Is this worth going to the doctor for?
April 20, 2020 5:31 PM   Subscribe

You're not my doctor or pharmacist. However, week I had an outbreak of dyshidrotic eczema on the palms of my hands and fingers. With everything going on due to covid-19, is this even worth going to a walk in clinic for? I don't know what to do!

I've had little outbreaks of this type of excema on my hands, but it's been pretty isolated usually. This outbreak looks disgusting and feels mildly uncomfortable.

It looks awful and really bothers me. I think in the past, it's usually gone away on its own, but I don't think I can wait that long with this outbreak. If there was no pandemic, I would have had this looked at when it first happened.

Now, I'm not so sure what to do. Should I just wait this out, or take the risk of going to a walk-in clinic to get this looked at? I really hesitate about going to a walk-in clinic, because there appears to only be one or two in the stupid small town I live in now. I'm scared to wait in a waiting room with people who might be contagious with anything, let alone covid-19. Is this worth treating and (potentially) getting covid-19, as a result? I'm not sure. This obviously isn't a life threatening condition, but having the palms of my hands riddled with these little fluid-filled blisters is not pleasant.

Unfortunately, I can't do a telehealth appointment because I don't have a family doctor here. I had a referral to a dermatologist earlier in the year for a completely different reason and the referral lasts for a year, so I am hoping that MAYBE I can have a telehealth appointment with him. But if that option doesn't work out, I just feel so torn. I don't want to put my tolerate with my hands looking like this.
posted by VirginiaPlain to Health & Fitness (26 answers total) 2 users marked this as a favorite
Response by poster: Okay, sorry, I forgot to proof read my post: "I don't want to put my health at risk, but I also don't know how much longer I can tolerate with my hands looking like this."
posted by VirginiaPlain at 5:34 PM on April 20, 2020

I don't know where you're located - here (alberta, canada) a pharmacist can prescribe some medications - do you have a small pharmacy near you? It might be a decent first stop even if they aren't able to prescribe where you live, there might be something OTC they can give you?
posted by euphoria066 at 5:38 PM on April 20, 2020 [2 favorites]

Covid or no, regular health needs still need to be looked at. Could you phone some clinics around to see if they can do either telehealth or in person appointment? A lot of places now will have you wait in your car and call you to come in, they don't have petridish waiting rooms. Can you call the walk in and see what they are doing to mitigate the virus?
posted by freethefeet at 5:47 PM on April 20, 2020 [2 favorites]

Have you tried any OTC options first, like topical hydrocortisone and/or antihistamines like Benadryl or Xyzal? If not, maybe try those first and see if you get any relief. Oddly enough, I also have had a much worse dyshidrotic eczema breakout recently, probably because I've been nervously fiddling/picking at my hands more. I also wear gloves at night and after I put moisturizer on, if that's an option for you.
posted by rachaelfaith at 6:09 PM on April 20, 2020 [12 favorites]

Do you have health insurance? Some of the insurance plans are now offering teledoc sessions - call the number on your card and ask.

Also, call the walk-in clinic and ask if they have a telehealth/video option that you can use.

Third option is to call and local dermatologist and see if you can get a video session with them. (Assuming your insurance doesn't require a referral first)
posted by metahawk at 6:21 PM on April 20, 2020 [3 favorites]

I don't know what's available in your area, but if you're able to do a phone call/video conference with a doctor (as suggested above), and you get a prescription, there are pharmacies offering curbside pickup and/or drivethrus (my local walgreen's already had a drivethru window available long before the pandemic).
posted by acidnova at 6:31 PM on April 20, 2020 [1 favorite]

Personally (if there was absolutely no way to do telehealth or a phone consult) I would look into more home treatment strategies and only go to a clinic in person if it showed signs of infection or really wasn't healing for a long time.
posted by needs more cowbell at 6:37 PM on April 20, 2020 [2 favorites]

Definitely try hydrocortisone first if you haven't (works well for me with this kind of eczema), and telemedicine next. Stress can contribute to eczema outbreaks and I don't think going to a clinic would help with stress that much right now!
posted by babelfish at 6:39 PM on April 20, 2020

Seconding freethefeet, call the walk-in clinic and ask what steps they are taking to protect patients in their facility. For example, my sister works in a walk-in clinic that is only seeing non-sick patients who must still wear masks.
posted by dreaming in stereo at 7:06 PM on April 20, 2020 [1 favorite]

I have this! I have not sought medical help for it because my insurance is terrible and I'm kind of used to riding anything short of, like, an obvious broken bone out, so ymmv. (I suspect I have issues around seeking medical care. So maybe this is more 'if you can't get to a doctor, try this'.)

I self-treat with lots of cocoa butter and other heavy-duty lotions, and generally just trying to keep my hands as moisturized as possible, while taking it as easy as possible when it gets really bad. Sometimes the blisters burst and it hurts a bit, but mostly they sort of...fade away, or go down, especially if I keep slathering them in cocoa butter. OTC medication helps with the pain. It's not fun, but I find it heals fairly quickly if I can keep my hands from getting dry -- so, basically, any time they have come into contact with water, I'm slathering on lotion as soon as possible.
posted by kalimac at 7:10 PM on April 20, 2020

I get severe excema from time to time, behind the ears and on my neck. I know it sucks, but in your shoes I'd treat with OTC and try to manage your stress.
posted by vrakatar at 7:11 PM on April 20, 2020

I have (maybe had) chronic dyshidrosis with an unclear trigger. I used to get it semi-reliably whenever I travelled, with a lag of a few days. No outbreak for quite a while, touch wood.

Bad outbreaks, while they are very gross, are (I would say) not serious enough to chance a doctor's visit under the present circumstances.

I have never actually gone to a doctor with this -- I've had it since I was a teen, when it was waved away as a mild allergy symptom, and it honestly never occurred to me to ask a professional about it as an adult.

I have self-medicated with a wide selection of over-the-counter medications, with varying degrees of success.

What makes everything worse: picking. When I was a teen I compulsively picked and picked and picked and popped all the vesicles, and my hands were always festering and full of weeping wounds and scabs. Every time I've had a lapse, even a little one, I've regretted it. Don't be me.

What didn't work at all: surgical spirits, hydrogen peroxide, various other disinfectants.

What seemed to work a bit sometimes maybe: hydrocortisone cream or ointment; mild oral antihistamines. I initially thought that (petroleum-based) ointment was better than (water-based) cream, especially since petroleum-based products normally irritate my skin much less than most water-based creams, but subsequently found that the grease can make the flare-ups worse and also is hard to clean off afterwards.

What seemed to work the best: off-label use of powdered aspirin as a topical treatment. I believe that aspirin is chemically close to, and breaks down into, salicylic acid (see below). Keeping hands clean and dry (by wearing medical cotton gloves purchased at a pharmacy).

(At least one person upthread is recommending the exact opposite of keeping your hands dry, so YMM very much V.)

(Warning: in the later stages of recovery from a bad outbreak, the skin in affected areas gets hard and dry and starts cracking at the finger joints, which is painful. Keeping your hands dry makes this worse. Keeping your hands moist makes the dyshidrosis flare up again. It's an annoying catch-22 situation.)

What I think eventually did the condition in: late in life I started using products on my face which contain salicylic acid and benzoyl peroxide. When I apply them to my face, they get on my hands. I believe that this is correlated with the near-complete disappearance of the dyshidrosis, although I haven't verified this entirely to my satisfaction.

This is all extremely anecdotal; I am not a doctor, etc..
posted by confluency at 8:20 PM on April 20, 2020 [3 favorites]

If you can get a salicylic or lactic acid cream, you can see if one of those helps. I used to get this a lot and it was related to an allergy to stearates, and I found the salicylic acid treatment for my occasional zit helped a lot with it. My FIL gets it and has a prescription for lactic acid cream.
posted by fiercekitten at 9:32 PM on April 20, 2020

Take pictures of your hands now, before starting any at-home treatment. Tomorrow, call that dermatologist. If necessary, make more calls. Telehealth options are changing so fast.

I think avoiding those walk-in clinics for your previously-diagnosed dyshidrotic eczema flare-up is fine, unless a medical professional tells you during your phone consultation that a clinic is your best option.
posted by furtive_jackanapes at 9:57 PM on April 20, 2020 [2 favorites]

Ugh, I get this. I'm pretty sure my trigger is certain hand soaps, but since we can't really be picky about those right now I've had some flare-ups . I would try telehealth with the dermatologist for sure. I did (with a GP) and the doctor gave me a prescription for Viaderm. It works almost immediately to relieve itchiness, and then I keep using it until the skin is totally healed (as per instructions). It basically breaks you out of the annoying loop of overly dry/overly irritated described above. Otherwise, maybe call into the clinic to see what the distancing practices are. I totally feel your pain - the eczema is SO distracting and unpleasant.
posted by thebots at 11:13 PM on April 20, 2020 [1 favorite]

As posters above have mentioned: I wouldn't bother going to the doctor, especially at a time like this. Anti-inflammatories have worked for me; moisturizers and lotions do nothing. I am sooo tempted to mash my skin until it weeps but always always regret it when I do.

Since no one has mentioned this, it is also possible that dyshidrotic eczema can be exacerbated with diet. If you are sheltering in place and rarely going to the store, you may be eating differently. It might make sense to pay attention to whether your symptoms appear to vary with what you're eating.
posted by Jpfed at 11:24 PM on April 20, 2020 [1 favorite]

Have you had a prescription before that helped? Right when the lockdown was starting, I called my doctor’s office and had them call in a refill for a psoriasis cream they had prescribed for me previously. I didn’t need to go in.
posted by amapolaroja at 12:42 AM on April 21, 2020 [1 favorite]

I know you said you've gotten this before, and the photos weren't loading on my old phone, so this may be way off base but just in case :
posted by sepviva at 4:12 AM on April 21, 2020

Please research Covid toes.

Almost certainly you have the same eczema you always do, but before you leave the house to seek treatment I suggest that you both check the possibility, on line comparing your hands and feet to the photographs, and via phone or on line consult with your dermatologist. It's an exceedingly small chance, and doesn't fit your description, and not a portent of doom if you do have Covid toes. It's described as being the only symptom of young healthy people who don't feel sick and recover fast. You still probably should check it out.
posted by Jane the Brown at 6:15 AM on April 21, 2020

Response by poster: It's definitely not Covid toes, my feet and other areas of my body are fine.

It looks like going to a walk-in clinic is my best option at this point. I don't have any steroid creams currently, because I haven't had an outbreak in so long and previous outbreaks were quite mild.

I called the dermatologist and the receptionist was completely dismissive of a telehealth appointment, I don't think it's worth it to travel almost 5 hours to see him about this. So, I'm very disappointed with that clinic (I'm pretty sure the receptionist thought I was being ridiculously paranoid).

I guess I'll just take my chances, eek.
posted by VirginiaPlain at 8:09 AM on April 21, 2020

I have eczema on my hands too, and at-home treatments like industrial-strength lotion don’t cut it, especially with all the hand washing required now. Get steroid cream. I’m really sorry your dermatologist won’t help, but I’d definitely chance the clinic.

I just ran out of my own steroid cream and I’m about to call my derm for help, too. Washing my hands is excruciating and I’m sure all the open cuts from cracking aren’t safe.
posted by liet at 10:24 AM on April 21, 2020 [1 favorite]

Many of the urgent care clinics in my area that usually function on a walk-in basis are doing teleheath visits - have you looked around to see if any urgent cares in your area are doing the same? If not, I’d try calling regular doctors offices and selecting a new primary care doctor who can take you on now and do a telehealth visit.
posted by insectosaurus at 10:49 AM on April 21, 2020

I'm sorry the call to the dermatologist was unproductive. If you have access to a nurse triage line through an employee insurance plan (HealthPartners' CareLine, BCBS 24 hour nurse line) or your national health service (Telehealth Ontario, Telehealth Alberta), or similar hotline, try calling. Maybe a pharmacist can help, as per euphoria066's comment. In this pandemic situation I'd call my previous dermatologist or doctor for guidance, knowing I wouldn't be the first person to do so, before walking into an unfamiliar clinic with a non-emergency.
posted by furtive_jackanapes at 10:57 AM on April 21, 2020

A follow-up suggestion for dealing with painful skin cracks (also applicable to non-dyshidrosis-related situations): superglue.

If you know for sure that you don't have an allergy to normal non-medical superglue, you can use that. You can also get specialised medical-grade glue which is probably also more flexible and generally better, but I've never bothered.

I have found this to be the best solution for dealing with cracks, small cuts and small weeping grazes (e.g. skinned knuckles, hangnail injuries) particularly on my hands, where plasters and surgical tape get sweaty and wet and dirty and start getting disgusting, and need to be replaced frequently, which disturbs the area you're trying to protect, and that's before you do whatever you need to do to remove the old dirty sticky residue.

The superglue both glues skin edges closed and provides a hard waterproof dirt-proof barrier which doesn't interfere with hand-washing or doing things with your hands. It also doesn't interfere with keeping hands dry or applying various topical treatments.

(Disinfect all the open wounds first and let the disinfectant evaporate. Don't do this with any injury that looks infected. When I do this for cuts, I first apply a plaster with an antiseptic ointment, and only do the gluing once the bleeding has stopped and I can make sure the cut area is clean and dry.)

For optimal use, apply the glue while the skin is not under tension and any gaps are in the closed position. After a few seconds use a folded up bit of paper towel to rub the surface vigorously from side to side, removing excess glue. (My understanding is that applying enough force perpendicular to the surface causes layers to shear off and prevents sticking.) This helps to apply a thin coat with a matt finish. You don't want to leave an undisturbed thick coat because the glue dries rigid and is brittle. Apply more coats if necessary.

Deep cracks at finger joints which are under a lot of stress are tricky, and it took me a while to figure out how to glue them effectively. Start by filing down the thickened skin with pumice or a nail buffer or a fine heel scraper -- the thick edges exacerbate the cracking. Then resist the temptation to pour glue into the open crack -- that inserts a solid barrier between (for want of a better term) the wet bits that you want to be in direct contact with each other, which also keeps cutting into the crack and making it worse. Close the crack so that the wet bits are touching, and add glue to the outside to glue only the dry bits to each other. Despite your best efforts you may need to reapply glue more frequently to these areas.

(It's fine to put some glue inside an angled cut to glue down a flap of dead skin.)

The glue gradually flakes and chips off by itself over time; I reapply it if necessary.

I've only used this for spot treatment of very small areas. It's probably not safe to glue large areas of skin. Superglue produces some heat when it sets, and some irritating fumes -- don't hold your hands right next to your face when you do this.

Be very careful not to glue together things you don't mean to glue together. Don't attempt this without acetone close at hand (nailpolish remover is fine). You can use the acetone to dissolve the superglue if you have a gluing malfunction (this still occasionally happens to me -- watch out for glue running into your finger while it's curled, or the bottle leaking while you're holding it).

(Again I emphasise that I am not a medical professional. Please observe extreme caution if you try this.)
posted by confluency at 5:31 AM on April 22, 2020

OK, IAARN, IANYRN. I have this! In the past, it would be just once in a while with little outbreaks along the side of one or two fingers. This time, it was the entirety of both hands and feet. It looked like a combination of mange and poison ivy. The itching, pain and burning was just infuriating.

I was at my rheumatologist's office when they took pictures and sent it to a dermatologist they're associated with. The dermatologist did a telehealth appointment with me and said to superglue any big cracks, use Dove soap, get Cutemol cream (it's on Amazon). She also prescribed me a super strong steroid ointment. She wasn't sure what the cause was, but suggested it was from stress (I kind of had a good laugh about that).

The soap makes a difference, the Cutemol is as thick as Elmer's glue, so a little goes a looooong way and doesn't smell bad at all. Due to a comedy of errors with CVS home delivery it took over 10 days to get the ointment (I used Dermaplast alternating with Aquaphor in the meantime and have been eating a lot of Benadryl). I also found that holding something cold helps when my hands really hurt.

It's been two weeks and the blisters have calmed down by about 90% but they're still coming. On the down side, I have epic (and I do mean EPIC) alligator scales on soles of my feet. As much as I'm moisturizing them, they still hurt. I've used a foot exfoliator in the shower and it helps, but you really need to slather them with the cream before putting on socks. I'm also pretty careful about how long I have gloves on - if my hands start to sweat while I have gloves on, I know it's going to make things worse. I did buy 12pr of cotton gloves on Amazon for around $7 and you can wear them under rubber gloves. I bought them to wear with the ointments. They're a bitch to take on and off and you can't use a touch mouse (I cut a tiny hole for my index finger!).

See if you can do a telehealth call with that dermatologist. Take pics with bright lighting so you can show the doctor (they usually can be uploaded beforehand) because you can't effectively get a realistic picture with the computer or phone while online. I totally feel your pain and itchies. Feel better!!
posted by dancinglamb at 9:30 AM on April 22, 2020 [1 favorite]

Is it an option for you to set up a regular in-person appointment with a (new) primary care doctor? I just went in to see my doctor yesterday and was pleasantly surprised by how low-risk it felt -- anyone with covid symptoms (and they asked about them at 4 separate times) was sent to a completely different part of the building while still in their car. The waiting area for my doctor's department was also super empty.
posted by serelliya at 1:18 PM on April 29, 2020

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