What is Dyshidrosis
Dyshidrosis also known as acute vesiculobullous hand eczema, cheiropompholyx, dyshidrotic eczema, pompholyx, and podopompholyx is a skin condition that is characterized by small blisters on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic, clear vesicles; scaling, fissures. Recurrence is common and for many can be chronic. (wiki Dyshidrosis) Clear blisters filled with fluid are very small. Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances. Nails on affected fingers, or toes, may take on a pitted appearance.
Causes of dyshidrosis are unknown but some allergens may trigger. People allergic to dust-mites or nickel or anything else have problems with this type of eczema. From my own expirience with this eczema I am convinced this problem is multi-level combination of contact deramtitis, allergy on some naturally occuring microorganisms living on the skin, food allergy/intollerance and very long term exposure to blue light at night/evening (typically one to several years) which impairs immune system functionality. See Prevention
Dyshidrosis is located on hands or feet only. Hands are washed with soap (with high pH >7) several times a day. Any detergent reduces natural acid enviroment of human skin (pH 4.5-6.2) and removes protective fatty acids in epidermis (i.e. ceramides), feet with shoes is humid and warm environment ideal for cultivation of fungi, mold, bacteria and yeast. As described below strong acid environment (pH<3) reduces size and dry-out the vesicles (small blisters).
My case of recurrent/chronic dyshidrosis
I'm approximatelly 30 years old man. I had all my life mild problems with eczema on hands (only dryness and thin skin). During childhood contact with clay and loan was quit problematic due to skin dryness. I lived at home also with a cat from approximately my 10years. I observed approximately in 20 that I have quite severe allergy to cats. I strongly avoid direct contact with cats (fur, spit). I do not have cat in my flat.
After some years I had severe triggers of dyshidrosis. My mom suffer with the same problem with dyshidrosis and mild atopic eczema too. Effective was soaking in vinegar, I tried also citrus juice. That was "mistake". I recognized that citrus or lime can treat vesicles but it also triggerd reaction. I observed that I have some mild allergy to citrus or lime because juice triggers the dyshidrosis. When consumed I do not have any severe symptoms in mouth, only very mild pain in stomach and few occasionally itchy pimples on upper lip. The same case when eating raw uncooked older carrot (this can be due to naturally occuring plant preservative Falcarinol (carotatoxin)). This is not the case for new fresh carrots which are sweet, toxic falcarinol causes bitterness of an older carrot. We can talk about intollerance because reaction is far away from strong allergy response and was simply overlooked especially if I eat some food with juice. I also observed that I'm sensitive to honey what causes very mild reaction as shortness of breath. My father had severe allergy to pollen and this might be linked with honey that contains some pollen particles and proteins. Actually I do not have pollen allergy during spring. All mild allergic reactions to citrus, lime, honey and raw uncooked carrots are so mild that can be simply overlooked but it looks that it can be food related trigger of dyshidrosis, especially if skin is in direct contact. Please realize that you might suffer with different types of food intollerance or an allergy and you must observe it.
During strong triggers I had to use medication H1-antihistamines (Cetirizine) and mast cell stabilizer (Ketotifen). This was the only help.
I also tried if I have any nickel related allergy but it is not still proven. I observed that I had severe triggers after changing my diet with lot of sauerkraut, any type of moldy cheese or lot of beer. All these foods contains very high levels of histamine. Histamine is normally digest in stomach but some people have limited capacity of degradation histamine from food (histamine intollerance). Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema.
Try to think about link with mild allergies on honey and citrus in stomach and gut. It can answer on histamine degradation capacity. Allergen in gut triggers histamine release and inflammation and simply any inflammation in gut reduces ability to digest anything. So when I eat allergen with high histamine food, histamine is not fully decomposed and elevated levels in blood can affect any allergic response. Please note that histamine is the same molecule that triggers inflamation when mast cell release histamine (triggerd by IgE from lymphatic plasma cell).
I have some evidence that dyshidrosis is also linked to psychological stress. As you can see this is not simple to understand all of these things. I think that it's very interesting that adrenaline hormone is very useful in treatment of anaphylaxis (strong allergic reaction). Adrenaline is released in life-threatening conditions to preapare body to fight. And our cultre developed society where this condition rarely occurs;-).
Treatment of Acute Dyshidrosis
First of all, even if you observe small number of vesicles (acute dyshidrosis), you sould take an action to protect your skin as much as possible from severe damage. Untreated vesicles tends to multiple in time and damage with inflamation large area of skin.
Treatment with soaking hands and feet in distilled vinegar. Distilled vinegar sold on a market is typically 8% acid and you must dillute 1 portion of 8% vinegar to 3-4 portion of water. 10 minutes of soaking is OK. Make this procedure three or four times a day. Everytime you use soap to wash hands, use some vinegar to keep your skin acid. Do not use any other vinegar like balsamic, apple, cane... because they contain unknown substances that can irritate your skin further. We are playing with allergy!
After soaking in vinegar, clean hands with lukewarm water and dry hands with clean towel. You can use some powder (like hydrated magnesium silicate with coloid sulphur) which helps dry-out the vesicles and reduces itching.
Very useful is topical antihistamine Fenistil Gel (dimetindeni maleas) This topical antihistamine can be used instead of vinegar. For faster cure you can use some type of topical corticosteroid but be careful and use this only limited time (max 10days)!
My preffered barrier cream is LA ROCHE CICAPLAST BAUME B5 for hands as prevention of erruptions. You can try Dermalex irritation or Dermalex Repair which helps to recover ceramides in skin. After that use some barrier cream with lanoline. Be careful about lot of vazeline or oily creams, it can worsen acute dyshidrosis.
If area of blisters is more than 1cm2 or first aid with vinegar or topical antihistamine does not help within one or two days, use H1-antihistamine (e.g. Cetirizine 10mg-20mg/day for adult traded as Zyrtec, Ziretc, Zodac etc.). Now my preffered is long-lasting oral-form Fenistil 24, this is the same antihistamine (dimetindeni maleas). There are some new 3rd generation antihistamine like Fexofenadine with much lower sleepiness effect. Maybe available only on prescription. You should use antihistamine several days with vinegar soaking. Avoid any contact with irritating substances like detergents, isopropyl alcohol etc. Swimming pool is not recommended also.
If H1-antihistamine and vinegar does not help within 3 days (erruption stopped, no itching, vesicles reduces volume sometime with brownish colouring), go to your doctor and ask for mast cell stabilizer like Ketotifen. It is a second-generation noncompetitive H1-antihistamine and mast cell stabilizer that has longer time effect on allergy. This is used also for asthma. Your doctor should help you. In severe cases you can use topical steroids (traded as Hydrocortisone) but it is not suitable long-term due thinning the skin and if antihistamine and vinegar can help hydrocortisone is simply an overkill.
Proven Alternative and Prevention of Dyshidrosis
Back to the roots: 100 years back. Edison incandescent lighting was right. Avoid working overnight, clubbing or watching screen with lot of blue: white, cyan and pink coulors is strong risk factor of this type of allergy in means of Red-Green-Blue colour mixing. Blue light blocks hormone melatonine produced after natural sunset. This hormone modulates our immune system: T-Lymphocytes Th17 and Treg (scientific magazine Vesmír 1/2016).
Just relax, enjoy free time, listen to music during evening. Use incandescent dimmed bulbs (avoid cold LEDs and fluorescent energy saving bulbs - they produce lot of blue light). Do not watch lot of TVs, iPads, computer screen. This efficiently reduces allergic reaction, during flarup suppress reaction with antihistamine, this is ok. We have to chagne our lifestyle if we want to remove dyshidrosis definitely. Be very, very patient. After changing lifestyle it takes several month when you will see changes in your skin. Melatonin produced after sunset changes gene expression and this takes lot of time to manifest changes in skin epithelium. But it really works!
Your circadian cycle will synchronize after approximatelly 2 month (you will feel sleepy within one hour after sunset, and you will wakeup on sunrise). You will probably notice reduction of flareups within 4 month, after 8 month alergic reaction will be 10 times reduced. This is based on my experimental experience with strong reduction of blue at night: First I avoid watching computer/TV screen after sunset. If any artificial light, I use dimmed incandescent bulbs (7-25W nominal) at about 1700K (approx. half of power). No LED, no fluorescent, nowhere in flat. Instead of sitting and watching, and watching,.... you will listen to music/radio, some stretching/excercise, some massage/sex/cuddling with partner etc. Removing blue from night is not only about light, but also about different behaviour. Indefinitely you cannot work or read in such weak light conditions.
Important is darkness during sleeping. If you have a lot of bright white light from public lighting, and neons, use black curtains. Avoid any light during night.
Obviously during day go outdoor where is lot of blue light or use cold LEDs/fluorescent in office, this helps serotonine production for a good mood because avoiding light during day is risk factor for depression. UVB light from sun produces D3-vitamin that also modulates our immune system. We need blue and little UVB, but only during day-light: 12 hours light, 12 hours darkness.
See LightsOut movie to understand that melatonine is not only about allergy:
I also used one moth natural medication sylimarin for boosting liver fucntion. (Silybum marianum). But this is not necessary. Liver process endotoxins from colon produced by bacteria. Young babies might suffer of eczema with bad composition bacterial colonies in colon.
There is also small possibility that eczematic skin is vulnerable to some microorganisms (yeast, fungi etc.) and they can trigger allergic reaction also. So I preffer to use a vinegar soaking occasionally say 2-3x per week on both hand and feet. Maybe you can use that on whole body with lower concentration, also on head and hair to reduce yeast and fungi cultivation and keep pH of your skin low at pH 4.5-6.2. Vinegar soaking of feet also reduces typical smell of feet.
Use protective gloves when you are in contact with any detergents, degreasers, alcohol or benzine/petrol based degreasers. Use time to time the Dermalex that recover ceramides in skin but it is quite expensive and it is not water resistant like low-cost creams with wax and lanoline. When you have no flare up it might be sufficent and cost effective protection.
Prevention of contact dermatitis
There are several natural irritants found in food. These can trigger acute dyshidrosis:
- Psoralen (or other furanocoumarins) - found in common fig, celery, parsley, all citrus fruits and triggers photodermatitis
- Falcarinol - found in carrot and celery (all Apiaceae family) and ivy
Potential irritants found in clothes.
- Chromium allergy: Leather contains chromium salts
- Nickel allergy: all rings, chainlets made from stainless steel
- Latex (latex gloves)
Use protective gloves when you are in contact with any detergents, degreasers, alcohol or benzine/petrol based degreasers. Use protective gloves when you work in the garden especially when manipulating the ivy if carrot triggers allergy. Use time to time the Dermalex that recover ceramides in skin but it is quite expensive and it is not water resistant like low-cost creams with wax and lanoline. When you have no flare up it might be sufficent and cost effective protection.
Prevention - low histamine diet
In case of histamine sensitivity avoid in descening order: sauerkraut juice, stale fish, soy fermented products (Miso, nonsynthetic soy sauce, Tempeh,...), sauerkraut, sea fish (esp. ), older cheeses like blue cheese, products containing yeast, vine, beer, federweisser.
Histamine is produced by yeast and fungi. List of fermented food is here.
I strongly suggest all people with ANY allergy to reduce consumption of high histamine food if you eat every day anything listed above. There is a direct link with mast cell signalling moleculle and your defficent digestive system could drain some histamine into blood. Maybe only reduction in consumption will help. Actually person with eczema never undergo the anaphylaxis due to histamine sensitivity but elevated levels in blood can trigger or worsen allergic reaction.
Read: Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema (AE). (CONCLUSION: Higher histamine plasma levels combined with a reduced histamine degradation capacity might influence the clinical course of a subgroup of patients with AE.)
Prevention - low nickel diet in case of nickel allergy
In case of nickel sensitivity avoid in descening order: chocolate, spinach, canned food, lof of legumes, lot of whole-cereals. Some people propose avoid cooking acid food in stainless steel pot. Stainless steel (austenite steel 304) is made from of ferrum, chromium 18% and nickel 8%. Traces of molybdenum and tungsten is probable.
Try to be realistic and not sadistic to yourself. Maybe only reduction in consumption will help and you will have to remove few things like chocolate, spinach, canned fruits which are acid and etch can surface.