drying lotions. In the peeling stage, the basis of treatment is fatty emollients and products with urea; they restore elasticity to the skin and prevent cracks. For persistent cases, phototherapy or systemic medications are used. All products are selected by a dermatologist: uncontrolled use of strong hormonal ointments thins the skin.
- External anti-inflammatory agents as prescribed by a doctor
- Emollients daily, especially after washing hands
- Cotton gloves under rubber when working
- Mild, fragrance-free detergents
- Treatment of foot and nail fungus, if found
- Phototherapy and systemic therapy for severe cases