What is dyshidrotic eczema?

Dyshidrotic eczema is an ongoing (chronic) skin condition. It's also called pompholyx. It causes a burning, itching feeling. Severe dyshidrotic eczema may also cause a blistering rash. It can affect your palms, the sides of your fingers, and the soles of your feet. It’s most common in people in their 20s, 30s, and 40s. But it can happen at any age. This skin condition is not contagious.

Skin has several layers. The outer layer is the epidermis. Under the epidermis is the next layer called the dermis. The dermis contains blood vessels, nerve endings, hair roots, and sweat glands. With eczema, your skin becomes inflamed. Inflammatory cells of your immune system invade the epidermis. They irritate and destroy some of the tissues there. Eczema is common. It’s also known as atopic dermatitis.

Dyshidrotic eczema is a certain form of this skin inflammation. It can cause mild to severe symptoms. In some cases, symptoms go away in a few weeks with no treatment or just with using hand lotion. More often, it continues over many months or years.

What causes dyshidrotic eczema?

The actual cause is unknown. It tends to be more common in people with other forms of eczema. It also tends to run in families. Other things may increase your risk of having it. These include:

• Having had atopic dermatitis in the past

• Having allergies, such as allergic rhinitis

• Being exposed to allergens or irritants, such as certain metals

• Smoking

• Receiving UV radiation

• Having overactive sweat glands

Certain things can trigger episodes, such as:

• Stress

• Very warm or cold weather

• Very dry or humid air

What are the symptoms of dyshidrotic eczema?

Often the first symptom is sudden itching on the palms, the sides of your fingers, or the soles of the feet. Next, small fluid-filled blisters (vesicles) may start to appear. These cause more intense itching and pain. These blisters may get bigger. In some people, these symptoms can cause a lot of problems with daily activities. The blisters often last for a few weeks before they dry up and flake away.

Dyshidrotic eczema is more likely to affect the hands than the feet. In most cases, the symptoms happen on both hands or both feet.

Some people have symptoms in frequent episodes. The episodes may happen every month or so for months or years. Over time, this may cause ongoing (chronic) hand dermatitis and lead to more symptoms, such as:

• Reddened, hard skin

• Scaling and peeling skin

• Cracks in your skin

• Color changes in your nails

How is dyshidrotic eczema diagnosed?

You may be diagnosed by a general healthcare provider or a dermatologist. A dermatologist is a healthcare provider who specializes in skin diseases.

Your healthcare provider will ask about your health history and your symptoms. Tell them about contact you’ve had to possible irritants. You will also have a physical exam. Your provider will need to make sure your symptoms aren’t caused by other conditions. These may include allergic contact dermatitis, ringworm, herpes, or a rare autoimmune disease. You may also have tests, such as:

• Skin scraping or biopsy. This is done to check for infection or other causes of the rash.

• Patch skin testing. This test looks for allergic causes.

• Blood tests. These are done to check for an autoimmune cause.

How is dyshidrotic eczema treated?

Treatments may include:

• Moisturizing lotion or cream. This helps treat dry skin.

• Steroid ointment. This can reduce inflammation.

• Calcineurin creams. These may also reduce inflammation.

• Steroid medicines taken by mouth (oral). These are used for more severe symptoms.

• Draining of very large blisters. This can reduce pain.

• Treatment with psoralen and ultraviolet light. This is used for people with chronic, severe symptoms.

• Other medicines. Several more targeted injectable or oral biologic medicines have now been approved for treating eczema. Early information suggests these may also help dyshidrotic eczema.

You will need to use moisturizing lotion or cream every day. This helps to treat skin dryness as the blisters heal. If your symptoms don’t decrease, you may need more tests to help check for other possible causes of your symptoms.

What are possible complications of dyshidrotic eczema?

This condition can sometimes let bacteria (such as Staphylococcus) infect the skin. Your healthcare provider may swab your skin to test it for infection. An infection may be treated with antibiotic medicine.

Living with dyshidrotic eczema

General skin care may also help you limit how often and severely your symptoms happen. Your healthcare provider may advise:

• Using lukewarm water instead of hot

• Using mild, fragrance-free cleansers

• Making sure you dry your hands well

• Using cream or petroleum jelly to protect your hands after drying them

• Wearing latex-free gloves when washing dishes

• Wearing gloves if the weather is cold or wet

• Staying away from possible irritants, such as detergents, solvents, or hair products

• Staying away from weather extremes, when possible

Reducing your stress may also help you limit your symptoms.

Key points about dyshidrotic eczema

• Dyshidrotic eczema is a type of skin inflammation. It causes a burning, itching feeling and a blistering rash.

• It can affect your palms, the sides of your fingers, and the soles of your feet. In some people, symptoms can be quite severe.

• You may need tests to help diagnose your condition.

• Steroid ointment and moisturizing lotion or cream are some treatments for the condition.

• General skin care may help you limit how often and severely your symptoms happen.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.