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Dyshidrotic Eczema

Dyshidrotic eczema, also known as pompholyx, is a type of eczema that causes itchy, fluid-filled blisters on the palms of the hands or feet. Once blisters clear, the area is often dry, cracked and sore. Pompholyx is a long-term condition that comes and goes, but treatment usually controls symptoms.

Last Modified: September 5, 2023
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What Is Dyshidrotic Eczema?

Dyshidrotic eczema is a common type of skin condition that presents with itchy blisters on the hands, toes and soles of the feet, typically lasting 2 to 3 weeks.

This type of eczema may suddenly flare up. The warning signs are a tingling or burning feeling in the affected area. After the flare-up, skin fissures or painful cracks may appear and even bleed.

Causes of Dyshidrotic Eczema

The exact cause of dyshidrotic eczema isn’t known. However, researchers believe the cause is a combination of genetics and environmental triggers, which can internally and externally impact the body. Risk factors of dyshidrotic eczema include:

  • Metals, and contact with them, including nickel, cobalt or chromium salts, though the precise nature of the cause relating to metals is unclear
  • Substances such as detergents, household chemicals or cosmetics
  • A history of atopic dermatitis
  • Receiving UV radiation
  • Smoking
  • Sweaty hands or feet, particularly in the case of individuals who must wear gloves for work or in the case of individuals with overactive sweat glands
  • Conditions that cause immunocompromise, such as HIV/AIDS
  • Seasonal allergies

Triggers also include stress, temperature extremes, and dry or humid air. It occurs most often during the ages of 20 to 40, and some evidence suggests it occurs more frequently in women.

There have been reported cases of dyshidrotic eczema following the use of Intravenous immunoglobulin (IVIg), which is increasingly used across multiple specialties to treat inflammatory and autoimmune diseases.

Symptoms of Dyshidrotic Eczema

The main symptoms of dyshidrotic eczema are an initial prickly or burning feeling, followed by the development of tiny, transparent blisters that are intensely itchy or painful.

Blisters typically clear in 3 to 4 weeks, after this the skin in the area will peel and feel dry. People with a darker skin tone may develop lingering dark spots. Cracks in the skin often develop, which are painful and may bleed.

Over time, flare-ups can lead to itchy or scaly, thick, dry skin with deep cracks. People with longstanding dyshidrotic eczema can also develop pits and ridges in their nails.

A doctor or a dermatologist can best diagnose dyshidrotic eczema. This is because other conditions may cause similar symptoms, such as nummular eczema, contact dermatitis, bullous impetigo, pustular psoriasis, ringworm, herpes, and hand, foot and mouth disease.

Signs of Infection

Because blisters are so itchy, people with the condition tend to scratch them, which can lead to a skin infection if the blisters open. The wounds can become exposed to germs, such as the Staphylococcus bacteria. Without medical care, such as antibiotics, this infection can lead to a more severe infection called cellulitis.

Signs of a skin infection include swelling, redness, pus, a yellow crust on the blistered area, and even fever. See your doctor immediately if you experience these symptoms.

Should You See a Dermatologist or Doctor?

Because dyshidrotic eczema affects the hands and feet, it can seriously interfere with the work of someone who uses their hands in their job, so it’s best to see a doctor before the condition worsens.

You may need tests to diagnose dyshidrotic eczema, so it’s best to have a doctor or dermatologist confirm the diagnosis, especially if you have never experienced these symptoms.

The treatment may involve prescription medications or creams that only a dermatologist can provide, and they can also offer ongoing symptom management in the way of effective skin care.

How to Treat Dyshidrotic Eczema

Dyshidrotic eczema is incurable, but it’s possible to manage symptoms and prevent flare-ups with the proper treatment.

The eczema treatment dermatologists provide includes steroid ointments and calcineurin creams to reduce inflammation. Your medical practitioner may prescribe oral steroids in the case of severe symptoms. Over-the-counter antihistamines can help relieve itching.

Hands require more potent topical steroids because the skin is thicker. It’s essential to moisturize while using topical steroids, which can dry the skin. For this reason, it’s advisable to use emollients (medical moisturizers) to wash and keep the skin moisturized during the treatment period.

Medical providers sometimes drain large blisters, reducing pain. It’s best for a dermatologist to do this to avoid infection.

For people with chronic, severe symptoms, dermatologists use PUVA, a type of ultraviolet radiation treatment, sometimes combined with a light-sensitive plant substance called psoralen. In addition, early information suggests a targeted treatment known as injectable biologic medicines can help with dyshidrotic eczema.

How to Prevent Dyshidrotic Eczema

Although this condition may not always be preventable, there are some practical tips for managing dyshidrotic eczema flare-ups.

  • Use lukewarm water: Cold or hot water may irritate the skin, so use lukewarm water with an emollient instead of soap. Remove rings before washing hands.
  • Reapply moisturizer: Your dermatologist may recommend a barrier cream that allows your skin to breathe while protecting it. Petroleum jelly also protects sensitive skin.
  • Wear cotton or silk fabrics: Socks and gloves should be breathable fabrics. If wearing waterproof gloves, wear cotton gloves inside them to control sweating and protect them from water. Socks should be moisture-wicking and footwear permeable if possible.
  • Bandage or wrap affected area: Covering the skin provides relief and ensures creams and ointments are absorbed. Cover any weeping blisters with a nonstick dressing.
  • For painful cracks: After treatment, if cracks remain, a hydrocolloid dressing can help skin heal because it provides a moist environment while protecting the skin.

It’s important to not scratch affected areas. If itching interferes with sleep, an antihistamine may be helpful at night. During a flare-up, avoid possible irritants and weather extremes if possible.

Reducing your stress may also help prevent your symptoms from becoming worse.
Good general skin care may help you limit the frequency and severity of dyshidrotic eczema.

Please seek the advice of a medical professional before making health care decisions.