Dyshidrotic Eczema (Dyshidrosis)

Dyshidrotic eczema, also called dyshidrosis or pompholyx, is a type of eczema that causes tiny, itchy blisters and dry skin. It usually affects the skin between your fingers, on your palms and on the soles of your feet.

The fluid-filled blisters look like small, cloudy beads. They’re about 1 to 2 millimeters wide — the size of a pinhead. Sometimes, they join together to form a larger blister. When the blisters dry out, your skin may turn scaly and crack.

Out of all people with hand eczema, 5% to 20% have dyshidrotic eczema. A healthcare provider can help you treat and manage it.

Dyshidrotic eczema symptoms

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

• Small, firm blisters
• Pain or soreness
• Itching
• Peeling or scaling
• Changes in color
• Extra sweating
• Dryness and cracking (after blisters go away)

In severe cases, 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.

Dyshidrotic eczema causes

Healthcare providers don’t know exactly what causes dyshidrotic eczema. They believe that both genes and the environment play a role. This condition can run in biological families. So, if your parent or sibling has it, you might get it, too. Certain things in your environment, like allergens or stress, can also trigger symptoms.

Dyshidrotic eczema isn’t contagious. You can’t catch it from someone else. And you can’t spread it through physical contact.

What triggers dyshidrosis?

A combination of triggers can cause a flare-up, like:

• Allergens or irritants: These are things in your environment that you might be allergic to — like nickel, certain personal care products and some foods.
• Fungal infections: A common example is athlete’s foot, which can trigger a reaction and cause symptoms.
• Moisture: Too much moisture or sweat on your skin from frequent hand washing or wearing gloves at work, sweaty hands or feet, or living in a humid climate may cause a flare-up.
• Seasonal changes: Warm weather and seasonal allergies, like hay fever, could make symptoms worse. Cooler months may calm them down.
• Stress: Both physical and emotional stress can make symptoms feel more severe.

Risk factors of dyshidrotic eczema

Dyshidrotic eczema can affect anyone. But it’s more common if you:

• Are between the ages of 20 and 40
• Are female
• Have a biological family history of eczema
• Have an allergic reaction when you touch something your body doesn’t like
• Get antibody infusions to help fight infections
• Take aspirin or birth control pills

Complications of dyshidrotic eczema

If you scratch the blisters, you might break your skin open. This can lead to an infection. Contact a healthcare provider if you notice an infection. They may give you antibiotics to clear it up.

As the blisters heal, your skin may become dry, peel or form deep, painful cracks. Scratching a lot can also make the skin on your fingers, hands and feet thicker over time.

Because you can see this condition on your skin, it might make you feel self-conscious and make daily tasks harder. This can cause stress. Stress may make your symptoms worse, since it’s a trigger. A provider can help you manage both your skin and your mental health, because your emotional well-being is just as important as your physical health.

How doctors diagnose dyshidrotic eczema

Your healthcare provider will look closely at the affected areas on your skin. They’ll also ask about your health history.

Tell your provider if you started using any new skincare products, wearing new jewelry or eating new foods. This information can help them figure out what might be triggering your symptoms.

Your provider may also suggest tests to confirm the diagnosis, like:

• Allergy test
• Biopsy
• Blood tests

These can also help rule out other conditions that look similar, like:

• Contact dermatitis
• Bullous pemphigoid
• Hand, foot and mouth disease

Dyshidrotic eczema treatment

Treatment for dyshidrotic eczema may include:

• Avoiding triggers: Your provider can help you figure out and avoid things that make your symptoms worse. This may include using unscented soaps, not wearing nickel jewelry and avoiding foods you’re allergic to.
• Creating a skincare routine: This condition weakens your skin’s protective barrier. Using extra moisturizer keeps your skin hydrated. It prevents cracking and dryness.
• Trying at-home remedies: You can manage mild symptoms at home between visits. This can help calm your skin.
• Using medications: Your provider may prescribe creams or lotions to help your skin heal faster.
• Treating the underlying cause: If your symptoms link to an underlying condition like athlete’s foot or excess sweating, your provider will treat those.

At-home treatments

You can do a few things at home to make your blisters more comfortable, including:

• Gently washing the affected areas with mild soap
• Applying an antibacterial cream or ointment
• Covering the areas with a bandage or gauze
• Changing your bandages at least once a day

It can be tempting to pop your blisters, but avoid doing this. The skin over your blisters helps protect the deeper layers from infection.

In addition to caring for blisters, you can try these steps to ease symptoms and help your skin heal:

• Soak your hands and feet in cool water to help you relax.
• Apply a cool compress for 10 to 15 minutes to lessen itching, then air dry and moisturize right away.
• Use unscented moisturizers often throughout the day to help with dryness.

What medications treat dyshidrotic eczema?

Your provider might recommend starting with treatments you can get at your local pharmacy, including:

• Low-strength topical corticosteroid creams (hydrocortisone)
• Oral antihistamines like fexofenadine (Allegra®) or cetirizine (Zyrtec®) 

For more severe cases, your provider may prescribe:

• Stronger topical corticosteroid creams or ointments
• Topical calcineurin inhibitors like tacrolimus or pimecrolimus
• Other topical nonsteroid medications
• Oral corticosteroids like prednisone
• Systemic immunosuppressive medications like methotrexate, mycophenolate or injections like dupilumab 
• Phototherapy (light therapy)

When should I see my healthcare provider?

Call your healthcare provider if you feel new or worsening symptoms. Let them know right away if you notice signs of an infection, like:

• Pus
• Severe pain
• Swelling
• Warmth to the touch
• Yellow crusting

What can I expect if I have dyshidrotic eczema?

Dyshidrotic eczema symptoms usually flare up and last about three to four weeks before clearing up. This condition affects everyone differently. You might only have symptoms once. Or you might have frequent flare-ups when you contact triggers like allergens, sweat or stress.

If you have repeated flare-ups, the condition may change your skin over time. Your skin could become dry, cracked or thicker. It can even affect your mental health if flare-ups keep happening. Treatment can help you avoid triggers and manage symptoms so they’re less uncomfortable.

Taking good care of your skin is a great first step to help you feel better. Your healthcare provider can work with you to manage this condition and keep your skin as healthy as possible.

How can I prevent dishydrotic eczema flare-ups?

To lower your risk of new symptoms or flare-ups:

• Use warm (not hot) water when washing your hands and wash your skin right after touching an allergen or known trigger
• Use gloves when washing dishes or handling harsh chemicals
• Skip new jewelry if you aren’t sure what it’s made of, and you have a metal allergy
• Dry your hands and feet well after bathing or swimming