What Are The Complications Of Vesicular Hand/foot Dermatitis
Secondary bacterialinfection with Staphylococcus aureus and/or Streptococcus pyogenes is common in vesicular hand/foot dermatitis and results in pain, swelling, and pustules on the hands and/or feet.
When involving the distal finger adjacent or proximal to the nail fold, it can result in paronychia and nail dystrophy with irregular pitting and ridges.
Infected vesicular hand dermatitis
- Soothing emollient lotions and creams
- Potent antiperspirants applied to palms and soles at night
- Protective gloves should be worn for wet or dirty work
- Well-fitting footwear, with 2 pairs of socks to absorb sweat and reduce friction.
Contact with irritants such as water, detergents, and solvents must be avoided as much as possible and protective gloves worn to prevent irritant contact dermatitis.
- Note that cream cleansers are not antimicrobial soap and water or a sanitiser is needed for washing hands in order to destroy pathogens such as the SARS-CoV-2 virus responsible for COVID-19.
People with vesicular hand dermatitis found to be allergic to nickel must try to avoid touching nickel items.
Clinical Patterns Of Hand Eczema
There are different patterns of hand eczema which differ only clinically, not histologically. Several clinical variants of hand dermatitis have been described, including hyperkeratotic , frictional, nummular, atopic, pompholyx , and chronic vesicular hand dermatitis. Hybrids of these patterns exist and some experts do not agree on classifications.
Many published classifications involve a combination of etiological factors and morphological features . However, no single classification of hand eczema is satisfactory.
Causes And Risk Factors Of Dyshidrotic Eczema
As with other forms of eczema, we do not understand what causes it or why it affects some more than others, but there do appear to be genetics involved, as it is more common in some families, says Lio. Frequent hand-washing, sweaty hands and feet, and contact with irritants or chemicals are all the most common . We see it in many healthcare workers, as you can imagine.
According to the AAD, dyshidrotic eczema is more likely to occur if you:
- Have sweaty or moist hands
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What If Home Treatment Isnt Enough For Dyshidrosis
Sometimes doctors recommend prescription-strength creams, like clobetasol. These treatments can reduce pain and itching.
In more severe cases, skin care routines and medications like antihistamines are not enough to control symptoms. If other treatments do not work, your doctor may recommend further treatment options, including:
- Systemwide corticosteroids: Sometimes, topical corticosteroids are not enough to relieve symptoms. Your doctor may prescribe an oral or injectable corticosteroid, such as prednisone .
- System wide non-steroidal immune suppression: Long term use of oral steroids is not recommended. Medications such as methotrexate or mycophenolate mofetil may be used in treating chronic disease.
- Exposing your skin to UV light may improve symptoms. You may receive phototherapy treatments at your doctors office or at a hospital.
What Are The Treatments For Severe Pompholyx Eczema
For severe pompholyx eczema, a dermatology referral may be required for treatment and/or diagnosing contact allergy . Treatment may include a short course of oral immunosuppressant drugs. Alitretinoin is an oral treatment licensed for use in adults with severe chronic hand eczema that has not responded to treatment with potent topical steroids. Alitretinoin works by reducing the inflammation associated with eczema as well as damping down the response of the immune system. It is a capsule that is taken by mouth once a day with a meal for 12-24 weeks, depending on how the condition responds to the treatment.
Alitretinoin can only be prescribed by dermatologists or doctors with experience both in managing severe hand eczema and in the use of retinoids. The specialist will determine whether your hand eczema is severe by examining your hands and asking a series of questions about how the eczema affects your life. You will also need to be carefully monitored.
Retinoids are likely to cause severe birth defects if taken during pregnancy. This means that any woman with child-bearing potential must avoid becoming pregnant during treatment and for one month after stopping treatment for example, by using two effective methods of contraception. The drug can only be prescribed if a pregnancy test is negative. Regular pregnancy tests will be taken during treatment.
You should not breastfeed while taking alitretinoin and for a month after completing treatment.
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What Is Systemic Contact Dermatitis
Once I started digging into these scholarly papers, I kept going, because there were plenty that seemed relevant.
I read this paper over here called Diet and Dermatitis: Food Triggers, done in 2014 by the Journal of Clinical and Aesthetic Dermatology, and there seemed to be some correlation between certain people and certain foods, and eczema.
This is called Systemic Contact Dermatitis, where the ingestion of certain foods can cause dermatitis directly.
I found it very interesting, and it prompted me to also read an article from AAIR from 2018 called, Microbiome in the Gut-Skin Axis in Atopic Dermatitis, which talks about the relationship between the biology of your gut, and its relationship with eczema.
Its conclusion basically was promising in the sense that it indicated that there was a relationship between your gut and how dermatitis or eczema comes about, but more studies are needed. This is obviously a fairly new field at this time.
Another paper I looked at is called Late eczematous reactions to food in children with atopic dermatitis, and this article further explores the relationship between dermatitis and food, particularly in children.
Such terms that are mention include IgE, AD , APT , and DBPCFCs .
Integrative And Complementary Approaches
There are many natural moisturizers that can be soothing, such as sunflower seed oil and coconut oil, says Lio. He adds that soaking in diluted apple cider vinegar or black tea can help to dry blisters. For milder cases, these can be enough to get people through, but usually if things are more severe, we often need more powerful treatments.
Research into the bathing remedies he mentions have had mixed results on people with related types of eczema.
A study published in January 2019 in the Journal of Dermatological Treatment studied 22 German people with facial eczema who received treatment with gauze compresses soaked in black tea, followed by cold cream, for six days. Though small, the study suggests this remedy led to significant decreases in itchiness and other symptoms, the researchers write.
On the other hand, another small study published in September 2019 in Pediatric Dermatology found that soaking skin in diluted apple cider vinegar up to the forearms led to irritation in 73 percent of the treated participants with atopic dermatitis and did not improve the condition of the skin barrier.
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Practice Good Skin Care At Home
Its also helpful to practice good skin care at home. The more self-care measures you take, the better your skin may respond to treatment.
Avoid hot showers as they can dry out your skin. Take warm showers or baths instead. Apply lotion or body oil after showers, baths, and swimming.
Apply moisturizer to your skin at least twice a day. If you can prevent dryness, your skin may become less irritated and itchy.
What you apply to your skin can also worsen eczema. Avoid strong or harsh perfumes and soaps. Use a humidifier to keep your skin moist, and avoid any fabrics that cause a rash or itchiness.
If possible, avoid scratching your skin to prevent redness. To control itching, use an anti-itch cream along with a topical or oral steroid.
Will My Itp Treatment Change Over Time Will I Be On Treatment For The Rest Of My Life
Since adult ITP is generally a chronic disease, people living with the condition will often cycle through many different types of treatment throughout their lifetime.
Dr. Ivy Altomare is an associate professor of medicine at Duke University Medical Center. She has clinical expertise in a wide variety of hematological and oncological conditions and diagnoses and has been conducting clinical and health services research in the field of ITP for over a decade. She is the honored recipient of both the Junior Faculty and Senior Faculty Teaching awards at Duke University and has a special interest in medical education for both patients and physicians.
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How Will I Know If My Treatment Is Working Will It Require Testing
The goal of ITP treatment is to reduce the risk of serious and fatal bleeding by keeping platelet counts in a safe range. The lower the platelet count, the greater the risk of bleeding. However, other factors can influence your bleeding risk, such as your age, activity level, and other medications youre taking.
A complete blood count test is used to detect increased platelet counts and determine responses to treatment.
What Do The Ecz
Although dyshidrotic eczema involves limited areas of the body, it can have a big impact on patients, said Dr. Gil Yosipovitch, MD, professor and director of the Miami Itch Center at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Florida.
Unlike some forms of eczema, you dont usually cover it with clothes, so its visible to others. It can affect social interactions you may not want to shake hands, for example.
Its very common to see emotional stress induce or exacerbate this type of eczema, he added. A college student may be in the midst of exams, for example, and suddenly develop blistering at the fingertips.
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S Of Dyshidrotic Eczema On Hands And Feet
Before we get into how together we might heal our irritating eczema, let us first look at some images that have been identified as dyshidrotic eczema.
These images have been specifically labelled dyshidrotic eczema or pompholyx, and I want you to look at them, just so you can judge if this what you think you might have, versus other types of skin issues.
With these examples, notice the blistering, the infected appearance, and the discoloration all over the skin of these poor people. No one wants this condition, and, sadly, the causes of eczema are still a bit of a mystery, and so its that much harder to manage.
Quite often, dyshidrotic eczema can be found on the hands and feet, in the form of these itchy red and irritated blisters, which can be filled with puss or a clear liquid discharge.
Part of the problem with eczema is that it does get confused with lots of other skin conditions, which have similar symptoms and present themselves in a similar fashion.
What is additionally unfortunate is that often times, doctors dont properly identify eczema as eczema, and will treat you incorrectly for different problems.
Learning to identify what you have as eczema, and particularly dyshidrotic eczema, is part of the purpose of this post. In this way, it can be more effectively treated.
Ah yes, I can very much relate to many of these images myself, as I have had eczema nearly everywhere on my body by this point. Like, I mean everywhere.
How Do Dermatologists Treat Dyshidrotic Eczema
Your dermatologist will create a treatment plan for you to follow at home. This treatment plan will be tailored to your individual needs and may include the following:
Soaks and cool compresses: Medicated soaks and cool compresses can be very effective for drying blisters. You will apply these two to four times a day for 15 minutes at a time.
Corticosteroid that you apply to your skin: After each soak or cool compress, youll likely need to apply a medicated cream or ointment, such as a prescription corticosteroid. This helps to reduce the inflammation and clear the blisters.
Anti-itch medicine: An antihistamine pill or other anti-itch medicine can reduce your discomfort. Anything you can do to reduce scratching is helpful because scratching tends to worsen dyshidrotic eczema. One anti-itch medication that dermatologists frequently include in a treatment plan is pramoxine . Available as a cream or lotion, this medication helps to relieve itch and pain.
Moisturizer or a barrier repair cream: Dyshidrotic eczema can make your skin extremely dry. To reduce dryness and decrease flare-ups, your dermatologist will recommend a moisturizer or barrier repair cream.
Be sure to use the moisturizer or barrier repair cream that your dermatologist recommends
You want to apply it when your skin is still damp after every:
-
Bath
-
Shower
-
Handwashing
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Is There A Difference Between Eczema And Dermatitis
Although the terms dermatitis and eczema may overlap in how theyre used, specific types of skin conditions are better known by just one of the names. For example, many doctors use the terms atopic dermatitis and eczema interchangeably but wouldnt use the term contact dermatitis in place of eczema.
There are also a number of distinct types of eczema and dermatitis, and, to complicate matters, its possible to have more than one type at the same time.
While both eczema and dermatitis typically cause redness and itching, some types also cause blistering and peeling.
How Often Will I Have To Go To The Doctor For Testing How Important Is Ongoing Testing
An ongoing relationship with an experienced hematologist is critical for anyone with ITP. The frequency of testing will vary depending on if youre actively bleeding or your platelets are extremely low.
Once a new treatment is started, testing may be done daily or weekly. If platelets are in a safe range because of remission or due to active treatment , testing can be done monthly or every few months.
one report ). Its more common to achieve durable remission after effective treatment.
Some treatments are given for a defined duration in hopes of achieving a prolonged treatment-free period, each with varying response rates. This includes steroids, IVIG, mAbs, and splenectomy. Other treatments are continuously administered to maintain platelets in a safe range. This includes TPO-RAs, SYK inhibitors, and chronic immunosuppressants.
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How Long Does It Last
In many cases, pompholyx will clear up on its own within a few weeks. The treatments below may help relieve your symptoms in the meantime.
Sometimes pompholyx may just occur once and never come back, but it often comes and goes over several months or years. Any of the triggers mentioned above can cause it to flare up again.
Occasionally, pompholyx can be more continuous and difficult to treat.
What Is Dyshidrotic Eczema Symptoms Causes Diagnosis Treatment And Prevention
Dyshidrotic eczema is a type of dermatitis that affects the hands and feet. It is also known as dyshidrosis, dyshidrotic dermatitis, foot-and-hand eczema, pompholyx, and vesicular eczema, according to the American Academy of Dermatology Association .
It is characterized by tiny blisters or vesicles, usually between the digits, and it can be extremely itchy, says Peter Lio, MD, a dermatologist who is a clinical assistant professor in the department of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago, as well as a board member and scientific advisory committee member for the National Eczema Association . Certain triggers can also make it flare, such as contact with irritating chemicals like soaps or detergents or hand sanitizers, sweating, seasonal changes, and sometimes even just stress.
Other causes and triggers include allergic skin reactions, atopic dermatitis, fungal and bacterial infections, exposure to nickel or cobalt, and excessive exposure to water, according to Chesahna Kindred, MD, a dermatologist in Columbia, Maryland, who is an assistant professor at Howard University College of Medicine in Washington, DC.
Dyshidrotic eczema is also a side effect of intravenous immunoglobulin infusions , which are typically used to treat certain immune system diseases, according to the AAD. Exposure to cement is another risk factor.
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What Is A B Lymphocyte
This is a question I never knew I would be asking, or really cared to ask, but here I am. Since it seems important to the process which is giving me my extremely debilitating allergic reactions, I do wonderso I looked into it.
B lymphocytes, also called B cells, according to wikipedia, are a
type of white blood cell.They function in the humoral immunity component of the adaptive immune system by secreting antibodies. BCRs allow the B cell to bind to a specific antigen, against which it will initiate an antibody response.
Ok, then. For a non-science nerd, this is getting a bit nerdy.
Prevention Of Dyshidrotic Eczema
While you cant prevent dyshidrotic eczema, you can do a number of things to avoid or minimize flare-ups.
Avoid triggers, wear cotton-lined gloves when washing dishes and doing other wet work, and keep other skin diseases under control, counsels Kindred.
To this list, Lio adds: Wear lightweight clothing and avoid gloves, socks, and shoes that trap moisture and dont allow your skin to breathe.
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Treatments Your Physician May Prescribe
To manage dyshidrotic eczema, your physician may recommend soaks with drying agents if many blisters are present, as well as the removal of any potential irritating agents.
- Medium- and high-potency topical steroids may be prescribed to be used twice daily. Use of a high-potency topical steroid initially that is tapered to an as-needed basis may be most beneficial.
- An oral steroid can very effective and fast in controlling symptoms, but treatment with oral steroids is often less desirable, as tapering off the medication can result in severe flares of the disease.
- Chronic, severe disease can be treated with a form of ultraviolet light therapy called PUVA or narrow-band UVB phototherapy administered by a dermatologist.