Dear Dr Cannell: Sun exposure, vitamin D, and eczema

Dear Dr. Cannell:

I have what has been diagnosed as dishydrosis on my hands. I get very itchy bumps that are filled with a clear fluid along with swelling of the affected areas. When the bumps break open, I get pain- sometimes it can be extremely painful. I think that has to do with how deep the bumps go as well as the fact that it happens on the pads of the fingers. Lots of nerve endings there.

I have tried everything, went to several doctors. Right now it is being “controlled” with a steroid cream that I apply twice a day. I’m using betamethasone, the strongest available.

One thing that I’ve noticed is that all summer long, I have no problems. I live in Minnesota. I spend a lot of time outside in the sun during the summer. Now that we are once again getting into the colder seasons and I’ve lost my sun, the skin problems are coming right back. It is very difficult for me to do anything with my hands like this. Even tying my shoes or zipping a jacket or buttoning a shirt can be difficult or even extremely painful. I bandage them up when they start breaking open. (I’ve had this condition since 1995)

Do you know of anything I can do for this? Does the sun provide something in the body that is healing for this particular issue? I know Vitamin D, but does a supplement provide the same as the sun? What would be the best one in that case? Could there be anything else that I could do or take to make up for the many months of no sun?

Any help you can provide would be so very appreciated.

Thank you,

Mary, Minnesota

Dear Mary:

Dishydrosis, also known as vesiculobullous hand eczema, is a skin condition that presents with the sudden onset of many itchy clear small blisters in the skin and then often with the development of fissures and thickening of the skin. Recurrence is common and for most people it becomes a chronic condition. We used to think it was blocked sweat glands but is now known to be separation of the outer layer of the skin with fluid due to allergy or autoimmunity.

As you already know it gets better in the summer, then UV light is one treatment possibility. Local hand irradiation with both UVA and UVB has been shown to help dishydrosis. We know that sunshine does more than make vitamin D. So, in the winter, you could try a low-pressure sunbed at a local sunbed parlor, which is equivalent to sunshine at the equator at 5,000 feet altitude. A low-pressure sunbed is an old-fashioned one, one that is like intense sunshine. So, if you use low-pressure sunbeds, be sure to expose the palms of your hands to the UV light. Be careful not to burn.

If you can’t or won’t go to sunbed parlors, oral vitamin D is another possibility. The subject was recently reviewed and quite a bit of evidence exists that eczema or atopic dermatitis may respond to oral vitamin D.

Mutgi K, Koo J. Update on the Role of Systemic Vitamin D in Atopic Dermatitis. Pediatr Dermatol. 2012 Sep 7

In addition, a small, randomized controlled trial recently showed that oral vitamin D helped regular eczema, so I suspect it could help dishydrosis.

Amestejani M, Salehi BS, Vasigh M, Sobhkhiz A, Karami M, Alinia H, Kamrava SK, Shamspour N, Ghalehbaghi B, Behzadi AH. Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study. J Drugs Dermatol. 2012 Mar;11(3):327-30.

Because the condition is so severe, my advice is to do both, take vitamin D and expose your hands to UV light. Get your vitamin D level up to high normal, 70-80 ng/ml.

If you don’t want to use sunbeds, consider buying a portable UV light such as the Sperti lamp, to shine directly your palms for five to ten minutes every day

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