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Dyshidrotic Eczema

What is dyshidrotic eczema?

A sudden rash of small, intensely itchy, water-filled blisters on the feet or hands is usually the first symptom of dyshidrotic eczema. The blisters can form on palms and soles and the sides or tips of fingers and toes.

“Although dyshidrotic eczema involves limited areas of the body, it can have a big impact on patients,” said Dr. Gil Yosipovitch, MD, professor and director of the Miami Itch Center at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Florida.

“It can affect social interactions — you may not want to shake hands, for example. And, unlike some forms of eczema, you don’t usually cover it with clothes, so it’s visible to others,” he said.

Dyshidrotic means “disordered sweating.” While sweat itself doesn’t cause the condition, having moist palms and soles can trigger flares because they can lead to itching and scratching.

“The actual cause of dyshidrotic eczema isn’t known, though it runs in families and is linked to fungal infection in the hands or feet,” Yosipovitch said.

The condition is also called pompholyx (which means “bubble” in ancient Greek), foot-and-hand eczema, palmoplantar eczema and vesicular eczema.

Symptoms of dyshidrotic eczema

Flares happen only on the hands and feet and usually begin with a rash of painful, deep-seated blisters called vesicles, although sometimes itching and burning sensations begin first. As blisters heal, the skin dries and often reddens and peels. This leaves it tender and dry and sometimes creates painful fissures or cracks. Skin can also become infected.

Symptoms can range from mild to severe and debilitating. Sometimes, for example, smaller blisters can merge and form larger, puffier blisters that weep fluid. When blisters affect the soles of the feet, walking can be painful.

“It’s hard to function without the use of your hands or feet, and more severe cases can affect your ability to do personal care and day-to-day tasks,” Yosipovitch said.

Who gets dyshidrotic eczema and why 

Dyshidrotic eczema is most common in younger adults, typically between the ages of 20 and 40. People can have a single flare of dyshidrotic eczema, but it’s more common for it to come and go over long periods of time.

Metals, particularly nickel, are a common trigger. This eczema can overlap with some other types, including contact dermatitis and atopic dermatitis, which affects about half of people with dyshidrotic eczema.

One of its most frequent triggers is stress, Yosipovitch noted.

“It’s very common to see emotional stress induce or exacerbate this type of eczema,” he said. “A college student may be in the midst of exams, for example, and suddenly develop blistering at the fingertips.”

The condition is also linked to seasonal allergies like hay fever, and to hot, humid weather. As noted, sweaty palms can trigger the rash, as can doing a job such as hair styling or health care that entails frequently getting the hands wet.

Dyshidrotic eczema can also develop in people receiving infusions of immunoglobulin, a treatment for disorders that make it hard for the immune system to fight infection. 

Treating dyshidrotic eczema

Dermatologists can usually diagnose dyshidrotic eczema with a skin exam and medical history. Many cases improve quickly with a short course of topical corticosteroids combined with soaking or applying cool compresses to affected areas a few times a day to help dry out blisters. If you have a fungal infection, your dermatologist may prescribe an anti-fungal medication.

Areas of dyshidrotic eczema are also at risk for bacterial skin infections, which can delay or prevent healing. If you develop swelling, crusting, pain or pus-filled blisters, visit your dermatologist to check for bacterial infection, which requires treatment with oral antibiotics.

When dyshidrotic eczema is severe or flares happen often, dermatologists may prescribe light therapy, topical calcineurin inhibitors (TCIs) or oral steroids. Occasionally, botulinum toxin injections are used to control the sweaty hands and feet that can trigger the condition.

“It’s important to identify and avoid triggers and to keep skin moisturized,” Yosipovitch recommended. “When the skin barrier isn’t intact, patients should use a heavy cream that includes ingredients like ceramides that help repair it.”