Mild dishydrosis

by Neil Pollick
(Thailand)

UNKNOWN CAUSE

I have had it 3 times in my life, always in hot countries, once in dry heat, twice in the tropics. It always went away when I moved to a cooler location.
However, I have been in many hot countries for long periods and NOT developed the condition, including tropical climates. Even when I spend the days indoors in a cool environment, new blisters appear.
Now I am in Thailand, a hot and humid climate and it has recurred. This is the worst bout ever, but that may be because on the other 2 occasions I traveled to a cooler climate much sooner.
I hope to stay in Thailand for 3 more months but I can't stay if this condition doesn't clear up.
I can't find what causes it. I have changed to soaps which are suitable for highly sensitive skin but still new "blisters" appear.

NOTHING STOPS THE ITCHING BUT REMOVING THE LIQUID INSIDE
I have not found anything, not even anti-histamine pills or topical steroids that can make the itching go away.
The only way I can do that is to pop the blister.
This works.
But it is a time consuming and non-ideal way to deal with the problem.
To minimize the possibility of complications such as infection and stinging, I use a very fine needle and I prick the vesicle/blister just once,or until the shiny fluid appears to squeeze it out.
I find that once the liquid is vented (it may require some pressure) the itching stops, though not immediately. The skin dries out and eventually flakes off. I rub in an antiseptic cream when I am done. There has been no infection whatsoever, which is the main risk of this procedure.
Doctors discourage people from popping the blisters, probably because of the risk of infection and because it damages the skin, both of these risks can be minimized. The only ill-effect I feel from this procedure is very slight stinging from time to time, but it is slight indeed.
If some doctor would show me a way to stop the itching, I would leave the blisters alone and let them disappear in their own time, but no doctor ever has so I cope as I find effective. As I said, I do not believe that piercing the blisters causes new blisters to appear or slows down the healing process but I am open to being proved wrong (the argument would need to be sound and to accord with my intimate experience of this condition)

KEEPING THE HANDS DRY
I have avoided going out into the high heat since this condition set in. When I do go out I try to keep my hands dry, I wipe away sweat with tissue or antiseptic wipes. Perhaps it keeps the number of new blisters.

2 TYPES OF BLISTER
The blister seem to be of 2 types, one that is on the surface and protrudes slightly, and a deeper kind below the surface. Both contain fluid but the more superficial one seems far more itchy. I do not try to release the fluid in the deeper vesicles because there are far too many of them, reaching them with the pin causes too much damage and they do not cause itching unless the skin is rubbed.
The blisters on the surface ALWAYS cause itching until the fluid is drained.
I do not believe that piercing the vesicles is making the condition worse, and I do not believe that this is why new vesicles/blister appear each day since they appear elsewhere on the fingers and palms

NO CURE
I am not confident that this condition will abate if I stay in my current location.
I may have to find out what, if any, allergen is causing the problem. It occurs in hot climates but not all the time. Last year I was in this very same country at this very same time of year and it did not occur.
Perhaps there is some deficiency in my diet or some trouble with kidneys or liver that is causing this outbreak. I know that skin conditions have complex aetiology.
It is no good to keep treating the symptoms indefinitely, I need to find out what is causing it.

TOPICAL TREATMENTS
Immediately after popping vesicles, I rub in a simple antiseptic ointment and zinc oxide ointment. Obviously the antiseptic prevents infection and I believe that the zinc oxide (made for nappy rash) aids in drying out the skin (and fluid build-up)and accelerates healing. Neither cream causes any irritation, even after the skin has bee pierced.
I am trying to avoid steroid creams because I have used them on my hands in the past and I want to avoid complications from skin thinning and steroids can inhibit the bodies own immune response and healing activity.

SOOTHING OILS
Twice a day I rub a mixture of natural products on to the hands. The base is pure coconut oil, with some local, Thai, herbal ointments made to treat eczema. I add a few drops of lavender oil and some more of the zinc oxide cream. I massage it into the fingers for a few minutes, the combination is very soothing and I believe it helps to keep the skin supple (so the joints move without itching or pain)

MILD HYDROSIS
I would characterize my condition as mild, compare at least to some of the pictures I have seen on the internet. I have not had small blister coming together to make large ones, as I have read about, maybe because I vent the serum inside the vesicles.
I know that infection would vastly complicate the condition so I guard against it.

SPONGIOSIS
I notice that in the upper portion of some of the fingers in particular can get quite puffy, and full of liquid, this must be what they call spongiosis. The flesh appears swollen. I was successful in reducing this swelling considerably by venting the liquid in the way I described above, using minimal intrusion. I "vented" the fluid over several days. There was no infection and the skin is firm now, not spongy, and healing well.

POSSIBLE CURES
I think that the condition will persist until I move to a cooler climate, it has never occurred in a temperate climate, only in very hot places
I may try to stop using any kind of soap, and just clean myself with water, or otherwise wear some thin waterproof gloves when I shower.
I will probably have a PATCH test for allergies done.
It has been suggested that the condition might disappear with a magnesium supplement, eating a lot of mangos would be one way to increase levels of magnesium in the body.

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May 01, 2015
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An update for the above post
by: Neil

This is Neil who made the original post
I can post that the dishydrosis has gone.
And I am still in Thailand
I followed a twice daily regimen of oil and herbs on the hands. First I would apply zinc oxide cream and antiseptic cream (the latter only when vesicles had been punctured), then coconut oil. I would dissolve a local Thai preparation called Yoki Powder into the coconut oil before massaging it into the palms and fingers.
(this is a white powder with declared ingredients as Zinc oxide, Triclosan, Camphor, Menthol, Calamine and Boric acid)
Finally I would apply a green Thai herbal balm containing "Saleht Pang Pon". (there are many brands)
Very limited numbers of new blisters and deeper vesicles still appeared over the last 2 weeks or so. Bu most of them no longer contained fluid though still itchy.
The skin has been slow to heal and is still overly sensitive, though itching is short lived.
I continue to massage in the coconut oil and the Thai balm twice daily.

Katrina's Reply: I'm glad you seem to have found a remedy for your condition. I would urge you to stay away from Triclosan, however.

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