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Dermatology/Blotches on hands and feet



  So for the past three days I've had a sort of rash or irritation on the palms of my hands and the soles of my feet. I have had outbreaks like this in the past and it usually lasts for a few days and goes away. I feel like it happens randomly, but it seems to happen a little more if I am stressed out or nervous.
  My hands are always a little sweatier than average, but it gets a lot worse right before and while the spots are present. My hands also feel hot and are sensitive to touch and heat, almost like pin pricks.
  I'm not sure why this happens or what to do to help it. I try to wash my hands often with cold water because that seems to soothe them, but it isn't really helping. When the outbreak finally does go away, there are no marks or blisters left.
  Thanks in advance for your help!

In dyshidrotic eczema, typical first-line treatment includes high-strength topical steroids and cold compresses. Short courses of oral steroids are the second line of treatment for acute flares, and other immunosuppressants have also been tried. Corticosteroids are cornerstones of topical therapy. Guidelines have been established by the National Institute of Clinical Evidence.Calcineurin inhibitors may also be effective.

Variable effects have been reported using oral administration of psoralen and subsequent exposure to long-wavelength UV light (PUVA) therapy. Topical photochemotherapy with 8-methoxypsoralen is probably as effective as systemic photochemotherapy or high-dose UVA-1 irradiation. For recalcitrant cases, corticosteroids are combined with immunosuppressants.

An evolving treatment seems to be the intradermal injection of botulinum toxin. Probiotics have been suggested as a potential treatment for eczema. Topical khellin and natural sunlight therapy have been suggested for patients with recalcitrant palmoplantar pompholyx.[28] Tap water iontophoresis with pulsed direct current may be helpful as adjuvant treatment.

Identification of the causes of stress and the use of stress management techniques as adjuncts may be helpful in some patients. Biofeedback therapy for stress reduction has succeeded in some individuals.


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Michael S. Fisher, <B>Ph.D., M.D.</B>


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