Expert: Michael S. Fisher, <B>Ph.D., M.D.</B> - 11/1/2006

Question
Hello Dr. Fisher,

I am a 36 y/o white male with no history of skin disorder for myself or my family.  I do not use harsh cleaning agents nor do I use an overly dry soap.  My condition and history is as follows:

Around May / June of this year I started getting small blister-like bumps on my hands near the center of my palms, filled with a clear fluid and a small spot in the middle of each.  Once these would dry out, the skin would die and began to peel locally around the bumps.  For a few weeks this was isolated to just the palms and then started to spread to my fingers as well.  This does not happen on the tops of my hands (or feet) but only on the palm side from the heel of my hands to the finger tips (same on feet).  I have gone to my GP and then to my dermatologist here in Germany and was told that this was "some sort of psoriasis" and not to worry.  I was prescribed a steroid creme to apply twice daily and this did help for the duration of the creme with about a 90% reduction in the bumps.

When the creme ran out (kind of expensive over here), I decided to go with Gold Bond 7 moisturizer creme but that helped very little.  Currently I am using a creme that can only be obtained from behind the counter at the pharmacy called Alfason Repair (for dry to very dry skin).  This works well in taking care of the dryness and peeling but it does not prevent the bumps from starting.

At first I thought this was syphilis because of the symptoms and I had just gotten a new tattoo a few weeks before the symptoms started.  I had blood work done to make sure and that was negative (big sigh of relief... didn't want to try and explain to my wife how I got syphilis especially when I am a faithful husband!).  Then I thought that maybe it was something related to lichmeniosous (sp) that is caught from sandflys in Iraq.  I spent roughly 18 months in central Iraq until Sept 2005.  The sores do not get red or infected and stay the size locally of the initial bumps, so that would count that out too.

This is really driving me crazy.  What started out with a couple small blister/bumps on each hand has turned in to 30+ bumps on each hand (worst case) and also the bottoms of my feet.  Is there something else I could try or maybe something I can tell my Dermatologist about that maybe he should look for?  I don't mind putting a special lotion on my hands and feet daily but God forbid I forget a day and my hands look like they are falling apart with all the dead skin and cracking.

Any help you can provide would be GREATLY appreciated.  Sorry for this being so long but I thought more detail would provide for a better understanding and thus a better possibility you might know what this could be.

Many thanks !

Dale

Answer
You most likley have a skin condition called Dyshidrosis.  This condition is genetic and stress makes it worse.  This skin condition only occurs on the hands and feet.  This condition can be controlled but not cured.  The treatment is with strong topical prescription cortisone like Clobex Lotion.  Since I cannot see your skin, I cannot be totally sure of the diagnosis so you might want to see a professional.