Pompholyx (dyshidrotic eczema)

Your skin may develop bumps or blisters that look like tapioca pearls. These blisters are typically one to two millimeters in diameter. The blisters may come together to form one large blister.

Dyshidrotic Eczema (Dyshidrosis)

Dyshidrotic eczema is a common skin condition that causes blisters and itchy skin. Healthcare providers aren’t sure what causes dyshidrotic eczema. Triggers may include allergies, stress and frequently moist or sweaty hands and feet. Effective treatments include at-home treatments, therapies and prescription medicines.

Overview

Dyshidrotic eczema causes dry, scaly patches of skin with blisters. These symptoms are common on your hands and feet.

What is dyshidrotic eczema?

Dyshidrotic eczema is a chronic (long-term) skin condition that causes small blisters and dry, itchy skin. It usually develops on your fingers, hands and feet. Other names for dyshidrotic eczema include dyshidrosis, acute palmoplantar eczema, vesiculobullous dermatitis and pompholyx.

Who does dyshidrotic eczema affect?

Dyshidrotic eczema can affect anyone. However, it most commonly affects people:

• Between the ages of 20 and 40.
• Assigned female at birth.
• With a personal or family history of eczema.
• With a personal or family history of contact dermatitis.
• Who develop allergic reactions when they touch an antigen, which is a foreign substance that causes an allergic reaction.
• Who receive immunoglobulin infusions. Intravenous immunoglobulin (IVIG) is an injection of antibodies for people with an immune deficiency.

About 50% of dyshidrotic eczema cases occur in people who have allergic reactions when they touch an antigen. Researchers think that people assigned female at birth may be more likely to develop dyshidrotic eczema because they more frequently interact with certain antigens, like nickel and cobalt in jewelry.

How common is dyshidrotic eczema?

In occupational or clinical settings, dyshidrotic eczema accounts for 5% to 20% of all cases of hand dermatitis.

How does dyshidrotic eczema affect my body?

Dyshidrotic eczema affects the skin around the palms of your hands, fingers and soles of your feet.

Your skin may develop bumps or blisters that look like tapioca pearls. These blisters are typically one to two millimeters in diameter. The blisters may come together to form one large blister.

After your blisters have dried out, they may become scaly and cracked.

Symptoms and Causes

What are the symptoms of dyshidrotic eczema?

Dyshidrotic eczema causes symptoms that come and go. These symptoms may last for several weeks at a time. The most common symptoms of dyshidrotic eczema include:

• Small, firm blisters on the sides of your palms, fingers and soles.
• Painful blisters.
• Itchy, scaly skin on or around your blisters.
• Increased sweat around your blisters.
• Dry, cracked skin that appears as blisters fade.

The skin on your fingers, hands and feet may thicken if you scratch them frequently. Large blisters or large areas of blisters may become infected.

What triggers dyshidrosis?

Healthcare workers and researchers don’t know exactly what causes dyshidrosis. A combination of triggers can cause dyshidrosis flare-ups, including:

• Immune system activation: If you have dyshidrotic eczema, your immune system reacts to minor irritants or allergens. This overreaction can inflame your skin.
• Allergies: Exposure to certain substances, including cement, nickel, cobalt and chromium, may trigger dyshidrotic eczema. Other allergies, including hay fever (allergic rhinitis) or food allergies, may also cause flare-ups.
• Moisture: Frequently sweaty or wet hands or feet may trigger dyshidrotic eczema.

Can dyshidrosis spread?

In severe cases, dyshidrosis blisters may get bigger and spread to the backs of your fingers, hands and feet. They won’t spread to other parts of your body.

Is dyshidrotic eczema contagious?

Dyshidrotic eczema isn’t contagious. You can’t spread it to another person.

If you scratch your blisters, you may break your skin, which can lead to infections. If your blisters become infected, contact your healthcare provider. They may prescribe antibiotics to clear your infection.

Diagnosis and Tests

How is dyshidrotic eczema diagnosed?

Your healthcare provider will examine the affected areas on your skin. They may ask if you’re undergoing significant stress or have a personal or family history of dyshidrotic eczema. They may also ask if you’ve recently started using new skin care products, wearing new jewelry or eating new foods.

What tests will be done to diagnose dyshidrotic eczema?

Your healthcare provider may perform several tests to confirm their diagnosis or rule out conditions that look similar to dyshidrotic eczema, including contact dermatitis, bullous pemphigoid and hand, foot and mouth disease. The tests may include:

Management and Treatment

How do you get rid of dyshidrotic eczema?

For many people, getting rid of dyshidrotic eczema starts with an at-home skin care routine. Home care may include:

• Using warm water instead of hot water when washing your hands.
• Soaking your hands and feet in cool water to improve your symptoms.
• Applying cool compresses as needed to relieve itching and irritation. Soak a clean washcloth with cool water and hold it to your skin for 10 to 15 minutes. Allow the water to partially evaporate (air dry) and then immediately apply moisturizer. Repeat this three to four times per day.
• Applying moisturizers frequently each day to improve dry skin.
• Thoroughly drying your hands and feet after bathing or swimming.
• If possible, don’t wear gloves, socks or shoes. If you must, wear gloves that repel or absorb moisture, cotton or wool socks that absorb moisture and loose shoes.

Your healthcare provider may recommend over-the-counter (OTC) medications such as topical corticosteroid creams or ointments that you rub directly on your skin. They may also recommend oral antihistamine pills, including fexofenadine (Allegra®) or cetirizine (Zyrtec®), that you swallow with water. These medications help reduce inflammation and itching.

What prescription medications or treatments are used to treat dyshidrotic eczema?

In more severe cases of dyshidrotic eczema, your healthcare provider may prescribe or recommend the following medications or treatments to help relieve your symptoms:

• System-wide corticosteroids: If corticosteroid creams or ointments don’t relieve your symptoms, your healthcare provider may prescribe an oral corticosteroid, like prednisone (Deltasone®).
• System-wide nonsteroidal immunosuppressive drugs: Long-term use of oral steroids may be unhealthy, so your healthcare provider may prescribe medications such as methotrexate tablets (Rheumatrex®), mychophenolate tablets (CellCept®) or dupilumab injections (Dupixent®).
• Phototherapy: Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps. The ultraviolet light waves in the light can help certain skin disorders, including dyshidrotic eczema. UVB can cause permanent dark spots (hyperpigmentation) in darker skin color, so it’s a good idea to check with your healthcare provider if you have darker skin.

What is the fastest way to get rid of dyshidrotic eczema?

Your body is unique. You may respond well to an at-home skin care routine and OTC medications, or you may require prescription-strength corticosteroid creams or ointments, like clobetasol (Cormax®).

Dyshidrotic eczema usually goes away with treatment, but it may come back later. You may need to follow a specific skin care routine at home or continue using medication to reduce your symptoms.

Pompholyx (dyshidrotic eczema)

Pompholyx causes itchy blisters on the hands or feet that come and go. The symptoms usually last 2 to 3 weeks at a time.

The first symptom is often a burning or prickling feeling in the affected area.

Fluid-filled blisters then appear on the skin. These are usually very itchy and may leak fluid.

When the blisters go away, the skin may be dry, cracked and sore. Sometimes it might bleed. Pompholyx most often affects the fingers and palms.

DR. P. MARAZZI/SCIENCE PHOTO LIBRARY

It can also affect the toes and soles of the feet.

ISM/SCIENCE PHOTO LIBRARY
https://www.sciencephoto.com/media/1159184/view

If you’re not sure it’s pompholyx

Other conditions can cause sore, itchy patches or blisters on the hands and feet, including hand, foot and mouth disease, psoriasis or athlete’s foot.

Do not try to diagnose yourself – see a GP if you’re worried.

Non-urgent advice: See a GP if:

• you think you have pompholyx
• you have pompholyx and the blisters are very painful, leak yellow or green pus or are covered in a yellow-brown crust – these are signs of an infection
• you have any other changes to your skin you’re worried about

Treatments for pompholyx

Pompholyx is usually a long-term condition that comes and goes over time. Treatment can help control the symptoms.

The main treatments for pompholyx are:

• moisturisers (emollients) – used every day to stop the skin becoming dry
• steroid creams and ointments (topical steroids) – used for a few weeks at a time to reduce irritation and soreness

If the blisters leak fluid, a GP may suggest soaking your skin in potassium permanganate solution. This helps dry the blisters and reduces the risk of them getting infected.

If the blisters become infected, a GP may prescribe antibiotics.

Treatments from a specialist

If your symptoms are severe or treatment is not helping, a GP may refer you to a skin specialist (dermatologist).

A dermatologist may recommend other treatments, such as:

• steroid tablets
• treatment with ultraviolet (UV) light
• other medicines, such as alitretinoin

Things you can do to ease symptoms of pompholyx

If you have pompholyx, your skin may get irritated easily. There are some things you can try to see if they help.

Don’t

A pharmacist can help with pompholyx

If your skin gets very itchy and it affects your sleep, ask a pharmacist about antihistamines that make you drowsy (sedating antihistamines).

If you take these before going to bed, they can help you get to sleep.

What causes pompholyx

It’s not clear exactly what causes pompholyx.

Certain things are thought to cause symptoms in some people, including:

• contact with strong chemicals like soaps, cleansers and detergents
• an allergy or sensitivity to certain metals, such as nickel or cobalt
• getting your hands wet regularly – for example, if you’re a hairdresser
• stress
• heat and sweat

Information:

If you notice something causes your symptoms, avoiding it as much as possible may help keep your symptoms under control.

Page last reviewed: 02 March 2022
Next review due: 02 March 2025

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