Comments: Dyshidrosis is a recurrent, inflammatory, chronic condition of infernal itching and pestilential encrustations prone to hard-to-heal cracking that brings a bucketful of misery into the lives it preys upon. A very thorough patient-written description, written by Duncan Watson, can be seen here:
New Zealand patient story
If you want to see what eczema is, and the various subtypes, and where dyshidrosis fits in, I recommend the Wikipedia article on eczema: http://en.wikipedia.org/wiki/Eczema
Comments: I've found an effective way to treat it, and based on my experience, I wager that if not curable, then it can be put into a fast remission. So take heart, fellow sufferer, and let a little flame of hope grow in your belly!
Comments: I have experienced occasional small bumps on my hands, and hard to heal cracks on the side of my fingers. My main problem has been on my feet, however; there I had massive encrustations on my heels and big toes, as well as red itchy areas on the side of the soles, and peeling, itchy soreness with some blisters between two of my toes and on the ball of my right foot. The heels had deep thin cracks that itched all the time, but especially at night. The heels had a scaly, peely feel to them, and had that off color "lichenization" look (at that time, I thought I had fungus that infected the skin lines of my feet; it is a very distinctive look). When I used pumice stone to try to improve the situation, the itch would increase greatly. By the way, I don't think scratching leads to the thickening; I think it is part of the disease. (Many others besides myself report mistaking the condition initially for foot fungus. What also confuses the issue is that antifungals sometimes work to clear up a flare.)
Other people report large itchy fluid-filled blisters, finger swellings, raw areas that do not heal; sometimes the condition becomes so severe that using one's hands or walking becomes almost impossible. I have spoken with a mother whose daughter had to be admitted to the hospital twice for an IV antibiotic drip, and whose eczema kept returning after it got a little better. This is a miserable, nasty condition, and it seems to be becoming more frequent, even occuring among young children.
For the details and progression of my disease, click here.
Comments: Working with my hands in frequently moist conditions. Tight or infrequently changed shoes. Certain skin creams. I am still trying to make up my mind about the role of irritant foods.
Comments: I first realized that weather played an important role when I participated on two forums, and in the winter most of dyshidrosis complaints came from Australia and New Zealand. On the other hand, some people report that serious outbreaks can last all year. I had one that was like that.
Comments: My mother used to complain of such a condition. She got some relief from vitamin A, then it stopped working. She got a good remission from her visit to the Black Sea.
Comments: I don't sweat much; never have. I don't see a link. Moist socks, from whatever source, do exacerbate the condition.
Comments: It has been known for about 100 years that eczema can be directly triggered by nutritional deficiencies. But after the advent of steroids, the interest in pursuing this avenue in research and treatment faded. Such weaknesses could be inherited and begin the chain of events leading to various types of eczema. Dyshidrosis itself, in my carefully considered opinion, is closely linked to the exposure to irritants, both contacted and ingested, as well as infection/infestation with bacteria, fungus, or parasites.
Antibiotics or antifungals are used if a secondary infection develops. Ultraviolet light of several months' duration can help. Oral antihistamines are commonly prescribed for the itch. Potassium permanganate, aluminum acetate (Burow's solution), or vinegar soaks are recommended to dry up the blisters.
Comments: Steroidal preparations can help accessible areas heal. They will not make much of a dent in thickened skin, in chronic encrustations as they cannot sink through to the needed extent. They are not advisable to be used for the time needed to fully deal with this condition once it has turned chronic. I found most emollient creams actually worsened the condition. (This is not surprising, since most are packed with irritants; even the ones prescribed by medical professionals.) Never did try UV light; I doubt my type would have been a good candidate. Other sufferers have reported helpful results from PUVA treatment, but the medical literature does not report an advantage over UVA light (which is safer). I tried cold vinegar soaks with no effect, but have since tried hot vinegar soaks, and find them very helpful. Some people report that coal tar preparations have helped, and others say the opposite. Aluminum chloride 20% (Dri-Sol) to dry up the vesicles, as well as permanganate, has been mentioned by fellow DE folks. Salt soaks are worth trying as people report improvement after visits to the seaside. You will find other ideas at the bottom of this page, in the "Stories" section. Some folks find antihistamines somewhat useful for the itch, others not at all.
It is unfortunate that medical treatment has focused almost exclusively on the suppression of symptoms rather than on potential cure. The mainstay of mainstream treatment, steroids and coal tars, are dangerous substances that must be used with great care and with awareness of the risks. Many doctors do not explain these to their patients.
Comments: Good grief, Charlie Brown! Not one of these very toxic treatments has been properly studied in dyshidrosis. And some doctors believe that their long term effects are detrimental not only for general health, but in terms of eczema control as well. Cyclosporin has been shown to work in atopic eczema, but long-term follow-up is lacking.
For atopic eczema, current experimentation includes combining Protopic or Elidel with steroids, intravenous immunoglobulin (lots of side effects, expensive), Tumor Necrosis Factor antagonists may be promising. Xolair (omalizumab), an anti-IgE antibody as an under the skin injection, was approved for severe asthma, but the treatment protocol is complicated and most people with eczema would probably not qualify, very expensive. Raptiva, developed for psoriasis, is an LFA-1 antagonist, enhancing the body’s ability to defend against inflammation; no studies yet with eczema but seems quite safe as a weekly under the skin injection. An anti-IL-5 antibody may be tested for atopic dermatitis soon
Chinese herbal treatments were closely studied in England by a noted eczema expert Dr Atherton, who reported good results. They have now been investigated for about 15 years by multiple groups. Some liver toxicity was noted in some of the combination remedies. The focus of research has been on finding the active principle that can be patented rather than speedy availability of the most promising mix to patients.
Probiotics have shown a real promise, but few dermatologists are paying attention in terms of using them in treatment, preferring to wait for more information. It is not clear to what extent any treatments pioneered for atopic eczema will benefit us.
I tried some herbal soaks but did not notice any results. Also used tea tree oil and oregano oil which seemed to keep things stable and helped with the itch, but the stench really got to me. The New Zealand patient site recommends some homeopathic preparations and Bach Flower Remedies for the itch. On the far side, another patient reports getting good results from an over the counter remedy for diarrhea, Donnagel (on account of atropine). I have heard from some who spray their hands with Windex and swear it works.
There are many web sites peddling miraculous eczema cures. They have no clue about dyshidrosis. Hang onto your money, honey...
On the other hand, most people with DE whom I know who were tested did not come up for anything; some came up for nickel or a preservative. While in research studies a significant minority of patients do have identified allergens, this only emerges after testing so extensive that I doubt any dermatologist would be willing or able to perform in a clinical setting. The situation is further confused by the fact that sometimes people will not react to an allergen when tested on the back, but will when tested on the hands or feet (where the disease occurs). At other times, they only react to an “oral challenge” by the offending substance, such as nickel. (WARNING: Oral challenges (i.e. ingesting large quantities) with heavy metals can bring on intractable, severe dyshidrosis and is NOT recommended for this condition!)
Foods and spices also play a role. And then, irritant substances (many of which are known to bring on a dyshidrosis flare) do not come up with allergy testing (because irritants are not necessarily allergens). And to add to the puzzle, sometimes, the disease will persist even when the original allergen or irritant is completely avoided.
For all these reasons, I am inclined not to bother with allergy testing, but to focus rather on eliminating problems encountered in every day life. This means learning to recognize the potential problematic substances, and seeing if one’s skin reacts to their avoidance or contact. Excluding most of the mass-produced cosmetics and cleaners has been part of my strategy.
Since nickel is a common allergen implicated in dyshidrosis, I also mention the low-nickel diet, which is however rarely recommended because it is difficult to keep, and the results nothing to write home to mother about. I have heard from one person who does stick to such a diet and has reported an improvement.
Irritant and allergic substances mentioned in the literature are medicaments (esp. neomycin and aspirin), implanted or ingested metals (esp. nickel, cobalt and chromate), fragrances and flavorings, balsams (e.g. balsam of Peru), preservatives (e.g. parabens, triclosan), skin parasites, bacteria and fungi (these often give off toxins the skin reacts to), soluble oils (as in metalworking), and foods (most often eggs, milk, tomato, cheese, spices, and food additives; also foods and herbs that contain sesquiterpene lactones, such as lettuce and feverfew). And there are even reports of people reacting to steroids and petrolatum.
I have used strong hydrogen peroxide (aka H2O2), the stuff used to sterilize wounds, plus several types of ointments. I rub the skin with cotton squares soaked in the H2O2 for a few seconds, and dab it dry. The skin will gradually begin to tingle, and it will turn white at the site of the disease. Healthy skin remains as is. A little later I rub an ointment into the skin to help it heal. This treatment gets rid of the vesicles pretty fast. After the skin crusts over, I use a plastic file to slough off the crust, and vegetable oil to keep it moisturized. In my experience, this simple and effective treatment got me from intense itching and blistering due to active disease, to no more itch and drying, healing blisters in just a few days!
You should see the skin on my soles! Smooth as a baby's bottom. But it took real persistence, so it's necessary to keep at it. This disease is very tough. Eventually, new healthy skin will build up, and be resistant to the peroxide -- the skin that still turns white lets you know the extent of the disease since the damaged skin burns and the healthy skin does not.
The one drawback of this treatment is the fact that the skin that the peroxide is working on often itches intensely for an hour after treatment. Taking Benadryl has not been shown to be helpful; I used to tough it out, massaging the foot to help with the itch. But I since learned that dunking the hand or foot in hot water takes care of the problem. (Some people prefer ice water.)
The ointments I've used are as follows:
1) zinc oxide ointment (diaper rash cream) -- I pick the one with no fragrance and the least amount of additives. Eckerds carries one that only has white petrolatum, beeswax and mineral oil in it. The zinc ointment is universally recognized by dyshidrosis sufferers as very helpful.
2) 1% hydrocortisone ointment (over the counter). Ointment is recommended over cream because it is absorbed better, and acts as an emollient. This non-prescription medication can be used for longer periods of time than stronger prescription steroids.
3) Bag balm is a time tested veterinary preparation used for cracked cow udders. I was given some during a troublesome relapse and found it very helpful. It is commonly available on the internet, as well as in some drug stores. The maker calls it an antiseptic protective ointment and lists the following ingredients: petrolatum, lanolin, 8-hydroxyquinoline sulfate 0.3% (which is an antibiotic). (WARNING: Some people are sensitive to sulfates or lanolin; if in doubt, do not use it. The treatment described here does not depend on it.)
All the above ointments are petroleum based. If you think this may cause a problem, ask your compounding pharmacy to create them for you using un-petroleum jelly (which is commonly available from health food stores). And non-petroleum diaper rash salves are not that hard to find these days.
I’ve used it full strength (27%) throughout, even on my hands. The key is to find a concentration that will burn the sick skin while leaving healthy skin more or less alone. All in all, I have found this concentration unproblematic, and have not had any damage from it. I've also used 7.5% at times when the 27% seemed too strong.
In other countries, chemists often carry stronger H2O2. In the U.S., stronger H2O2 can be obtained in the following ways: 7.5% and 27% are available from some pool care stores. Go to www.baquacil.com, click on "where to find" and input your zip code. You will see dealers in your area. Ask for the "shock". Spa shock is the 7.5% and comes in a small bottle, and pool shock is the 27% and comes in a gallon bottle. The peroxide does not appreciably weaken after the bottle is opened. Leftover H2O2 can also be added to bath water (2-4 cups per tub).
Baquacil was the first purveyor of hydrogen peroxide for pool use. I have since learned that there are 2 other similar products out there, both containing 27% H2O2: Clear Comfort Clarifier, and Soft Swim-C. Soft Swim-B is 15%. I have not examined these products in terms of any potential additives.
Health food stores sometimes carry 35% H2O2 but it tends to be very overpriced, and it is too strong to use directly. I have heard of stores refusing to carry it because their customers got hurt. I have not used it. There is a contingent of fans of this product that is offered on the web. They claim that only this 35% is "food grade" and pure. This is not accurate. The Baqua-Shock 27% contains H2O2 and water and nothing else.
I am told by another sufferer that "you can buy 40 volum peroxide in any beauty supply and some drug stores. Look in the hair coloring section. 40 volum is the same as 27% H2O2 and it is cheap. Only about $3.00 for 16 ozs. I have been using it for about 6 months with great results."
I have come across a medical article recently that details how a patient who was given extra oxygen to help with sleep apnea experienced major improvement in a bad case of dyshidrosis that was resistant to cortisone treatment. The doctors speculate that the condition cleared up because of better tissue oxygenation.
As you can imagine, I am eager to see if this treatment that has worked so well for me will work for you. Please write with your experience, positive or negative. I will publish it here, and our knowledge base will grow. It is my fervent hope that you will find this information of use. You can be well! Dare to experiment -- the only thing you risk to lose is....
Researched and written by Vera Bradova © 2003-2008
Updated 9-4-2008
Other languages: dyshidroticky ekzem, dishidrotisch, disidrose, dyshidroticka dermatitis
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