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I am a New Zealand registered nurse and nutritionist (Grad Cert Sci: nutrition, Massey Univ). I am a Certified Zone Instructor, and have worked teaching Zone diet principles to hundreds of clients over the last 10 years. More recently after finding that eating Paleo food choices was the "icing on the cake" health wise, I have become a Paleo enthusiast and teacher. Follow me on twitter @juliannejtaylor

Itchy fluid filled blisters – hands and feet or dyshidrotic eczema, pompholyx, what may get rid of it

Dyshidrotic eczema or Pompholyx is a form of eczema that occurs on hands and feet. It can also be called

  • Cheiropompholyx
  • Dyshidrosis
  • Foot-and-hand eczema
  • Pompholyx
  • Vesicular eczema
  • Palmoplantar eczema

This is a fairly common form of eczema that causes small, intensely itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. The blisters are tiny and filled with fluid. They typically last 2 – 4 weeks, and as they resolve the skin can crack and peel.  It is is twice as common in women as it is in men. The cause is unknown, however stress appears to exacerbate it, and those who are prone to seasonal allergies and asthma are more likely to have it. Dyshidrosis often flares in spring or early summer, which means it is likely to have a component of allergic reaction. Dermnet New Zealand has an extensive article on this eczema and conventional treatments here: Pompholyx Dermnet NZ

Here are some images from Dermnet

And from: National eczema association

I have dyshidrotic eczema, and in one of the Facebook groups I belong to for Hashimotos – auto-immune thyroid disease,  there are many who also complain of it.

I found this interesting – is it more common in people who have Hashimotos, or other auto-immune diseases? I could not find studies linking these – possibly not done.

Other things that can aggravate dyshidrosis:

Allergic reaction to metals or contact with metals like cobalt and nickel; a low cobalt, nickel and chromate diet has been shown to help: Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema  and Low-cobalt diet for dyshidrotic eczema patients

Dyshidrosislike eczematous eruptions with the use of intravenous immunoglobulin (IVIG) infusions have been reported.

Hyperhydrosis- excessive sweating appears to play a role.

Fungal infections may be a cause and should be ruled out, if so treatment with an anti-fungal will resolve this. It is of note that fungal foot infections can cause dyshidrosis on both hands and feet.

In this study, causes were looked at for 120 patients – there was a definite link for contact with certain everyday products “As a whole, contact pompholyx cases were broken down into hygiene product intolerance (46.7%), metal allergy (25.0%), and reaction to various other allergens, such as rubber, formaldehyde, lanolin, PPD, and balsam of Peru (28.3%). Hygiene product allergy was related 10 times to a fragrance allergy and 4 times to a balsam of Peru allergy” A 3-Year Causative Study of Pompholyx in 120 Patients There are few connections noted with foods, only 4 people in the above study had food reactions.

Can you get rid of dyshidrotic eczema?

There are no clinical studies that I found for successful treatments to resolve dyshidrosis. Steroid creams can calm it, removing nickel and other metals from the diet helps some, fungal treatments help some. Avoiding contact with aggravating products help.

Okay – back to me, and how I got rid of my dishydrosis (also links to others who successfully got rid of it)!

I had dyshidrosis, however it stays away now, and the only time I get a flare is when I eat out and eat certain foods or additives. I discovered the connection by following the paleo diet. When I took gluten, dairy and processed foods out of my diet the eczema cleared up. When I also eat an anti-inflammatory diet that provides plenty of fibre for gut bacteria, it also helps. Fish oil seems to help as well, as does optimising vitamin D levels. All the same components that resolved my auto-immune joint inflammation.

One other factor that appears to trigger my eczema is carrageenan an emulsifier found in numerous foods. I discovered the connection when I changed brands of coconut cream. Carrageenan is shown to cause gastrointestinal inflammation in animal studies.  In fact carrageenan is used to cause inflammation in animals.

Ingredients – Kara Coconut cream

Fresh natural coconut cream (99.9%), Stabilizers (Xanthan Gum E415, Guar Gum E412, Carrageenan E407).

I typically react within 1 -2 days of eating a food that triggers my eczema. Sure enough my hands were covered in patches of tiny itchy blisters within 2 days of consuming just a small amount of Kara in my coffee. On switching back to an emulsifier free brand the eczema cleared up.

As long as I eat my usual diet of cook from scratch paleo food, I am free of eczema. When I eat out – even being careful – I usually end up getting small patches, as you can see in this photo, and the skin peeling is a result of earlier patches. It is likely additives or gluten contamination, but as it is rarely any worse than this, I’m not too worried. I’ve been away on holiday for 10 days recently with lots of meals out.

While researching for this post – I came across some anecdotal (N=1) success stories. With no research showing dietary effects of removing foods, I think it is useful to include these, and view them as self reported case studies. It is clear we need studies to test whether or not diets that remove trigger foods are effective.

From this thread: “The biggest help I found was going gluten free. (Accidental discovery after going gf for other reasons.) It took a couple months to heal up, comes back if I eat gluten.”

A really great case study/ anecdote from Reddit: My Severe Dyshidrotic Eczema Journey, and What Finally Worked (read the whole story – here is an exerpt)

“There is evidence that dyshidrotic eczema may be a food allergy and/or indicative of an extreme candida overgrowth in the gut. It’s possible that some candida overgrowth can be triggered by fungus picked up in the environment, which is what I believe happened to me, as I’d never had this issue before. The fungus is commonly called a dermaphyte. You can’t, and shouldn’t, try to get rid of candida entirely, as everyone needs it in their digestive tract. However, an overgrowth in certain individuals can manifest in forms of severe eczema. Diet changes and supplements can curb or eradicate the problem in certain individuals. I just prayed that I was one of those individuals.

What Finally Worked

Diet Changes: For three months thus far, I have completely cut out wheat, refined sugars, alcohol and switched to a low-carb, whole food diet (with the majority of my carbs coming from root veggies). This is hard as shit for someone like me, but stuff like refined sugars, carbs (which turn into sugars) and alcohol can feed the candida overgrowth. Wheat, in some individuals, can also contribute to the problem. I have recently started to re-introduce alcohol (because life ain’t worth living without beer every now and then) to no ill effect thus far. You must do the diet for at least 3 months before starting to slowly add foods back into your diet (unless you’re a dummy like me who needs a beer sometimes), to see if one of them triggers a breakout.

Supplements: I started taking strong probiotics twice a day (once in the morning, once in the evening). I also started using oil of oregano. Twice a day, I dilute 6-7 drops of oil of oregano in a glass of water (oil of oregano burns like hell, you MUST dilute it) and drink it, and then dilute 4-5 drops in olive oil and apply it to my hands and feet.

Die-Off Symptoms: I did have candida die-off symptoms, though they were not as bad as I’d prepared myself for. I had a few rashes, a few bouts with the porcelain goddess, and a few days when I felt fuzzy and tired, but that all quickly passed.

About two weeks after starting this regiment, my blisters started disappearing. I dropped down to 20mg of Predinose, and then quickly down to 10mg of Prednisone a day (that withdrawal was NOT fun). I also dropped down to 1g of mycophenolate a day, since I couldn’t take the damn stomach cramps anymore.

After a month, I woke up to my first day with NO new blisters in two years. I dropped down to 5mg of Prednisone at the behest of my dermatologist. I switched to taking mycophenolate every other day instead of every day. Each time I dropped the dosage of one of my meds, I would have a small outbreak of blisters on my hands, but nothing close to what it had been. The blisters were smaller and healed much faster than they had been.”

Further responses to the post above

“I also found a change in diet is absolutely the way to go! Now I get very minor flare-ups and only occasionally. I know the eczema is triggered when I eat shit (chocolate and other sugary foods, or any heavily processed foods, really). I’ve been off soft drinks (fizzy drinks) since December 2013.

It really annoys me that the doctors I saw were all about pumping me with pills, as a medium/long term solution. Never once did they discuss my diet with me or provide me with a more holistic approach.”

And another response:

“Dude I just want to say thank you from the bottom of my heart for this post. TLDR – I started taking probiotics, spirulina and oil of oregano three days ago, and there has been a MASSIVE improvement in my skin.”

This is another Reddit series of posts that have successful suggestions Dyshidrotic eczema healing successful

A success story from the UK outlined on this blog http://www.dyshidrosis.co.uk/

This person believed that the cause was candida, or another fungal infection, and used systemic antifungal treatment as well as diet changes:

“Dyshidrosis is best described as an overreaction by the individual’s immune system to a normally harmless dermatophyte, that is taking advantage of the hormonal disturbance to change into something seen as more threatening by the body’s normal immune response.”

DIET: Doing the Atkins diet or Paleo or any ketogenic diet, and taking probiotics is recommended by many sufferers. This is unproven, but I started to notice a great improvement in my own Dyshidrosis in 2000 when I was on the Atkins diet. Candida loves candy and all sugars and carbs…….”

So just to outline all the main points from various papers and N=1

Suggestions on dealing with dyshidrotic eczema

(Note – these are suggestions that may work, as with any change in diet or supplements – medical advice is recommended)

  • Treat any fungal infections, skin, gut, systemic etc
  • Change your diet:
    • Remove gut irritants that increase inflammation – like gluten grains, dairy and possibly legumes, emulisfiers and alcohol
    • Remove all sugars, and highly processed starches (which turn rapidly into glucose)
    • Remove foods containing additives – these affect gut bacteria and contribute to dysbiosis and gut inflammation – emulsifiers especially carrageenan
    • Remove all ultra-processed foods – a combination of refined starch, sugar, seed oils and potentially problematic additives
    • Diets that remove these foods include paleo or low carbohydrate diets
    • Consider an auto-immune paleo diet – use it as an elimination – re-introduction diet to test responses to foods.
    • Write a food diary to see if you can pinpoint reactions to foods, note that it may take 1 – 3 days for the reaction response
    • Eat a high nutrient diet, that has anti-inflammatory foods – seafood for omega 3, plant foods high in polyphenols, choose healthy fats like avocado and olive oil
    • Cook foods from scratch using fresh ingredients with no additives or human interference
  • Consider adding probiotic foods or probiotic supplement
  • Fish oil is anti-inflammatory (I find this useful) Check the quality – many are oxidised. I use OmegaRx2 from Zone Labs
  • Optimise your vitamin D levels 80 – 120 nmol/L
  • Test for seasonal or other allergens if you suspect these might be a problem for you (skin prick testing)
  • Consider removing foods high in nickel and other metals like cobalt
  • Remove all products that may cause contact reactions – consider your make-up, cleaners, household chemicals, clothes detergents/powders (especially ones with enzymes), soaps, shampoos, perfumes etc. Use none or low allergen types.

 

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3 Responses to “Itchy fluid filled blisters – hands and feet or dyshidrotic eczema, pompholyx, what may get rid of it”

  1. I actually get this! Just randomly. Glad to know it has a name…

    October 18, 2017 at 5:56 pm Reply
  2. Jim Jozwiak #

    I think the first reaction to dyshidrotic eczema should be “I am hyperinsulinemic.” And remember that even eating low-carb, you can have hepatic insulin resistance!

    October 30, 2017 at 6:47 pm Reply
    • Jim, I’m not quite sure what insulin resistance has to do with it. I personally am not insulin resistant and only get it when eating certain foods and additives. I eat lower carb most of the time, and it is not related to the amount of carbohydrates I eat at all.

      October 30, 2017 at 6:56 pm Reply

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