How to get a (pompholyx) dyshidrotic eczema treatment cream?

Table of Content:
What is dyshidrotic eczema? | Do you need a prescription? | How to get a prescription? | Best treatment creams for dyshidrotic eczema | Over the counter creams for dyshidrotic eczema | Pills and injections for dyshidrotic eczema | About dyshidrotic eczema | FAQ

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What is dyshidrotic eczema?

Dyshidrotic eczema, also known as dyshidrosis or pompholyx, is a type of eczema that causes small, itchy blisters on the edges of the fingers, toes, palms of the hands, and soles of the feet. These blisters are often filled with fluid and can be quite uncomfortable.

Often, pompholyx shows a clear seasonal predominance in the warmer spring and summer months, so it has long been assumed to be related to a chronic sweating disorder with periods of flare-ups and remission.

However, with proper management, symptoms can be controlled and the frequency and severity of flare-ups can be reduced¹.

Do you need a prescription for dyshidrosis treatment creams?

Dr. Carolina Fernandez, board-certified dermatologist, says that if you have tried over the counter creams and ointments for your dyshidrotic eczema and they have not worked for you, it is advisable to have a consultation with a dermatologist to get a prescription-strength treatment cream. 

She also mentioned that consulting a dermatologist is important because there are associated pathologies such as distant infectious foci, among others, that it is important for the dermatologist to rule out.

How to get a prescription for a dyshidrotic eczema treatment cream?

You can have a photo-consultation vía Miiskin. First consultation is $59 and prescription renewal is $39. A board-dermatologist will evaluate your case and in less than 2 business days will provide you with a prescription.

What are the best treatment creams for dyshidrotic eczema?

Corticosteroid creams and ointments 

Topical corticosteroid creams are only used to control acute flare-ups of dyshidrotic eczema and reduce inflammation and itching quickly. Once the flare-up is under control, the frequency of application is usually reduced, and maintenance treatments are implemented to prevent recurrence.

These topical creams and ointments come in different strengths ranging from low to very high potency. Your online dermatologist will assess the severity of your condition and will prescribe a treatment cream that has the right strength for you.

Topical calcineurin inhibitors

Topical calcineurin inhibitors like tacrolimus (Protopic) and pimecrolimus (Elidel) do not contain steroids, making them suitable for long-term use without the risk of steroid-related side effects.

 These topical treatments reduce inflammation by inhibiting the activity of calcineurin, a protein involved in activating the immune response. This helps control the itching and redness associated with dyshidrotic eczema. Besides, calcineurin inhibitors do not cause skin thinning, making them a safer option for delicate skin areas.²

Potassium permanganate soak

Potassium permanganate, often used in the form of Permitabs, is sometimes employed in the treatment of dyshidrotic eczema. It works as an antiseptic and astringent, helping to dry out the blisters and reduce the risk of secondary infection. Patients typically dissolve Permitabs in water to create a dilute solution, which is then used for soaking the affected areas. This treatment can help alleviate symptoms and promote healing by reducing inflammation and preventing bacterial growth. However, it should only be used under the guidance of a dermatologist to ensure safety and effectiveness.³

Are there any over the counter creams for dyshidrotic eczema?

Yes, there are several over-the-counter (OTC) creams that can help manage the symptoms of mild dyshidrotic eczema. While these may not be as effective as prescription medications, they can provide relief, to some extent.

• Vaseline: Provides a barrier that locks in moisture and protects the skin.
• Thick creams: Products like CeraVe, Eucerin, Aquaphor, and Aveeno are effective at moisturizing and protecting the skin.
• Ointments: These are thicker than creams and can provide a longer-lasting barrier, for example, Aquaphor Healing Ointment⁴ 
• Dimethicone-based creams: These help form a barrier on the skin to protect it from irritants. Products like Cetaphil moisturizing cream contain dimethicone.
• Aloe vera gel: Known for its soothing properties, aloe vera can help reduce irritation.
• Calamine lotion: Provides soothing relief from itching.
• Oatmeal-based products: Aveeno offers a range of products containing colloidal oatmeal, which can help soothe and protect the skin.

Are there oral medications (pills) or injections for dyshidrotic eczema?

Oral antihistamines

You can use a wide variety of over the counter and prescription-strength antihistamines to control itching, especially if the itching is severe.⁵

Oral steroids

In severe cases, your dermatologist may prescribe short courses of oral corticosteroids to combat flare-ups.⁶

Immunosuppressants

In chronic and severe cases, your doctor may prescribe methotrexate tablets (Rheumatrex), mychophenolate tablets (CellCept) or dupilumab injections (Dupixent).⁷

Alitretinoin (Toctino) 

Alitretinoin (known commercially as Toctino) is an oral retinoid used for the treatment of severe chronic hand eczema (including pompholyx) 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.⁸

Intradermal Botox injections

Intradermal injection of onabotulinumtoxinA (Botox) has been explored as a treatment for dyshidrotic eczema, particularly for cases resistant to conventional therapies. This treatment involves injecting small amounts of Botox directly into the affected skin areas to reduce sweating, which can be a trigger for eczema flare-ups. By decreasing sweat production, Botox can help reduce moisture-related triggers and inflammation, potentially alleviating symptoms like itching and blistering. Studies have shown promising results, but this treatment should be administered by a qualified healthcare professional and is typically considered when other treatments have not been effective.⁹

About dyshidrotic eczema

Is dyshidrotic eczema the same as dyshidrosis?

Yes, dyshidrotic eczema and dyshidrosis refer to the same condition. Both terms describe a type of eczema characterized by the appearance of small, fluid-filled blisters on the palms of the hands, sides of the fingers, and soles of the feet.

What causes dyshidrosis?

Although the exact cause of dyshidrotic eczema is not fully understood, it is believed to be triggered by stress, allergies, moist hands and feet, and exposure to certain metals like nickel or cobalt. There also may be a genetic component to it, as it sometimes runs in families.¹⁰

How do I know if I have dyshidrotic eczema?

To determine if you have dyshidrosis (dyshidrotic eczema), you should look for the  symptoms that are characteristic from this condition. You should also consider seeking a professional diagnosis from a board-certified dermatologist via Miiskin.

What are the symptoms of dyshidrotic eczema?

Blisters

• Small, fluid-filled blisters appear on the edges of fingers, toes, palms, and soles.
• The blisters are typically very itchy and may cause a burning sensation.

Itching and pain

• Intense itching often precedes the appearance of blisters.
• The blisters can be painful, especially if they become large or burst.

Redness and swelling

• Affected areas may become red and swollen.
• Surrounding skin may appear inflamed.

Skin changes

• After the blisters dry up, the skin may become scaly, cracked, or peel off.
• The skin might also thicken and develop deep cracks, particularly on the hands and feet.¹¹

What triggers dyshidrotic eczema?

• Irritants: Contact with certain metals (like nickel or cobalt), chemicals or detergents
• Stress: High stress levels can exacerbate symptoms
• Allergies: Known food allergies, hay fever or other atopic conditions
• Lack of moisture: Frequent hand washing or exposure to water¹²

What else can you do to get rid of dyshidrosis?

• Apply wet compresses: Applying wet dressings can soothe the skin, reduce itching, and prevent scratching.
• Ultraviolet light therapy (PUVA): Exposure to ultraviolet light can help reduce symptoms, particularly in severe or chronic cases.
• Avoid triggers: Identifying and avoiding known triggers such as certain metals (nickel, cobalt), and prolonged exposure to water or irritants.
• Wear protective gloves: Wearing gloves when doing housework, gardening, or when in contact with potential irritants.
• Stress management: Techniques such as mindfulness, meditation, or other stress-relief practices can help since stress can trigger or worsen symptoms.
• Dietary changes: Identifying and eliminating food allergens or irritants from the diet.
• Good Skincare Routine: Establishing and maintaining a regular skincare routine to keep the skin moisturized and protected.
• Self-care practices: Keeping the affected areas dry, avoiding excessive washing, and using mild, fragrance-free soaps.
• Use moisturizer: Use a moisturizer after washing your hands to protect your hands from excessive dryness¹³

What should I avoid if I have dyshidrotic eczema?

Dr. Fernandez says that if you have dyshidrosis (dyshidrotic eczema), there are several things you should avoid to help manage the condition and prevent flare-ups.

Nickel and cobalt

• Avoid jewelry, coins, and other items that contain nickel or cobalt
• Limit consumption of foods high in nickel and cobalt, such as nuts, seeds, chocolate, and certain green leafy vegetables.¹⁴

Prolonged exposure to water

• Take short showers or baths
• Wear gloves when washing dishes or handling water frequently

Avoid extreme temperatures

• Avoid extreme heat or cold, which can trigger symptoms
• Keep your living environment at a comfortable temperature

Identify and avoid allergenic foods

• Identify and avoid food allergens that may trigger symptoms, such as dairy, eggs, gluten, nuts, and shellfish
• Reduce intake of foods high in nickel, such as chocolate, soy products, lentils, and canned foods
• Limit foods high in cobalt, such as fish, shellfish, and certain leafy greens

Use mild skin care products

• Avoid harsh soaps, detergents, and cleaning products
• Use mild, fragrance-free soaps and cleansers
• Avoid products with alcohol, fragrances, or other harsh chemicals
• Use gentle, moisturizing products formulated for sensitive skin

Avoid tobacco and limit alcohol

• Avoid smoking and limit alcohol consumption, as they can aggravate skin conditions.
• Specific clothing and accessories

Avoid synthetic fabrics or poorly ventilated shoes

• Avoid wearing non-breathable, synthetic fabrics that can trap sweat and irritate the skin
• Choose loose, breathable clothing made from natural fibers like cotton.
• Avoid wearing tight or poorly ventilated shoes that can cause sweating and friction on the feet

Frequently asked questions about dyshidrotic eczema

Is dyshidrotic eczema contagious?

Dr. Fernandez says that dyshidrotic eczema is not contagious. The condition involves “sympathetic reactions at a distance,” which means that inflammatory lesions can appear on parts of the skin that are similar in structure to the area of the infection. This often occurs in cases of athlete’s foot, where there is a significant inflammatory response. However, dyshidrotic eczema itself cannot be spread from person to person.

Is dyshidrotic eczema caused by stress?

Dr. Fernandez says that although stress is a significant trigger for dyshidrotic eczema, it is not the sole cause. This skin condition likely results from a combination of factors, including genetics, allergies, irritants, moisture, diet, infections, and seasonal changes. Stress can exacerbate symptoms by affecting the immune response, leading to the characteristic blisters and itching. To manage dyshidrotic eczema, it is important to reduce stress through techniques like meditation, yoga, and maintaining a healthy lifestyle. Additionally, addressing other triggers and working with a healthcare provider can help control and reduce flare-ups effectively.

Is dyshidrotic eczema dangerous?

Dr. Fernandez says that while uncomfortable and sometimes painful, dyshidrotic eczema is not considered dangerous. However, it can significantly impact quality of life due to its symptoms and potential complications such as:

• The blisters and cracked skin can become infected if bacteria enter through broken skin. Signs of infection include increased redness, warmth, pus, and swelling. In severe cases, an infection may require antibiotic treatment.
• Persistent itching and pain can interfere with daily activities, work, and sleep, leading to chronic discomfort and stress.
• Repeated flare-ups and scratching can lead to long-term skin changes, such as thickening (lichenification), scarring, or discoloration.

Can apple cider vinegar help with dyshidrosis?

Dr. Fernandez says that apple cider vinegar may offer some benefits for managing dyshidrotic eczema due to its antibacterial properties and ability to balance skin pH. However, it should be used with caution, always diluted, and not applied to open wounds. Consulting a healthcare provider before using vinegar treatments is recommended to ensure safety and effectiveness.

Can clotrimazole be used to treat dyshidrotic eczema?

Dr. Fernandez says that clotrimazole is not used for the treatment of dyshidrotic eczema, however, it can be used to treat secondary fungal infections that may occur alongside the condition. The proper diagnosis and consultation with a healthcare provider are essential to ensure the appropriate use of clotrimazole when you have dyshidrotic eczema.

Is there a permanent cure for dyshidrotic eczema?

Dr. Fernandez says that although dyshidrotic eczema is a chronic condition, many people find ways to manage their symptoms effectively and reduce the frequency and severity of flare-ups. Working closely with a dermatologist to develop a personalized treatment plan is crucial for managing the condition.

Does dyshidrotic eczema affect the hands or palms? 

Dyshidrotic eczema frequently affects the hands, leading to blisters, itching, redness, and sometimes pain. Effective management involves a combination of treatments, protective measures, and avoiding known triggers to reduce symptoms and prevent flare-ups.

Does dyshidrotic eczema affect the soles of the feet? 

Yes, dyshidrotic eczema can affect the feet, typically manifesting as small, fluid-filled blisters on the soles and sides of the toes. These blisters can be intensely itchy and sometimes painful, leading to redness, swelling, and subsequent skin peeling and cracking. Effective management includes using topical treatments, keeping the feet dry, avoiding irritants, and wearing breathable footwear to reduce symptoms and prevent flare-ups.

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