This is the best available information as at 1st February 2014
Dyshidrosis (also known as Dyshidrotic eczema or Pompholyx,) is small, fluid-filled blisters on the palms and fingers of the hands in 80% of sufferers, or the soles of the feet in 10%, with another 10% having the minute vesicles 'blisters' on both hands and feet. Usually the condition starts on the interdigital skin and spreads to the glabeous skin of the palms and the soles. This skin has more sweat glands, more pressure receptors, and histamine receptors. It is not unknown for ordinary skin on the arms and other parts of the body to have the vesicles. When it is on parts of the body other than the hands and feet it is usually, tho' not always caused by contact with a substance that excites, irritates and annoys the body's immune system and usually appears within minutes of contact. This is Contact Dermatitis.
Dyshidrosis proper, affecting the hands and the feet only, comes on slowly, starting with a few itchy blisters which increase in number and itchiness for no apparent reason.. Once the blisters dry, cracks form in the skin which can be unsightly and very painful. This is Delayed or type IV response.
However, GPs frequently misdiagnose Dyshidrosis as Contact Dermatitis.
Causes of dyshidrosis
If it is dyshidrosis, and not contact dermatitis, the root cause in all cases is the 'Id reaction' . The 'id' is short for 'dermatiphid' or 'dermatophyte' and the reaction is a histamine reaction (or allergic reaction) to the dermatophyte. The problem is finding the dermatophyte, which is usually a fungus or a yeast or a mold. It may be a bacterium or a virus, which are technically NOT dermatophytes. If a person has Athlete's foot, caused by any one of a number of tineas, which are fungi, then curing the Athlete's foot will cure the dyshidrosis.
Dyshidrosis is almost always misdiagnosed by MD/GP doctors as contact dermatitis, but almost never by podiatrists, who see much more of it in conjunction with Tinea. aka Athlete's foot. Dyshidrosis may be seasonal due to the increase of mold in the air due to weather changes. People tend to confuse this with respiratory allergies.Antedotal reports of increases after storms and floods and with recent hurricanes are undoubtably due to damp conditions aiding mold growth, in the air, and in buildings.
Most people have the bacterium Staphylococcus Aureus on their skin, and their immune systems recognize it as present and relatively harmless. But in some cases for reasons unknown, the immune system sets up a histamine reaction to this commensal bacterium and the result is dyshidrosis. In the UK, but not in the USA, the guidelines for the treatment of eczema are 'bleach baths'. In which 2 or 3 times a week, people with eczema, including children, sit in a bath of warm water with 4% chlorine bleach (general household type bleach). This kills a lot of staph and other commensals, and it can appear to cure eczema. It does not stop the histamine reaction, but it stops the cause of the histamine, the immune system searching for the 'enemy' but unable to find it as it is outside the body.
The greatest cause of dyshidrosis is Candida Albicans. This is unproven and difficult to prove. Everybody has Candida in their body, in their gastrointestinal tract and other parts. It is the cause of Thrush in babies and varginal infections in women. Dyshidrosis is 2:1 (different studies cite different statistics) women to men, and this may be a reflection of the preponderance of 'yeast' infections suffered by women.
Candida is present in most people as a commensal yeast so it is difficult to say Candida must be the cause of dyshidrosis, since so many people with Candida have no dyshidrosis. The test for Candida does not differentiate between Candida Albicans in its yeast form or in its fungal form.
My hypothesis is that only the fungal form and it's damage to the gut wall causes the 'id reaction', that flood of histamine that causes dyshidrosis.
Candida Albicans is an opportunistic pathogen. Given the right conditions this usually harmless yeast (If you have AIDS you can die from Candida infections.) can morph into a fungus of great tenacity. This is definitely recognized as the enemy by the body's immune system. A histamine reaction comes into play. But: The dimorphic Candida is usually hiding in the gut walls, the histamine cannot find it, cannot attract repair enzymes to the site, dyshidrosis is the result of the excess histamine going to the histamine receptors in the glabeous skin. Ie the ‘fingerprint’ skin on the soles and palms via capillaries and along nerves. The left ring finger is a common starting point.
What causes the Candida to morph?
A change in hormonal status: Puberty, Pregnancy, the Pill, (hormonal contraceptives) Pumping Iron(steroid drugs) are the most common causes. A careful medical history reveals that the Dyshidrosis started sometime after one of the 4 Ps.
It has come to my notice that a lot of patients have had operations and been given large amounts of antibiotics and steroids as prophylaxis and then developed dyshdirosis. The greatest number of cases have arisen due to pregnancy.
Often, stress is cited. Stress is a false enemy. Bad eating, too much sugar, not sleeping, and stress hormones like Cortisol, and other physical factors of stress probably encourage Candida to morph into its mycelial form. But the root cause always seems to be due to some hormonal/steroidal change.
Naturopaths talk about 'The leaky gut'. They believe that the mycelial Candida roots to the gut wall allowing food that is not properly processed to leak into the bloodstream and cause food allergies. This is unproven. It's a good theory, but at the moment, it is hypothetical. There are physiological problems to the theory as the gut is semi-permeable to allow nutrients to pass into the blood. Food is usually fully broken down into the basic elements of protein, carbohydrate and fats. If the mycelial fungus was in a part of the gastrointestinal tract prior to complete digestion of a particular type of food, this leaky gut would explain why food allergies are so prevalent as a part of Dyshidrosis, and are seen by many sufferers as the cause of their condition.
I am working on this.
Many people claim nickel as an inciting factor. Nickel as a contact allergen is common. If you are allergic to nickel, ingesting nickel will set up a allergic reaction.
Yeasts in any part of the body, in particular the sinuses (the Sinii) may cause dyshidrosis.
Tineas on the feet, scalp or genitals and generalized on the body are a frequent cause of dyshidrosis.
It is quite possible to have a sub-clinical infection, called a 'colonization' by a fungus or yeast. This may excite and annoy the body's immune system, causing the degranulation of mast cells and the release of histamine without any visible sign of a yeast or fungal infection.
There is a theory that even if the infection is treated and goes away, the immune system remain stuck with the 'on' switch on. This is unproven. I used to believe this, now I am less sure. I now believe that airborne molds cause many cases of dyshidrosis.
Dyshidrosis is not infectious. It is not genetic, although the susceptibility may be. 20% approximately, of people are ATOPIC. This is really just more actively reacting to allergens.
It is not an auto-immune condition as this is commonly understood by doctors.
It 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 more threatening.
CURES FOR DYSHIDROSIS
There is a simple test to prove that the condition is dyshidrosis.
If the condition is an ALLERGY to a dermatophyte, any dermatophyte, it will respond to oral anti-histamines. The best is FEXOFENADINE. You need to take 180mg per day for 5 days. To maintain a even level of Fexofenadine it is better to take 60mg every 8 hours. But this is hard to remember to do. Fexofenadine has a 14 hour half-life.
Alleviation (To make symptoms more bearable)
This is not a cure. Fexofenadine should not be taken long term.
Soaking the hands and feet is recommended at the rate of 10 litres of warm water with 2 cups or half a litre of vinegar or 4% bleach, in it. This works by neutralizing the histamine, and desiccation of the skin. As soon as the body has built up an amount of histamine to circulate, the itching and swelling will reoccur, usually about 5 days. Soak at night, late evening as histamine levels naturally rise at this time.
To get rid of the offending dermatophyte is the first priority.
There must be a strong suspicion that Mycelial Candida Albicans is the cause if the sufferer has symptoms of IBS. (Irritable Bowel Syndrome.)
NYSTATIN: The very best treatment for this dermatophyte is NYSTATIN orally, preferably in drops, at the rate of 2 million units per day, that is 500,000 units taken 4 times a day for 14 days then a break of a few days, some authorities recommend a high sugar diet to bring out the spores in this break, it is unproven, but a second course is required to kill any spores that have 'hatched'. NYSTATIN was developed in 1948, it has a long history of safe usage, it is given to babies, it is an over the counter medicine in many countries. (The Middle East and Mexico) But in Australia, Britain and the USA, doctors are reluctant to prescribe it. They believe that Ketoconazole, Fluconazole and Itraconazole are more effective as they are broad-spectrum anti-fungals. If the dermatophyte causing the id reaction/dyshidrosis is NOT Candida, then yes, OK, but wouldn't you rather take a drug with great specificity, only kills Candida, not any good fungi or bacteria, and is well-tried over many years and has as fewer side effects than most drugs on the market, and is less stressful on the liver than the -conazole anti-fungals?
Yet I continue to bang my head on GPs who persist in the dogma that Dyshidrosis will not benefit from a course of Nystatin.
The best brand is Mycostatin by Bristol Myers Squibb, with NO sugar (sucrose) in it.
DIET: Doing the Atkins 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.......
TOCTINO: is a retinoid drug. It has been available since 2008 in Britain and most European countries, and is available in Canada, but not yet in the USA or Australia. Retinoid drugs are complex in their actions. Basically they make the skin turn over faster, some close down some of the varied receptors in the skin. This is how Accutane works, it shuts down the sebum production in the skin. In Dyshidrosis, Toctino appears to cause the skin to turn over faster and thus the dermatophytes cannot mature to divide and increase in number.
Retinoid drugs are created from vitamin A.
Thanks to this website I have been able to acquire a great many more patients than before, and I have noticed that I had 3 fails this year. Common cause was the patients were Vegan/Vegetarians.
This is almost certainly due to the fact that drugs need to be carried thru the system with fat and protein, not carbohydrates.
Vitamin A in particular needs to be taken with a fatty meal.
Lots of people worried that Vitamin A was toxic.
You would need to take/eat 25,000 iu for every kilo you weigh to reach immediate toxicity.
Google Mawson, an Australian Antarctic explorer of 1912/13, who ate his huskies and their liver, ingesting it is now believed in excess of 200,000 iu of vitamin A daily, and nothing else. He lived, and fathered 2 daughters within 3 years.
A great many people had problems getting their doctor to prescribe Nystatin. This varies with country. But the USA seems to refuse to prescribe this well tested drug. I have no advice on how to get it, but if you find a willing doctor, please let me know so I can direct others to him.
Nevertheless, get a liver enzyme check before doing the vitamin A protocol. And Do not get pregnant.