Training With Dishydrotic Exema

Medical Q&A [Moderated]
1

Hello doctors,

This is a condition I have developed, seemingly out-of-the blue, 8 months ago. The palms of my hands continuously breakout in small blisters; my left hand is significantly more affected than my right, although both can end up looking quite bad. There is no real wax / wane to the condition, it’s pretty much constant in severity.

I have been working with my primary care physician and am currently waiting on a referral to a dermatologist. Unfortunately, it will take several more months before I am able to see a specialist in this matter. In the interim, my doctor and I have been attempting to manage the symptoms with varying degrees of success, and I am trying to determine if I should or should not be training.

During the 8 months I have dealt with this condition, I have experienced exactly one instance where the blisters ceased and my hands reverted mostly back to normal: a bit of calloused skin remained on my right palm, and the fissures got better but never fully healed. This was a window of approximately 8-10 days, and then blisters began forming under the skin of the tip of my right pinky finger and eventually my palms again. Within 3 weeks, the state of my hands returned pretty much to how they were before the improvements began.

It has been difficult to determine what caused the improvement in my hands, as at the time I was sick with an infection in both ears, severe bronchitis, was not training, and had briefly switched one of my two daily treatments with betamethisone 0.5% topical cream with pimecrolimus 1% cream. I discontinued use of the latter after exactly 1 week as I found it difficult to keep the cream on my hands throughout the day. I then switched to using a betamethisone 0.5% lotion in the mornings, after showering, and an ointment at night. It was approximately a week after making this last change that my hands began to noticeably clear up.

I resumed light training a 2 days after my hands appeared to be recovered and ceased use of the steroidal creams / lotion. I kept my hands well moisturised and had no symptoms for another 5-6 days, before the blisters returned. I was training every 3rd day, and everything seemed fine after my workouts, but the blisters returned. I have continued to train despite them, and my doctor has not said to avoid training when I have asked. I am concerned that perhaps heavy lifting is exacerbating the problem, but I cannot find any information to this effect.

My assumption is the pimecrolimus cream is the reason for the brief period of improvement, as it likely had a delayed effect, and I am in the process of testing this theory again, but it will take time to yield results — if any. I was treated with antiobiotics (amoxicillin / clavulan 750/250) for 1 week which remedied 2 ear infections around the time my hands got better. I would imagine it is impossible that there is any correlation there, and likewise for the NSAIDs and decongestants I was taking at the time (all over-the counter, and within recommended doses).

In your experience, are you aware of any reason that training would be discouraged while dealing with this condition? Since taking up weight training over 2 years ago, the physical and mental health benefits have been substantial and I now consider training to be a very important part of my life. If it is unlikely that training is exacerbating the conditioning, then I want to continue doing it.

Do you have any advisement for me in this situation? I understand the limitations of a web forum in this matter, especially given the ailment in question, but any general information or suggestions would be greatly appreciated.

Thank you for your time, and I apologise if there is too much extraneous detail in this post.

2

Sorry to hear about your difficulties with this.

What is your occupation? What are all the topical steroids you have tried so far?

I see no compelling reason to avoid training in this situation as long as we don’t suspect any contact exposures / irritants in the gym environment, particularly when you’ve experienced so much benefit from training.

3

I am an IT support / help desk guy, so I am sitting at a desk typing quite a lot.

I have not used other steroids. My understanding is we’re trying to calm the situation down and then work on management while awaiting a referral.

The condition developed in early March (timeline estimated based on photos I took of “my hands looking weird”), and took a while to progress to the unsightly later stages. For a while it manifest as bumps on the palm and a lot of dry skin, which didn’t respond to moisturisers I expected. I ignored the issue and kept going about my life until mid-July, at which point even my considerable stubbornness was overridden by concern for my health and ability to function properly.

By the time I sought my doctor, the condition was quite severe in terms of coverage and number of blisters. Initially I tried an antifungal (clotramazol), suspecting it might be hand ring-worm, and it seemed to help, but that ended up being nothing more than the wax / wane of the blisters growing out and popping on their own. I wasted 4 weeks thanks to this faulty assumption. The next step was to move right to betamethisone, which I have come to understand is extremely potent. No other topical steroids have been used at this point — to my knowledge this is my first experience with them, ever.

At this time, I do not believe this is a contact allergy situation. There appears to be no correlation between the clustering of the blisters and contact with anything I handle. Nickle and cobalt are the suspects most often referenced and have no reactions to the gold and silver jewellery I wear, or my steel watch band. I have not been formally allergy tested either. To the best of my knowledge I have no seasonal, food or medication allergies. I am unsure if sweat could be a component of this – I do often get what I guess are clogged hair follicles on my legs and lower abdomen when I sweat excessively. I’ve recently taken to using a towel between sets to ensure my hands aren’t overly sweaty. I have recently purchased gloves to wear while training but have only used them twice.

I have an appointment with my doctor on Saturday, to discuss the situation further.

4

Thanks for this information. Very helpful.

Yes, assuming the dermatologic diagnosis is correct (i.e., that it really is dyshidrotic eczema), the initial treatment of choice would be a high potency topical corticosteroid used twice daily. It’s important to note that betamethasone isn’t necessarily a super-high-potency steroid, depending on the formulation. For example, betamethasone valerate 0.1% in lotion form is relatively low in potency, whereas betamethasone dipropionate 0.05% in ointment form is extremely potent. Clobetasol propionate 0.05% is another example of a high potency steroid that might be an option in this case.

With all that said, I still do not think you need to avoid training, and I do think you’d likely benefit from seeing a dermatologist to confirm the diagnosis and see whether they have any other recommendations for you.

5

I’ll broach the subject of other steroids as options. I’ll continue to train as well, until I find reasons to the contrary.

Thank you very much for your time!

6

Which hand is more affected? Your mouse hand? I occasionally have the same / similar condition and while the blisters can appear anywhere on my hands, they most often appear on the ‘table’ side of my mouse hand, i.e. the part that gets clammy resting against table/mouse.

Just curious

Anyway, things that may or may not cause or exacerbate a flare up, in my experience are; heat, sweat, latex gloves, cheap office furniture, medications, oatmeal, certain hand lotions, Mercury in retrograde.

7

A bit of an update, as I continue to try and manage this frustrating situation.

Following my last post, I spoke with my doctor about the positive results I seemed to be having with a mix of pimecrolimus cream (1%) and betamethisone dipropionate (0.05%) cream. Physician’s suggestion was to try using tacrolimus (0.1%) ointment at night, and a mix of betamethisone valerate (0.1%) lotion after showering in the morning, followed by mometasone fuorate (0.1%) around mid-day or so. I initially did not use the mometasone for a week, as I felt the other two treatments were working reasonably well. I was not training at all during this time, but approximately a week later the blisters began to return again.

I stopped using the betamethisone valerate lotion as I felt it didn’t do much except dry out the skin, and instead would apply the mometasone fuorate cream approximately 4-5 hours after my shower (for no reason other than wanting to be a bit more functional). This method seemed to work well and, after a week it seemed as though my hands were both healing up – something they never really did when just using steroids – and the blisters stopped occurring. The blisters were especially prevalent on the tip of my right-hand pinky finger, and those finally subsided as well.

At this point, I had not been training for 3 weeks. I decided to ease myself back in, and limit my workouts to machines, some free weights for shoulder exercises, and I wore gloves which covered all but the tips of my fingers. At this point, I had ceased use of the mometasone cream after my first training session back. I continued using the tacrolimus at night and intended to ease into a maintenance cycle of 1-2 uses per week given how persistent this issue has been. I saw a single blister return, which seemed to respond very well to a single treatment of mometasone cream.

I have since experienced yet another reoccurrance of blisters in most of the usual locations on my palm. Presently, it is mostly confined to my left hand – which has always been affected more severely by this issue – but 1 or 2 blisters have appeared on the right hand as well.

At this point, I don’t know how to approach training. It is possible that it has nothing to do with my problem, but I cannot be sure. Even with gloves, there is some degree of friction when using machines for exercise, although I do not see anything in the distribution of blisters that would correlate to my grip. Post-workout my palms get fairly red, but they don’t burn or sting and quickly return to normal colouration. (Post-work, I wash my hands with a non-soap cleanser and apply a moisturising cream which I also use throughout the day.)

If the issue was friction or sweat from training, my assumption is I would be noticing a fairly immediate reaction, rather than waking up the following day and noticing the beginnings of new blisters below the skin. Does this seem correct, or am I off-base here?

Also, I am unsure of this information is of any use, but I have never once experienced any itching with this skin problem — which I am thankful for, to be honest.

(Without moving up via a cancellation list, it’s going to be 10 months before I am able to see a dermatologist regarding this issue. The infinite wisdom of my province shuttering dermatology residencies in the 90s is now biting me in the ass. As such, I am trying to figure this situation out as best I can given limited resources and expertise.)