Cluser of Blisters on Hands

[worriedsew]

Recently, I developed a cluster of small blisters appeared on one of my right hand fingers. Initially, I observed tiny clear blisters on back of my finger. After a couple of days, the blisters became red and expanded to cover a relatively wider area; it was extremely itchy. I then developed another cluster of blisters on the bottom of my left thumb. The blisters were raised and extremely itchy. Fortunately, I had an appointment with my Doctor for annual checkup when I had the blisters. I showed it to her and her colleague. They told me that they haven’t seen such raised and itchy blisters. They took pictures and sent it to a Dermatologist and I am still waiting to hear either from my Doc or the Dermatologist. After my visit, I had two sets of clustered blisters on my right hand. I noticed that the itchiness stops after a day or two. But it takes time to heal; when it heals, it leaves a dark spot. I started getting these itchy clusters for a while now. But the frequency of getting them has increased recently. January was an extremely stressful and difficult month for me and on top of that I was getting only a few hours of sleep. Information that may be useful is that my two children have eczema which has been diagnosed last month. I have been applying creams to their sores without wearing gloves.

I had sexual encounters with prostitutes but always use condoms for intercourse. I understand I use condoms all the time with no exceptions; but I still worry about the possibility of being infected with HIV.  Are the clusters of blisters on my hands related to HIV or other STDs?

Thank you for your attention to my question.

[worriedsew]

Thank you Dr. for the detailed response. The Family Doctor thought the blisters do not anything like Eczema since the blisters are raised. I did more dish washing in January more than the usual and was exposed to detergents. After the dish washing, I felt extreme dryness in my hands.

My wife suffers from a chronic form of Eczema and I am aware of the different stages of treatments. She started with steroid ointments and had the light treatment. When that didn't work, the Dermatologist prescribed antibiotics which didn't work either. None of them worked for her. She is now being treated with herbal medicine and is showing significant improvement. I feel that the Dermatologist didn't do a good when it  comes to understanding the root cause and failed to take into account her skin complexion and biological make up.

I am against applying steroids after I have seen what it has done to my wife's hands and feet. I applied Garden Cress (Lepidium sativum) to the blisters which seemed to accelerate the healing time and helps to relieve itchiness. I grind the Garden Cress and mixed it with water. I then rubbed it over the blisters.

[Bhupinder Kaur, MD]

Hello,

Thanks for posting your query.

I can understand your concern for the symptoms. It is very difficult to precisely confirm a diagnosis without examination and investigations but your symptoms are suggestive of pompholyx which is also called dyshidrotic eczema. The first stage of pompholyx shows tiny blisters (vesicles) deep in the skin of the palms, fingers, instep or toes. The blisters are often intensely itchy or have a burning feeling. The condition may be mild with only a little peeling, or very severe with big blisters and cracks which prevent work. The later and more chronic stage of pompholyx shows more peeling, cracking, or crusting. Then the skin heals up, or the blistering may start again.

Since your children also have a history of eczema which has a hereditary predisposition, chances are more likely that it is due to pompholyx.

The exact cause is not known and excessive sweating can be one of the reasons. But some triggers like allergic reaction to soaps, detergents, foods, latex, nickel etc may trigger the symptoms. These blisters are less likely to be related to HIV or STD’s. STD’s like herpes may cause sores or hereptic whitlow on the hands but it presents as painful sores rather than itchy blisters.

If you are apprehensive regarding the status of herpes ( although which seems unlikely)then you can investigated for herpes. Chances of HIV are less likely because you have a history of protected intercourse.

For mild-moderate symptoms a weak steroid may be used (e.g. hydrocortisone as dermacort), whilst more severe cases require a higher-potency steroid (e.g. clobetasol propionate, fluocinonide).But they are available under prescription and should be taken only after consulting a dermatologist. Symptoms  can be exacerbated by dryness of the skin. Use good quality moisturizers to prevent moisture loss from the skin. Use only thin applications of moisturizer ointments as excessive amounts of ointment may restrict breathing of the skin and aggravate the condition.

If they prove unsuccessful, then Light treatment: UVA-1, PUVA, Grenz rays, Low Level Light Therapy using a Red + NIR (LED) combination can be used. For recalcitrant cases, corticosteroids combined with immunosuppressants may be used. In addition, you can apply aloe vera to the hands. It will help.

Hope that this information helps and hope that you get better soon.

Wishing you good health.