Dyshidrotic eczema often starts as an acute onset of itchy small blisters on the surfaces of palms, fingers, soles and toes. Usually, it is self-limiting and thus may not need any treatment. The symptoms can be managed accordingly. The disease is also known as vesicular eczema, palmoplantar eczema, foot and hand eczema, pompholyx, and dyshidrosis. A child with dyshidrosis may overcome this condition as he/she becomes an adult.
Signs and symptoms
Itching, burning sensation and small-sized blisters, red discolouration, skin cracks, excessive sweating over palms, fingers, soles & toes and thick nails are the common signs. Generally, these difficulties disappear after 2 or 3 weeks. In serious cases, there may be discomfort in holding things, walking, or even touching the water.
Causes
Though the real cause of dyshidrosis is unknown, persons with family history of this condition often suffer from this. Health conditions like allergy, eczema, increased sweating of palms and soles, infections or stress may be a cause. Contact with metals such as nickel, cobalt etc is another reason. Females and persons between 20-40 years of age are at higher risk.
Diagnosis
This condition can be diagnosed clinically. A patch test can confirm any allergy to metals. There is no specific lab tests to diagnose dyshidrosis.
Complications
The main complication is infection of the blisters due to increased itching.
Treatment
For healing the blisters, steroids ointments can be applied. Severe dyshidrosis can be treated with antihistamines, steroids, immunosuppressant drugs, botulinum injection. Sometimes, drainage of blisters may be needed. Ultraviolet light therapy and wet compress over the blisters are also helpful. Frequently wash the hands and soles with lukewarm water and mild soaps. Keep the palms and soles properly dried. Applying moisturizers can prevent drying of skin. Use gloves whenever touches water. Do not scratch the blisters. People with any kind of allergy should stay away from allergens. Those who are allergic to metals like cobalt, nickel etc should adopt appropriate protective measures. Avoid the food items that contain these metals (eg: chocolates, nuts, shellfish etc).
Ayurvedic concept
Dyshidrosis is not mentioned as such in Ayurvedic scriptures, but the symptoms can be correlated with those of Charmadala kushta (a kind of kshudra kushta). It is caused by aggrevation of Pitta nd Kapha doshas. Some researchers consider this as ‘Dooshi-visha janya visphota kushta’, and hence vishahara chikilsa as well as Rasayana therapy are recommended.
Nidana
All those factors that can vitiate pitta and kapha dosha can be the nidanas/ causes. Food articles having more sour, salty, spicy tastes, certain activities (eg: contact with nickel, cobalt) or even seasons (hot, after rains) that aggravate Pitta and Kapha doshas may be the potential causative factors.
Poorvarupa
Twak parushya, sweda bahulata and kandu are the poorvarupas (prodromal symptoms).
Samprapti
All the skin diseases develop from the deranged physiology of tridoshas and dhatus like twak, mamsa, shonita and lasika.
Lakshana
The lakshanas of Charmadala kushta are kandu, vyadha, osha and sparsha as ahata.
Prognosis
As it is a dwidoshaja vyadhi, Pittakaphaja kushta is krchra sadhya (difficult to manage).
Chikilsa
The management of pittakaphaja kushta is basically ghrta (ghee) predominated. All the measures that can reduce aggravated pitta and kapha can be adopted. These include ruksha kapha hara oushadhas, principles of kushta chikilsa/ charmadala chikilsa and raktaprasadana oushadhas along with symptomatic management.
Commonly used medicines
Tiktaka ghrta, Amruthottaram kashaya, Guluchyadi kashaya, Manjishtadi kashaya, Nimbadi kashaya, Panchatiktakam kashaya, Patoladi kashaya, Vilwadi gulika, Nimbakalka lepa, Rasottamadi lepa, Eladikera, Ayyappala taila, Panchathiktakam Ghrutham, Patolamooladi churna .
Home remedies and behavioural changes
Take food items which are easy to digest. Vegetables having bitter taste (bitter gourd, snake gourd etc) are recommended. Avoid meat, curd, milk and fruits having sour taste. Vajraka taila, paste of haridra/ nimba can be used for external application before bath. Water boiled with Khadira can be used for drinking or cleaning the affected area. Avoid scratching over the blisters and habit of day sleep.
Yoga
Yoga can be incorporated as a supportive therapy to reduce the associated stress. Meditation techniques help a lot in skin problems along with yogic purification therapies (Shatkarmas).
Researches
- Mindfulness based cognitive hypnotherapy is useful in skin problems including Dyshidrosis. (Shenefelt PD. Mindfulness-Based Cognitive Hypnotherapy and Skin Disorders. Am J Clin Hypn. 2018 Jul;61(1):34-44. doi: 10.1080/00029157.2017.1419457. PMID: 29771216.)
- A case report of Dyshidrosis suggest treatment including Aragwadhadi Kashaya, Patolakaturohinyadi Kashaya, Vilwadi tablet, Triphala churna (externally), Kalyanaka ghrta etc as effective intervention. (Dhaliya R, Babu H. Ayurvedic visha hara (antitoxic) chikitsa in recurrent dyshidrotic eczema skin disease: A case report. J Ayurveda Integr Med. 2021;12(1):156-160. doi:10.1016/ j.jaim. 2020.06.010).
- It can also be considered as Vicharchika and treat accordingly. (Hegde P, Hemanth DT, Emmi SV, Shilpa MP, Shindhe PS, Santosh YM. A case discussion on eczema. Int J Ayurveda Res. 2010;1(4):268-270. doi:10.4103/0974-7788.76792).
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