Lawrence. C. Parish, MD
Q: Our teenage daughter has water blisters on her hands. We thought she had "ring worm" and treated her with anti-fungal cream, but it didn't help. The itching is driving her crazy and she's finds the blisters embarrassing.
A: She has dyshidrosis, also called pompholyx or dyshidrotic dermatitis. It's an abnormality of the sweat glands of the palms and soles. There is a malfunctioning of these sweat glands that leads to the formation of water blisters (vesicles) on the palms and soles. Oftentimes, excessive sweating (hyperhidrosis) is associated with dyshidrosis, but it's a separate condition.
Dyshidrosis can be also occur with eczema (atopic dermatitis) and may be made worse if the child also has contact dermatitis. Dyshidrosis, usually found on the sides of the fingers, is thought of as a summertime problem, but it can smolder in the winter due to dryness in the air.
Because the skin is thicker in the palms and soles, the vesicles may be deeper rather than just on the surface. When these blisters rupture, collarettes (scaling) result. Oozing and weeping can also accompany dyshidrosis.
The blisters of dyshidrosis are easily confused with fungal infections of the hands and feet. Fungal infections, also called dermatophyte infections, are redder and look more inflamed. Contact dermatitis and even psoriasis are other possible diagnoses that may be confused with dyshidrosis.
Cortisone-like creams and the new topical immunomodulators such as Elidel are recommended treatment. If there is a secondary bacterial infection, oral antimicrobial agents might be prescribed. For the oozing, a solution made by mixing one packet of Burow's solution (1:40), available in drugstores, in a pint of water may be used. Soak gauze pads in the mixture and then use the compresses three times a day. Using ice water to dilute the powder is another way of relieving the itching
Remember that dyshidrosis waxes and wanes. It may be troublesome for several months, only to disappear or flare up once again. It's not an infectious disease, is not a serious problem, and doesn't lead to any scarring. If home treatment doesn't work, then your daughter should see her doctor or a dermatologist.
Lawrence Charles Parish, M.D., is a clinical professor of Dermatology and Cutaneous Biology and director of the Jefferson Center for International Dermatology, Jefferson Medical College, Philadelphia, PA. Please send your questions and comments to him care of Pediatrics for Parents, P.O. Box 63716, Philadelphia, PA 19147.
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