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Help! I can't get rid of this rash on my hands

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The question

I'm a healthy 34-year-old woman. A few months ago, i noticed a few tiny blisters that turn into dry, painful skin on the palm of my hand. It's now on both palms and spreading. My dermatologist prescribed a cortisone cream and diagnosed it as eczema, but it doesn't seem to be curing it.

What advice do you have? My diet is considerably healthy (I'm a vegetarian and don't eat a lot of sugar).

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The answer

From your description, it sounds like your body may be reacting to something in the environment. A general term used to describe the inflammatory reaction of the skin to a trigger in the environment is called dermatitis (eczema is one type of dermatitis).

When it affects your hands in the pattern that you describe with the initial blistering progressing to dry, painful skin - this may be a more specific type of dermatitis called dishydrotic eczema. This is also known as hand eczema or vesicular eczema and can affect the feet as well.

It is not entirely clear what triggers this reaction, but it is thought to be multifactorial and due to exposure to irritants such as soap, cleansers, rubbing alcohol and occasionally may be due to exposure to metals such as nickel and materials such as latex. This is a common condition in people who work with chemicals or metals regularly such as hair stylists or mechanics or those who have regular exposure to moisture when doing tasks like cooking or cleaning.

Of note, dishydrotic eczema is more common in women and stress may also play a role in triggering symptoms.

Having seasonal allergies or suffering from skin conditions such as you do with eczema, also puts you at higher risk for this condition.

Given that it seems linked to exposure, the first step is to avoid these triggers which may help alleviate symptoms.

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  • Avoid scented products (creams, detergents, soaps)
  • Limit exposure to chemicals and water: Especially relevant if you work in an occupation where you have exposure to chemicals, wearing gloves to act as a barrier may protect your skin. At home, you may want to consider gloves when cooking and cleaning.
  • Manage stress: easier said than done, but regular exercise, eating a healthy diet as you already do and other stress reduction techniques may help manage symptoms.

Other therapies which may help to alleviate symptoms:

Topical steroids: These come in different potency creams or ointments and depending on the location, severity and your own history - your doctor can prescribe accordingly.

These are meant to be used sparingly and use caution if used near eyes/mucous membranes. If your condition and symptoms are severe, your doctor may consider a short course of oral steroids.

Antihistamines: If you have severe itch, antihistamines may be helpful to manage symptoms and can come in non-drowsy formulations over-the-counter.

Phototherapy: If the aforementioned treatments are not effective, your doctor may refer you to a dermatologist for consideration of ultraviolet light therapy which can be helpful for some people.

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It is important to note that when the skin becomes dry and painful, bacteria can enter through small cracks in the skin and result in infection - which may need topical or oral antibiotics.

Dishydrotic eczema can be a challenging condition to treat as minimizing exposure to triggers is difficult to achieve, but a focused effort and use of medication may help to relieve this common condition.

The answer

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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