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

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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.

 

19 COMMENTS

  1. 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!

    • 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.

  2. I used to suffer with severe hand eczema so I can completely understand the struggle! Over the years I have tried all types of creams, prescriptions and over the counter. Nothing has ever worked. I received the Made from Earth Pure Aloe Treatment on 1/2018 and I immediately put it on. I was pleasantly surprised at how it soothed my sore hands, even with this first application. On the second day I was shocked at how my hands felt and the pain wasn’t as bad, I can honestly say I saw a difference . It only gets better with each passing day. I have been using it now for 4 days and my hands haven’t looked or felt this good in a very long time!!!!! I just placed an order for 4 more jars.

  3. Very interesting to see this post and recognize what my partner had on his feet over 20 years ago. He treated it successfully with alcohol-based povidine iodine. Water-based iodine didn’t do it for him. He’s never had it since and is on a GF diet and taking 1g of fish oil. He eats a lot of salmon and sardines as well.

    • Sounds like his was a result of a fungal infection. When I was a child that is what we used for fungal skin infections. That together with the GF and fish oil, interesting to hear it went away.

  4. Hi there! Great source of information. I just want to share my experience (maybe it help someone).

    I have been suffering from the dyshidrosis since I was 12. It was still up-n-down and actually, when I was around 18 it went completely off with help of corticoids, antihistamines and potassium permanganate bath. Nevertheless, at age 18 I was called by the army health-check committee to be approved to “fullfill my citizen’s duty” (I am European and at that time it was compulsory and well I didn’t want to spent a year in a bootcamp). Well, to evade the service, I cut the medicament and voila , it flared up and I was considered unfit for the service! And the real struggle started (if I’d know…). I reapplied the treatment and it partially worked. No special diet needed and I had always corticoids and antihistamines with me wherever I moved. A decade later I moved to Asia for work and while I had no health insurance in the country to get the medicament, it went bad. Few years later on after a lot of complications (mostly social complications) I decide that this is not the way (yeah, I know that I should start to do something much sooner … consider it as the stupidity of the youth ). I went full sugar free/vegan/alcohol free for a month (not so tough if you drink a lot of water). It helped greatly, but the flare ups occasionally occurred again. I added cheese and fresh fish. No change. I was wondering, how come that the diet helps just partially. Then I read some articles on the topic and I spoke to few “alternative” guys. The missing part was SAUERKRAUT. I know it sounds so silly (it did to me), but after just a week of eating it every morning and evening I feel really huge improvement! So, now my diet looks like vegetarian food with at least one cheat day per a week, sauerkraut every morning and evening, as less sugar as possible (hard to track and I like beer, so a bit complicated), fruit at least 2x a day and all gluten free. I am in this regime for a week and I am very surprised how much it helps: no new flare ups, the old clusters are retreating and even the itching is more manageable! I am soooo grateful to the author of this article and the author of the reddit thread (in middle of the article)!

    (sorry for all spelling/grammar/vocabulary mistakes )

    • Thanks for sharing your experience – that is very interesting that sauerkraut helped. However probably not surprising as it seems that there is a link to gut integrity with dyshidrosis.

  5. I have been battling this for almost a year now…don’t know what to now..actually I don’t get the ” don’t eat this food stuff” I need help..it messing my palms and feet…

    • Have a look at what has helped other people. For me – a paleo diet without processed foods made all the difference. There are plenty of books and instructions on the internet for following this diet if you want to give it a go to see if it helps.

  6. I have pinpointed dairy products, mainly milk, sour cream, and ice-cream as the culprits. Hard cheeses and cooked dairy seem to be ok in small amounts. It was a pity I couldn’t wash dishes for a month while I had the most recent severe case!! LOL

  7. Dyshidrosis is on palms of hands and soles of feet, either/or. It starts as small, tiny, blisters that turn into cracks and fissures. It can be incredibly itchy.
    Dyshidrosis is the allergy to a dermatophyte in another part of the body.
    ‘The ID reaction’

    Here is the short version of my 21 years of my research.

    *** KNOWN CURES: 2nd version.

    If it is only on your hands and/or feet, that is Dyshidrosis, and that is totally curable.
    r/Dyshidrosis
    http://www.dyshidrosis.co.uk

    Please fill out my questionnaire, every case history in this orderly manner adds to my statistics and you receive a tailored diagnosis, absolutely free. Bear in mind I am Australian and medication names may be different.

    I have studied dyshidrosis since 1998.

    KNOWN cures: But you, and I (a retired podiatrist), are not allowed to call it a cure. Why? Because MDs have decided it is auto-immune and therefore it only goes into permanent remission.
    In reality Dyshidrosis is the allergic reaction to an occult (hidden) infection, known to all podiatrists as ‘the Id reaction’. But in Dyshidrosis, you can’t see the infection as it is usually internal in the gut or nostrils or vagina as a ‘yeast’ infection. (Podiatrists see it as the reaction to Athlete’s foot and fungal nails). Most common by far appears to be in the lower bowel infections of mycelial Candida species. Candida is a yeast that turns into a pathogenic fungi under the influence of hormones, the pill, pregnancy, oral steroids, too much alcohol/sugar or antibiotics.
    This is determined by the fact that Nystatin works so effectively. Nystatin is Candida species specific and in use since 1951.

    Dyshidrosis is NOT the fungal infection itself, but the allergic reaction, the body’s immune system response which produces histamine, to the fungal/yeast/dermatophyte infection. You need to treat the infection, not the dyshidrosis.

    TREATMENTS.
    Toctino by Baslea of Switzerland. A vitamin A sub strata called Alitretinoin RA cis 9. en.wikipedia.org/wiki/Alitretinoin
    Alitretinoin, or 9-cis-retinoic acid, is a form of vitamin A. It is also used in medicine as an antineoplastic (anti-cancer) agent developed by Ligand Pharmaceuticals. It is a first generation retinoid. Ligand gained Food and Drug Administration (FDA) approval for alitretinoin in February 1999. Given in 10mg, 20mg and 30mg….experimentally 40mg, for 28 or 48 or 90 days….doctors’ choice, according to body weight. Does it work? Yes. anything from 52 to 87% of the time. Side effects very dry skin. Cost: Aus $1,000 per month.
    Precautions: DO NOT GET PREGNANT.

    VITAMIN A: 5,000 iu per 10 kilos bodyweight.
    35,000 iu per day maximum. Needs to be eaten with fat food. Needs to be taken for 90 days. Needs a low carb high fat diet to be really effective. Does it work? Yes, about 80 to 87% of the time.
    Side effects: very dry skin.
    Precautions: DO NOT GET PREGNANT. Take a liver function test.
    Cost: Cheap. Fish oil derived is best. German is best.

    Nystatin: 2 million units oral per day for 28 days. Must be sugar free, in tablets or powder. Divided doses x 4 with food. Does it work? Yes, if combined with a very low carb diet. No statistics. Nystatin is Candida species specific and in use since 1951.
    Side effects: Diarrhea. It is removing the pathogens.
    Precautions: Only if you are allergic to it. One of the very few drugs you can take when pregnant.
    Cost: Cheap and over the counter in 3rd world countries.
    Impossible to get in the US. (Old medication). Powder from Fludan fine chemicals in Canada. On Ebay as Adiclair from German pharmancies. (In 500,000 unit tablets). Deemed a world essential drug by WHO.

    Itraconazole 200mg or 300mg if over 75 kilos person per day in 2 doses every 12 hours with food for 28 days.
    Does it work? Yes. No statistics. For some people in as little as 10 days. This is a broad spectrum anti fungal. For fungal toenails it is taken for 42 days.
    Side effects. Various but mild.
    Precautions: Bad for the liver. Uses the same enzymes as paracetamol and alcohol. Get a liver function test first. So a sugar free and alcohol free month is essential.
    Cost: Cheap and over the counter in 3rd and some 2nd world countries. Brazil sells it like candy in any pharmacia.

    If Nystatin and Itraconazole are taken concurrently, together, the remission rate is 87%.

    NOTE: ALL THE CURATIVE MEDICATIONS CAUSE ‘THE HERXHEIMER REACTION’ WHICH MEANS IT GETS WORSE FOR A FEW DAYS AFTER STARTING THE MEDICINES. THIS IS A SURE SIGN THAT THE MEDICATION IS WORKING. IT IS KILLING THE FUNGI/YEAST/DERMATOPHYTE AND THAT IS RELEASING THE TOXINS FROM THE PATHOGENS INTO THE BODY. THIS IS MORE ITCHY AND PAINFUL BUT LASTS ONLY A FEW DAYS AT MOST. SOME PEOPLE DON’T SUFFER IT AT ALL.
    ALSO CALLED A HEALING CRISIS. (Don’t be scared off by the Wikipedia entry, that level of severity does not happen with dermatophyte Herxheimer reactions.)

    DIET: Not really a cure. But Atkins, Keto, paleo and low, low carb all starve the pathogens and keep it at bay. Increases the effectiveness of all medications above exponentially.

    ALLEVIATION MEDICATION:
    Fexofenadine HC (Allegra) 180mg per day. More effective if taken as 60mg every 8 hours.
    It stops the histamine being released.
    Vinegar and water soaks: As acid neutralizes the alkaline nature of histamine.
    Hot water soaks: Cooks the proteins in histamine.
    These only work on the histamine already in the skin.

    STEROID CREAMS: Close the histamine receptors for a while. No healing and do nothing for the root cause.

    IMMUNE SYSTEM MODULATORS:
    Methotrexate
    Dupixent (A BIOLOGIC, the jury is out on long term use. Really should be labelled ‘experimental’).
    Prednisone
    Avoid. They lower the immune system response to the allergen. They leave you open to many other infections and cancers.
    IN effect the Immune system modulators and steroids act like anti-histamines, which may make you drowsy, but have few serious side effects. Everybody should try FEXOFENADINE for 5 days at least. Due to the cyclic nature of histamine release and breakdown, it does take a few days to ‘kick in’.

    For such cracks in the skin, you should smother the hand with NEUTRAGENA NORWEGIAN FORMULA hand cream which is glycerin base and hypoallergic, and cover with cotton gloves, cut open the tips to make hand use easier, if you do this every night, it really helps until the meds work.

    • Thanks for this info – interesting.
      I personally do not have any yeast / fungal issues (been tested and none present). The only time it flares is with some allergen in the environment in late spring – a pollen I suspect – which also affects my eyes and chest. Or when I travel and do not cook my own food.
      The vitamin A connection is useful to know.

      • I would be interested to know how you were tested?
        Since Candida is most common in the gut in the mycelial form, it is difficult to find if you have Candida yeast, which is harmless, or Candida as a fungi which is the problem. Your immune system is not going to read the difference either, so it cannnot attack something it sees as commensal.
        This seasonal flare is probably correct for you. But I would be interested to know the results should you decide to try either the vitamin A protocol or the anti-fungals as I have had half a dozen patients who declared their DH was seasonal or stress (stress is total BS in my humble opinion) or a food, when they did the protocol, it eliminated the problem. Remember you are on a paleo diet, which starves the pathogen in the gut. There has to be a gut connection if Keto, Paleo or Atkins works to alleviate your DH.
        If you fill out my questionnaire, I can diagnose much more precisely.

        • Organic acids urine test for metabolites of fungal origin. Also no pathogenic gut bacteria. How does the paleo diet starve the pathogen? I am not low carb. I eat a moderate intake mostly root vegetables and fruit. I also have a small amount of sugary gluten-free foods regularly. No issues there, and in increase in sugar does not trigger it.
          RE the seasonal allergies – we have a tree here that has prolific flowers in late spring and triggers asthma in many people. It is right next to our house and caused a lot of chest irritation for a few weeks and the eczema flared a little too. Since it has stopped flowering I’ve had no issues.

  8. You can add drinking oregano oils as a “cure” for N=2. I followed very closely the Reddit post you cite and cured my three years old severe plantar eczema. My observations are that probiotics made no difference and neither did alcohol abstinence. Otherwise, I switched to a light paleo diet (veggies above the ground are OK but no cereals and limited fruits) and just religiously took oregano oil every day.

    Took six months to largely eliminate massive blisters and skin cracking but the healing of the years-long damage and dissolution of finger-disfiguring fibroids took another year and a half. Still have a couple of stubborn spots fibroid-filled spots that occasionally start itching but it’s nothing like the actual eczema I had and even these flares are very infrequent.

    I am very skeptical about the Candida explanation but at the same time absolutely convinced that oregano oil made all the difference (simply because I have tried just about everything else before that).

    • Thanks for sharing your success. Oregano oil is anti-fungal and anti-bacterial, so it is possible it killed off a pathogen that was contributing to your eczema.

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