- Pompholyx (dyshidrotic eczema)
- Similar skin conditions
- Likely suspects that cause dyshidrotic eczema
- Treatment options for dyshidrotic eczema
- “I Got Blisters On My Fingers!”
- Causes of blisters
- When to see your doctor about blisters
- Blister treatment
- Prevention of blisters
Signs and Symptoms
The most common locations for athlete’s foot include:
- Spaces (webs) between the toes, especially between the 4th and 5th toes and between the 3rd and 4th toes
- Soles of the feet
- Tops of the feet (very unusual in children)
Athlete’s foot may affect one or both feet. It can look different, depending on which part of the foot (or feet) is involved and which dermatophyte has caused the infection:
- Between the toes (the interdigital spaces), athlete’s foot may appear as inflamed, scaly, and soggy tissue. Splitting of the skin, called fissures, may be present between or under the toes. This form of athlete’s foot tends to be quite itchy.
- On the sole of the foot (the plantar surface), athlete’s foot may appear as pink-to-red skin with scales ranging from mild to widespread (diffuse).
- On the top of the foot, athlete’s foot appears as one or more red, scaly patches ranging in size from 1–5 cm. The border of the affected skin may be raised and may contain bumps, blisters, or scabs. Often, the central portion of the lesion is clear, leading to a ring-like shape and the descriptive (but inaccurate) name “ringworm.”
- Another type of tinea infection, called bullous tinea pedis, appears as painful and itchy blisters on the arch (instep) and/or the ball of the foot.
- The most severe form of the infection, called ulcerative tinea pedis, appears as painful blisters, pus-filled bumps (pustules), and shallow ulcers. These lesions are especially common between the toes but may involve the entire sole. Because of the numerous breaks in the skin, lesions commonly become infected with bacteria. Ulcerative tinea pedis occurs most frequently in people with diabetes and others with weakened immune systems.
Pompholyx (dyshidrotic eczema)
The dermatologist will discuss with you the most appropriate treatment options for your condition. These may include phototherapy and more potent medication, such as immunosuppressants.
Similar skin conditions
Conditions that can have a similar appearance to pompholyx include:
- bullous impetigo – a contagious skin infection that mainly affects children and causes sores and blisters
- bullous pemphigoid – a blistering skin condition that tends to affect the elderly
- contact dermatitis – a type of eczema caused by skin contact with a substance that causes irritation or an allergic reaction
- hand, foot and mouth disease – a viral infection that mainly affects young children, which can cause small blisters to develop on the fingers and palms of the hands
- herpetic whitlow (whitlow finger) – an abscess (collection of pus) at the end of the finger that can cause it to become suddenly red, swollen, painful and blistered
- pustular psoriasis – an uncommon type of psoriasis that causes pus-filled blisters to appear on your skin
- Find out more about pompholyx (dyshidrotic eczema) on the NHS website
Joan Wanamaker has lived with eczema practically since birth. She’s had all the various subtypes, co-occurring at different times in her life, with hand eczema being her constant (yet unwanted) companion.
“A few years ago, my doctor told me it’s dyshidrotic eczema,” Wanamaker said. “He prescribed a succession of different creams, and eventually a topical steroid worked.”
With all the recent advances in eczema research, treating dyshidrotic eczema is still pretty much hit-or-miss, according to Dr. Elaine Siegfried, a professor of pediatrics and dermatology at Saint Louis University School of Medicine in St. Louis. She believes dyshidrotic eczema is the least understood of the condition’s many subtypes.
Even its name creates confusion: “The term dyshidrotic means ‘disordered sweat.’ It was first coined in the late 19th century, reflecting the belief that a malfunction of the sweat glands in the hands caused this type of eczema. Today, we know that sweat may trigger the itch-scratch cycle, but it doesn’t actually cause eczema,” Siegfried explained.
Dyshidrotic eczema goes by several other names, such as palmoplantar eczema, foot-and-hand eczema, vesicular eczema and pompholyx. This last term comes from the Ancient Greek word for “bubble.”
That’s what the condition’s characteristically small blisters looked like to our forebears-and the name stuck. It’s still used today, but dyshidrotic eczema is the most common term for the small, itchy blisters that appear on the edges of the fingers as well as the palms of the hands and soles of the feet, often quite suddenly.
At their most severe, the blisters can be painful and even crippling. As a child at summer camp, Wanamaker developed them on her feet. “It was painful to walk,” she said, “and it took all summer for them to clear up. Apparently, I had an allergic reaction to the chemicals in the swimming pool. What’s puzzling is that the very next year, I had no problem with the pool chemicals. Over the years, my triggers have changed.”
Still, knowing and avoiding your triggers remains the first line of defense against dyshidrotic eczema.
Likely suspects that cause dyshidrotic eczema
An overview of dyshidrotic eczema on Medscape estimates that close to 50 percent of those who develop dyshidrotic eczema already have atopic dermatitis (AD), making already existing eczema a leading risk factor. Clearly, explained Siegfried, there’s a genetic component to the condition.
Adult females between ages 20 and 40 are at particular risk. However, many triggers of dyshidrotic eczema fall into the “manageable” category, including nickel, cobalt, balsam and bacterial or fungal infection, with nickel considered the prime suspect.
“Some doctors believe that an allergy to nickel is the principal cause of dyshidrotic eczema,” Siegfried said, given the high levels of nickel in sweat and the concentration of sweat glands in the palms and soles of the feet.
“There’s no consensus yet among experts about this, but patients can test the nickel hypothesis by consulting a nutritionist and trying a nickel-free diet for six weeks to see if it helps clear the blisters.” Editor’s Note: The wellness newsletter Healthline offers a list of popular nickel-containing foods.
Avoiding such everyday objects as nickel-rich coins, zippers, cellphones, belt buckles and eyeglass frames can also help to confirm or rule out nickel as a trigger in some people with the condition. For a comprehensive list of sources of nickel, see the Mayo Clinic’s nickel allergy fact sheet.
Dyshidrotic eczema is also strongly linked to seasonal allergies, especially to changes in humidity. It normally takes six weeks for the body to adapt to seasonal change, said Siegfried. And by the time a person adapts, the season might start changing again.
Treatment options for dyshidrotic eczema
That doesn’t mean patients should throw up their hands and give up. The most important step is to get a proper diagnosis.
“Dyshidrotic eczema can mimic contact dermatitis and even palmoplantar pustulosis, a type of psoriasis appearing on the hands and feet,” said Siegfried. “The only way to tell which is which is with a biopsy. Without a definitive diagnosis, patients could receive suboptimal treatment.”
On the positive side of the line, people with the condition have several options. In addition to avoiding triggers, Siegfried pointed to the following treatments and their limitations. “Topical corticosteroid cream can be helpful as a quick-acting remedy,” she said.
“Think of it as the ‘hare’ in the fable of ‘The Tortoise and the Hare.’ It may get quick results, but it can also weaken the skin over time, leading to a cycle of flare and remission.It’s best to switch to another therapy after a couple of weeks, such as a topical calcineurin inhibitor or phototherapy.”
Over the years, Wanamaker has tried all these and more. Her grandmother used to create a paste from cornstarch and water and apply it to her young granddaughter’s hands—a home remedy that brought short-term relief for her itchy skin.
As an adult, Wanamaker remains open to “exploring and experimenting” with a variety of options, from nutrition to natural cleaning products. She and her husband enjoy making their own soap, shampoo and laundry detergent, using tallow and local plants found near their home in Orange County, New York, during the summer.
And they’re hopeful that better treatments are on the way. We’re at the dawn of the “decade of eczema,” as Siegfried sees it. With all the medications in the pipeline for AD, can dyshidrotic eczema be far behind?
Elaine Siegfried, MD is a member of NEA’s Scientific Advisory Committee and Director of Pediatric Dermatology at SSM Health Cardinal Glennon Children’s Hospital. She is board certified by the American Board of Dermatology in both Dermatology and Pediatric Dermatology. She is also a Professor of Pediatrics and Dermatology at Saint Louis University School of Medicine.
Pause for a second and think about the looong list of things you use your hands for every day. Then consider how annoying and difficult it would be to accomplish those tasks if your palms were covered in small, incredibly itchy blisters. Ditto for your feet. Unfortunately, this is just life for some people with dyshidrotic eczema.
If you haven’t heard of this kind of eczema, don’t worry, it doesn’t mean you’re out of the loop. Though there are a few different forms of the condition, atopic dermatitis (often thought of as “classic eczema”) typically takes center stage. But dyshidrotic eczema, also called dyshidrosis, can be just as frustrating as its more well-known relative. Here are a few important things you should know about dyshidrotic eczema, plus what to do if you suspect you have it.
What is dyshidrotic eczema, and who’s most likely to get it?
Dyshidrotic eczema happens when your skin can’t protect itself as well as it should, so it gets itchy, dry, and erupts into teeny tiny blisters, according to the American Academy of Dermatology (AAD). People with this condition usually develop small blisters on their palms and the sides of their fingers, but sometimes the blisters can show up on the soles of their feet, too.
These blisters typically last for up to three weeks, according to the Mayo Clinic, and they come with another dyshidrotic eczema hallmark: “ typically very, very itchy,” Bruce A. Brod, M.D., clinical professor of dermatology and co-director of the Occupational and Contact Dermatitis Program at Penn Medicine, tells SELF.
Doctors don’t know why some people get dyshidrotic eczema and others don’t, Cynthia Bailey, M.D., a diplomate of the American Board of Dermatology and president and CEO of Advanced Skin Care and Dermatology Inc., tells SELF. That said, there are a few things that can raise your risk of developing the condition, per the AAD:
- Being between 20 and 40 years old
- Having atopic dermatitis, contact dermatitis (skin inflammation that happens after you touch an irritating substance), or hay fever (experiencing an allergic response to indoor or outdoor allergens)
- A family history of dyshidrotic eczema
- Having sweaty or moist hands
- Wetting your hands throughout the day for work
- Working with cement
- Working with metals like chromium, cobalt, or nickel
What are common dyshidrotic eczema symptoms?
Dyshidrotic eczema has a few distinct signs you should know, especially to distinguish it from other health conditions:
1. For starters, those blisters on your hands and maybe feet: You can tell these apart from other blisters in a pretty specific way. “Blisters from dyshidrotic eczema have been described as tapioca pudding,” Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai Hospital, tells SELF.
These blisters, which Dr. Brod notes are a sign of acute inflammation in your epidermis (the top layer of your skin), are usually small and clustered, but they can join together and become larger blisters as well, the Mayo Clinic says. They can leave behind scaly skin once they dry out, then bubble up again before your skin is even fully healed.
2. An itchy or burning sensation: You can have this either before your blisters pop up or after they’ve shown up, the AAD says. These sensations are part of your body’s immune reaction to your skin inflammation, Dr. Bailey explains.
3. Excessive sweating where the blisters appear: Your palms and soles have a high concentration of sweat glands and, when either area is irritated, you can sweat more than usual, Dr. Brod explains. Unfortunately, this can make things even worse. “Increased sweating while you have the inflammation that leads to will lead to bigger blisters and more blisters,” Dr. Bailey says.
4. Pain in the blistered areas: The inflammation that comes with dyshidrotic eczema can irritate the nerve endings in your hands and feet, Dr. Brod explains. As a result, it can be pretty uncomfortable. For people with more severe cases of this condition, it can be so bad that they can have trouble doing basic things like washing the dishes or walking, the AAD says.
5. Scaly, peeling skin: When the blisters clear up, that top layer of your skin has to heal. “This layer grows from the bottom out, and the damaged part gets shed as scales,” Dr. Bailey explains, adding that the left behind skin can seem crusty, too.
It’s possible to have a flare of dyshidrotic eczema for seemingly no reason, Dr. Bailey says, but some people experience these symptoms in response to certain triggers like stress and exposure to hot, humid weather, the AAD says.
If I think I have dyshidrotic eczema, how do I get a diagnosis?
To get a proper dyshidrotic eczema diagnosis, you’ll need to see a dermatologist. If your dyshidrotic eczema is flaring or in the process of healing, your derm can probably diagnose it just by looking at your skin, the AAD says. It’s also pretty likely that they’ll ask about factors like your medical history, work, hobbies, and how stressed out you’ve been lately to make sure their diagnostic hunch is correct.
Depending on your specific symptoms and answers to the doctor’s questions, they may want to run some tests to rule out other health conditions like allergies or a fungal issue, the Mayo Clinic says.
What might my doctor suggest to treat my dyshidrotic eczema?
There’s no cure for dyshidrotic eczema—womp womp—but it is treatable. One of the best things you can do is to try to ID your triggers and then avoid them, Dr. Goldenberg says. That can mean taking measures like wearing gloves when you do certain things that would wet your hands, such as washing the dishes, Dr. Bailey says. But sometimes it’s pretty much impossible to stay away from triggers, like if your job involves getting your hands wet all the time sans gloves or if you’re just really stressed out right now.
In that case, there are a few treatment options for dyshidrotic eczema that you may want to consider. They include corticosteroids pills or creams to help battle inflammation, anti-itch drugs or lotions, and wet compresses to soothe your skin, among others, the Mayo Clinic says. Since everyone is different, don’t try to tackle this on your own. It’s really best to work with your doctor and design a treatment plan that, hopefully, makes these blisters a relic of your past.
- 6 Eczema Symptoms You Should Bring Up With Your Derm
- 5 Types of Eczema You Should Know, Because There’s Actually More Than One
- 11 Things Dermatologists Want You to Know About Sensitive Skin
What is dyshidrosis?
Dyshidrosis is a skin condition that causes small blisters and dry, itchy skin. It usually develops on fingers, hands and feet. It is also known as dyshidrotic eczema (DE), acute palmoplantar eczema or pompholyx.
This type of eczema is a chronic (long-term) condition. With treatment, most people can control their symptoms. Dyshidrosis is not contagious (cannot pass from person to person).
Who is most at risk for getting dyshidrosis?
Anyone can develop dyshidrosis. The condition is most common in adults between ages 20 and 40. In occupational or clinical settings, dyshidrotic eczema accounts for 5 to 20 percent of all cases of hand dermatitis.
Women are more likely than men to develop dyshidrosis. This gender difference may be because women are exposed to certain skin irritants more often than men. These irritants include things like nickel or cobalt in jewelry.
You are at higher risk of developing dyshidrosis if:
- Other members of your family have the condition.
- You have a history of atopic or contact dermatitis.
- You receive immunoglobulin infusions. Intravenous immunoglobulin (IVIG) is injections of antibodies for people with an immune deficiency.
What causes dyshidrosis?
The exact cause of dyshidrosis is not known. It may occur because of triggers including:
- Increased stress
- Allergies, including hay fever
- Frequently moist or sweaty hands and feet
- Exposure or contact allergy to certain substances, including cement, nickel, cobalt or chromium
What are the symptoms of dyshidrosis?
Dyshidrosis causes symptoms that come and go. These symptoms may last for several weeks at a time. The most common symptoms of dyshidrosis include:
- Small, firm blisters on the sides of fingers, palms of hands, and soles of feet
- Itchy, scaly skin at or around blisters
- Pain at or around blisters
- Sweating heavily around areas of skin affected by blisters
- Dry, cracked skin that appears as blisters fade
- Thickened skin where itchy, blistered skin appears
The skin on your fingers, hands, and feet may thicken if scratched frequently. Large blisters or large areas of blisters may become infected and can be painful.
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Your doctor can prescribe an ointment or cream with a steroid in it to bring down swelling and help get rid of the blisters. Your skin will take in the medicine better if you put a wet compress on it after you use the cream. If you have a severe flare-up, you might need to take a steroid drug, like prednisone, in a pill.
An antihistamine like diphenhydramine (Benadryl) or loratadine (Alavert, Claritin) can help with the itch, too. Or you might hold a cold, wet compress on the blisters for 15 minutes at a time several times a day.
If these treatments don’t work well for you, you might try one of these:
- Light therapy: This uses ultraviolet (UV) light to clear up your skin. You might get a medicine first to help your skin respond better to the light.
- Botulinum toxin: These shots stop your hands and feet from sweating, which can trigger the blisters.
- Medicines that slow down your immune system: Tacrolimus (Protopic) ointment or pimecrolimus (Elidel) cream can calm the swelling and irritation. These drugs can be options if you don’t want to take steroids.
- Draining the blisters: Your dermatologist can drain fluid from the blisters. Don’t try to do this yourself. You could make the eczema worse.
To control the blisters at home:
- Wash your hands and feet every day. Use lukewarm water and a mild, scent-free soap. Afterward, gently pat your skin dry.
- Take your rings off before you wash your hands. Moisture can get trapped under your rings and cause more blisters.
- Wear gloves with cotton liners whenever your hands are in water, like when you wash dishes.
- Put a thick moisturizer on your hands and feet every time you shower or wash. Rub it on while your skin is still wet to seal in water. You also might use a cream that has dimethicone to protect your skin.
- Turn on a humidifier in dry weather to keep your skin from cracking.
- If allergies set off your eczema, try to stay away from things that trigger them.
- Don’t scratch the blisters — you’ll make them worse.
“I Got Blisters On My Fingers!”
The stubborn focal eruption on this 6-year-old boy’s left fourth finger remains unaffected after a one-week course of oral cephalexin, so his pediatrician refers him to dermatology. The problem initially manifested as a cluster of tiny blisters, which tingled a bit but didn’t hurt. When redness developed around it, the patient’s mother brought him for evaluation.
The boy experienced the same problem in the same location almost exactly a year ago. It was treated the same way and within a week or two had resolved.
The child is otherwise reasonably healthy, despite being allergy-prone. He has a history of seasonal allergies and is susceptible to skin infections, such as staph.
On the dorsal aspect of his finger are grouped vesicles on an erythematous base, measuring about 1 cm altogether. Several of these demonstrate central umbilication, and several are filled with pus. The erythema is minimal, and there is no tenderness on palpation. Palpation of the epitrochlear area reveals a tiny, nontender node.
What is the diagnosis?
Causes of blisters
Children get blisters when fluid builds up under their skin. This happens because of damage to the skin. The most common cause of a ‘water blister’ is friction – for example, new shoes rubbing against the back of your child’s heel.
Other common causes of blisters include burns (including sunburn). Your child could also get blisters with insect bites and eczema.
Blisters are often caused by viral infections like chickenpox, cold sores and hand, foot and mouth disease. Bacterial infections like impetigo can cause blisters too.
When to see your doctor about blisters
You should take your child to the GP if:
- the blister is smelly or filled with yellow-greenish fluid (pus), or the surrounding skin is red, warm, swollen or tender, because this might mean that the blister is infected
- your child has lots of blisters and a fever
- your child isn’t well.
Small blisters usually heal by themselves, so you can just put a bandaid on them.
But some blisters can be very large and uncomfortable. They might take a long time to heal, because the fluid inside the blister slows down the healing process.
If your child has a big, uncomfortable blister that hasn’t broken by itself, you can take the following steps:
- Prick the side of the blister with a sterile needle. To sterilise the needle, pour boiling hot water over it, or wipe it with an alcohol wipe.
- Gently massage the fluid out. Smooth the thin covering of skin down over the base of the blister so it can act as a natural ‘bandaid’.
- Cover with a non-stick, dry dressing.
- Repeat as needed.
After this blister treatment, the blister should dry up in a few days and a crust will form. Let this crust peel off naturally.
If your child has a blister caused by shoes, it can help to have your child wear open shoes, or shoes that don’t press on the blister.
Blisters caused by other things might need specific treatment, like antibiotics for impetigo or antivirals for severe cold sores.
Prevention of blisters
Make sure your child wears shoes that are neither too tight nor too loose. If your child has new shoes, put sticking plaster on the back of her heels for the first week, until she ‘breaks in’ the shoes.