Acute palmoplantar eczema (more popularly known as dyshidrotic eczema) has an intense itch, small to large bubbles under the skin affecting the palms, soles, or both [1,2]. It is characterized by deep-seated lesions. Recurrence is common and patients typically experience frequent episodes for months or years. It occurs in younger individuals with equal distribution in men and women. This condition will resolve on its own, however, there is a strong association to contact dermatitis that increases with age.
Why do I mention this now? There is a significant association with allergies. Here in Lubbock, the first freeze and defoliation result in the startup of the cotton gin. This is a significant source of both intrinsic and extrinsic allergies.
First line treatment is avoidance of irritants or exacerbating factors is beneficial for most patients with dyshidrotic eczema. General skin care measures aimed at reducing skin irritation and restoring the skin barrier include:
- Using lukewarm water and soap-free cleansers to wash hands.
- Drying hands thoroughly after washing.
- Applying emollients (eg, petroleum jelly) immediately after hand drying and as often as possible.
- Wearing cotton gloves under vinyl or other nonlatex gloves when performing wet work. Powder free gloves may be of use as well.
- Removing rings and watches and bracelets before wet work.
- Wearing protective gloves in cold weather.
- Wearing task-specific gloves for frictional exposures (eg, gardening, carpentry).
- Avoiding exposure to irritants (eg, detergents, solvents, hair lotions or dyes, acidic foods [eg, citrus fruit]). It has been noted in other literature that antibacterial gels can be a common trigger. It is the preservative used or the fragrance.
Elta MD has a non-inflammatory Body Lotion or Body Moisturizer that is a good first line treatment. Topical steroids and allergy control are second and available by your doctor. This condition is commonly mistaken for other infections or inflammatory conditions. This problem should improve with the above measures but can also recur.