Dyshidrotic eczema is a chronic eczematous dermatitis that affects the skin of the palms and soles and is characterized by rashes in the form of small serous bubbles. As with other types of eczema, the specific causes and mechanism of development of this disease have not been determined, only the role of some provoking factors is known. Diagnosis of the disease is carried out mainly by excluding a similar pathology. Treatment is carried out with ointments, antihistamines and sedatives, if necessary corticosteroids. The elimination of provoking factors plays an important role.
L30 Other dermatitis
Dyshidrotic eczema in 80% of cases occurs with a lesion of the hands and only in 20% there are rashes on the soles. The disease got its name because its connection with the blockage of sweat glands was previously assumed. However, modern dermatology has proven that in many cases the sweat glands in dyshidrotic eczema function normally. In women, dyshidrotic eczema is most common in 20-25 years, and in men at the age of 40 years. The disease occurs with the same frequency in both sexes.
Dyshidrotic eczema causes
Endocrine diseases, diseases of the nervous system, immune disorders and shifts in metabolism can lead to the development of dyshidrotic eczema. In many patients, the disease occurs or worsens after suffering nervous overstrain, contact with substances that irritate the skin (most often these are various household chemicals). The development of this diseases is promoted by increased sweating — hyperhidrosis. Possible connection with food allergens. Approximately half of the patients have a hereditary predisposition to allergic diseases: bronchial asthma, atopic dermatitis, hay fever in their closest relatives.
The main element of the rash in dyshidrotic eczema is vesicles. They are bubbles of 1-5 mm in size, filled with a transparent liquid. With this pathology, the bubbles are characterized by a deep location in the epidermis and pronounced itching, which not only accompanies the appearance of bubbles, but can also precede them. Rashes are located in groups on the palm surface of the hands, the soles of the feet and the lateral surfaces of the fingers. Vesicles can also occur on the skin of the back surface of the hands.
Over time, the bubbles of dyshidrotic eczema burst, forming erosions. Erosions can be quite large if they were formed after the opening of several vesicles fused together. Erosion healing occurs with the formation of flat yellowish or brownish crusts. The vesicle resolution process usually takes from 1 to 3 weeks and leaves a dark spot of hyperpigmentation on the skin. This is not the end of the course of dyshidrotic eczema. In the future, chronic skin changes characteristic of eczema occur: redness, thickening (lichenification), peeling and cracking.
There are acute forms of dyshidrotic eczema. But in the vast majority of cases, the disease has a chronic course with relapses. Periods of remission can last from several weeks to several months. Exacerbations often occur without connection with any provoking factor and last for several weeks.
When pathogenic microorganisms (mainly streptococci and staphylococci) get into the erosion or cracks of the skin, secondary infection occurs. Purulent inflammation (pyoderma) develops with the formation of pustules containing pus on the skin. The general condition of a patient with dyshidrotic eczema may worsen at the same time. The body temperature rises. There is swelling and soreness of the affected areas of the skin. Regional lymph nodes increase: ulnar and axillary with lesions of the hands, popliteal and inguinal — with dyshidrotic eczema of the feet. Their soreness may be observed.
There are no specific methods for diagnosing dyshidrotic eczema. The characteristic pattern and localization of rashes make it possible to immediately suspect this disease, and the chronic recurrent course only confirms the diagnosis. Additional studies are aimed at the differential diagnosis with fungal infections, contact dermatitis, palmar-plantar psoriasis.
If dyshidrotic eczema is suspected, a microscopic examination of the scraping for pathogenic fungi is carried out, which makes it possible to exclude the mycotic cause of skin lesions. Seeding of the separated erosions or the contents of the bubbles helps to confirm the primary non-infectious nature of the disease, and when a secondary infection is attached, antibiotic therapy is adequately selected.
Dyshidrotic eczema treatment
The treatment is prescribed by a dermatologist. Patients are recommended a diet that excludes alcohol, seasonings, spicy foods and allergenic products: eggs, chocolate, citrus fruits, strawberries, honey, etc. It is also necessary to limit salt intake, since it contributes to the accumulation of fluid in the body and the development of edema. In case of dyshidrotic eczema, interaction with potential allergens should be avoided: household chemicals, washing powder, pollen of flowering plants, etc. If we are talking about dyshidrotic eczema of the soles, then it is necessary to abandon tight shoes and synthetic socks.
With this disease during the period of bubble rash, accompanied by severe itching, lotions with a solution of tannin, amidopyrine or Burov liquid are prescribed to relieve the patient’s condition. For the medical treatment of eczema, sedatives and antihistamines for oral administration are recommended: chloropyramine, cetirizine, clemastine. Thalassotherapy, in particular baths with Dead Sea salts, has a beneficial effect on the course of dyshydyshidroticdrotic eczema.
In the treatment of dyshidrotic eczema, ointments or talkers, corticosteroid ointments made according to a specially selected recipe are often used. In some cases of severe exacerbation of dyshidrotic eczema with the ineffectiveness of other methods of treatment, short courses of corticosteroid therapy are used. Their long-term or frequent use is not recommended due to the possibility of complications and steroid dependence.
An important role in the prevention of infectious complications of dyshidrotic eczema is assigned to the observance of personal hygiene. Local baths with a decoction of chamomile, oak bark, sage, yarrow, and turn have a disinfecting, soothing and therapeutic effect on the skin. Baths for brushes or feet are carried out for 15-20 minutes. When the elements of dyshidrotic eczema are infected, local antiseptic treatment is carried out, ointments with antibiotics are used.
Of the physiotherapeutic methods of treatment for dyshidrotic eczema, laser therapy and cryotherapy are used. The procedures of darsonvalization, ultraphonophoresis, magnetotherapy, general UVI are effective. To normalize the state of the nervous system and reduce itching with dyshidrotic eczema, acupuncture sessions, general soothing herbal and aromatic baths, electroson are prescribed.