If your dyshidrotic eczema is quite severe and involves lots of fluid-filled blisters, don't pick at them or squeeze them. Instead, go see your doctor and have them properly treated. Your family doctor may treat you directly or refer you to a dermatologist (skin specialist). Regardless, the doctor will likely apply some antibiotic cream and dress the blisters properly with sterile bandages, so as to limit the risk of infection, minimize scarring and promote healing. If the blisters are particularly big, the doctor may drain them first.  Change the bandages daily (or immediately if they get accidentally wet and dirty), but remove them carefully so as to minimize skin irritation. When the blisters do break open, apply an antibiotic ointment to the area and cover loosely with another clean bandage. Your doctor may also consider other potential causes of your skin condition. Other skin conditions that can mimic dyshidrotic eczema include fungal infection, bacterial infection, scabies, atopic dermatitis, psoriasis and chickenpox. Because they modify the body's immune response, cortisone, prednisone and other corticosteroids are thought to decrease the redness, irritation and itchiness of eczema. Corticosteroids also have strong anti-inflammatory properties. Prednisone is stronger than cortisone and is often the better choice for eczema — it decreases skin inflammation by reversing the size of capillaries beneath the skin and suppressing the immune system's inflammatory response.  Wrapping the treated area in plastic wrap can improve absorption of corticosteroid cream and help blisters disappear quicker.  If your eczema is severe enough, your doctor may recommend oral steroid therapy (pills) for several days in order to combat the inflammation and discomfort. Long-term side effects of corticosteroid therapy include thinning of the skin, edema (water retention) and compromised immune response. Immune system suppressing creams and ointments, such as tacrolimus (Protopic) and pimecrolimus (Elidel), may also be helpful for severe eczema — particularly for people who want to avoid the side effects of corticosteroids. As their names imply, these medications suppress the body's immune response to the irritant that causes eczema, which means less inflammation, redness, and itchiness. However, these drugs can increase the risk of skin infections and even skin cancer, so use them as a last resort.  Immunosuppressant creams and ointments are not appropriate for children and pregnant women. Suppressing your immune system can make you more susceptible to infectious diseases, such as the common cold and flu. If other treatments aren't effective for your eczema, your doctor may recommend a kind of light therapy that combines exposure to ultraviolet (UV) light with certain drugs that help make your skin more receptive to the UV radiation. Phototherapy appears to work by increasing vitamin D production in the skin and killing any causative microorganisms on the skin — the effects are reduced inflammation, less itch and faster healing in about 60 to 70% of people.  For treating skin conditions, narrowband ultraviolet B (UVB) light is the most common type of phototherapy. Broadband UVB phototherapy, PUVA (Psoralen and UVA) and UVA1 are other forms of phototherapy that are sometimes used for treating eczema. Phototherapy avoids the UVA portion of sunlight, which is very damaging to the skin and can accelerate aging and increase the risk of skin cancers.
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