An Overview of Dyshidrotic Dermatitis

Hand closeup with eczema

 Daniel Bruno / Getty Images

In This Article

Table of Contents

This condition goes by several different names—dyshidrotic dermatitis, dyshidrotic eczema, foot-and-hand eczema, and pompholyx. Symptoms include small, itchy blisters over the palms, fingers, or feet. These progress to scaly spots over the course of several weeks.

The word dyshidrotic is used because it was, at one point, believed that this condition was caused by sweat gland malfunction, but this association has been refuted. The name pompholyx comes from the Greek word for bubble, which accurately describes this disorder.

Symptoms

The rash of dyshidrotic dermatitis occurs on the hands and feet. The majority of cases involve the palms and sides of the fingers. The soles of the feet and between the toes can also be involved.

Dyshidrotic eczema is a chronic condition so once you've developed it, it will most likely recur.

Symptoms of the condition include:

  • Deep-seated vesicles (small, fluid-filled bumps)
  • Red, inflamed skin
  • Intense itching
  • Dry, scaly, cracked patches
  • Peeling skin
  • Pain and burning

The rash can begin quite suddenly, as a crop of clear, tapioca-like vesicles that appear in clusters. The vesicles resolve in three to four weeks and are replaced by 1- to 3-millimeter rings of scale. These patches may crack and peel before the skin ultimately heals.

The vesicles can sometimes blend into each other, becoming rather large blisters.

Open blisters are at risk of becoming infected. Signs of infection include increased redness, heat, pain, swelling, oozing, or crusting. If you notice signs of infection, you should call your doctor.

Burning and itching may precede a breakout. This condition can also be painful, to the point of making walking or using your hands difficult.

Chronic dyshidrotic eczema leaves the skin reddened, thickened, and with deep cracks, especially if it has been repeatedly scratched. It may also cause changes in the nail.

Dyshidrotic eczema is not contagious.

Causes

Nobody knows for sure what causes dyshidrotic dermatitis. Even today, it is a misunderstood condition.

It was once thought that dyshidrosis eczema was caused by a dysfunction of the sweat glands. Today, it's known that the condition is not caused by an abnormality of the sweat glands, but rather occurs around the glands.

Dyshidrotic eczema is most common between the ages of 20 and 40, although it may appear at any age. Women are twice as likely to develop the condition than men.

There is a strong link between this condition and atopic dermatitis. Almost 50% of those with dyshidrotic dermatitis also have atopic dermatitis.

This leads some to believe that dyshidrotic dermatitis is a form of atopic dermatitis on the hands and feet.

It's also more common in those with seasonal allergies, and those with a history of contact dermatitis. You are also more likely to develop it if you have relatives who also have dyshidrotic eczema.

Those who are on intravenous immunoglobulin therapy have a higher risk of developing the condition.

Trigger Factors

There are many factors that can trigger a flareup of dyshidrotic dermatitis. Triggers factors don't cause the condition, but they can contribute to a flareup or make an existing rash worse.

Contact with metal, especially nickel. This includes things like zippers, jewelry, coins, and belt buckles. Metal allergy may be a very important trigger factor, with some studies showing avoidance of metal completely clearing up the condition.

Ingestion of allergens, such as chromate, neomycin, quinoline, cobalt, or nickel, may trigger some cases. Diets that restrict nickel or cobalt, for example, may be suggested in cases that aren't getting better with other treatment may be suggested. The drawback is they are very hard to stick to long term.

Prolonged damp hands or feet. People with professions that require hands be in contact with water many times per day (for example, hair stylists and those in the medical field) may develop dyshidrotic eczema on their hands. Spending long periods of time in damp socks can trigger a flare on the feet.

Hyperhidrosis, or excessive sweating, may trigger a flareup because not only does it keep the skin damp for long periods of time, sweat itself is also high in nickel which may irritate the skin.

Extremes in weather, either very hot or very cold, or changes in humidity from very dry to very humid may trigger a flare. For some people, dyshidrotic eczema is worse during the change of seasons.

Emotional stress can make dyshidrotic dermatitis worse but does not cause it.

Diagnosis

There is no specific test that can definitively diagnose dyshidrotic eczema. Instead, dyshidrotic eczema is generally diagnosed by a physical exam, coupled with a detailed medical history.

Your physician will ask about any allergies, your profession, and your hobbies. (Asking about your work and your hobbies gives your doctor insight into the substances that your skin may come in contact with.)

If there is any uncertainty, your physician may also order:

  • A skin scraping or biopsy to check for infection
  • Patch testing to check for allergens
  • Blood testing to test for, among other things, allergies and autoimmune disorders

Dyshidrotic eczema is often misdiagnosed, as can easily be confused with other skin problems like:

Treatment

There is no cure for the condition, but it can be managed.

Most attacks resolve spontaneously within one to three weeks, but since the rash can be intensely itchy, medications may be used to speed healing or control the itching.

In some cases, medications must be used to help keep dyshidrotic eczema under control.

Topical steroids are used as first-line treatments to help control itching and reduce inflammation. Because the skin of the hands and feet is thick and absorb medication slowly, high strength steroids are prescribed.

Topical calcineurin inhibitors have been shown to be effective in some cases. These are non-steroid medications that help stimulate anti-inflammatory compounds to be released in the skin.

Oral steroids may be used for short courses in severe cases and during acute flares.

Immunosuppressants (such as methotrexate) are sometimes prescribed in severe cases that aren't responding to other treatments. They're most often used along with other therapies.

Over-the-counter oral antihistamines don't improve the rash itself, but may help relieve itching. Ask your doctor if these may be of help in your situation.

Wet dressings can be used to soothe and relieve itching. A cloth, dampened with water or Burrow's solution (aluminum subacetate) is applied to the affected areas several times per day. Follow your doctor's instructions and guidance for wet wrap therapy.

Oral antibiotics are sometimes prescribed if the rash has become infected. Treating infection may help clear up the rash.

Botox injections don't treat dyshidrotic eczema rash per se, but they can be used to treat hyperhidrosis of the hands or feet. Stopping excessive sweating can help reduce flareups if sweat and damp skin is a personal trigger factor.

Large blisters can be drained by a health care provider; doing so can help reduce pain.

Most people need a combination of treatments to see really good improvement of the rash.

Prevention

Although it's not possible to completely prevent a flareup, with careful treatment you can greatly reduce the frequency of flareups. Knowing your personal triggers is the best defense for preventing future outbreaks of the condition.

  • Keeping the skin well-moisturized. This helps keep the skin's barrier healthy and less likely to become irritated. Apply after every shower, hand washing, and throughout the day as needed. Hypo-allergenic, fragrance-free products are preferred.
  • Use gentle hand cleansers to avoid stripping and drying the skin.
  • Protect your hands and feet. Use waterproof gloves when cleaning or washing dishes, soft cotton gloves if working in the yard. Moisture-wicking socks keep your feet cool and dry.
  • Try removing metal allergens to see if that causes an improvement of symptoms.

A Word From Verywell

The intense itch and pain of dyshidrotic eczema make it a maddening condition to deal with. Remember, prevention is the best defense. Try your best to identify and avoid your personal triggers. Your physician can help you determine what those triggers may be, as well as devise an appropriate treatment plan for you.

Was this page helpful?

Article Sources

  1. Lee WJ, Lee DW, Kim CH, et al. Pompholyx with bile-coloured vesicles in a patient with jaundice: are sweat ducts involved in the development of pompholyx? J Eur Acad Dermatol Venereol. 2010 Feb;24(2):235-6. doi:10.1111/j.1468-3083.2009.03383.x


Additional Reading