Dyshidrotic eczema, also known as dyshidrosis or pompholyx, is a skin condition in which blisters develop on the soles of your feet or the palms of your hands and fingers.
The blisters can appear as tiny bumps on fingers or can grow together and cover larger areas on the hands and feet. These blisters are usually very itchy and may be filled with fluid. Blisters normally last for about 3 to 4 weeks and may be triggered by a variety of issues like an allergy, genetics, or stress.
The exact cause of dyshidrotic eczema is unknown. Previously, it was thought to be an issue with an individual’s sweat ducts, but that was proven false.
People living with dyshidrotic eczema most likely have hypersensitivity to something like:
- metal, particularly cobalt or nickel
- a specific ingredient in a personal care product like soap or moisturizer
- medication, especially birth control or aspirin
- smoking (tobacco)
- a skin infection like Athlete’s foot
- an intravenous immunoglobulin (IVIG) infusion
Stress can be another trigger for dyshidrotic eczema, as can changes in the weather. Some people experience flares when it’s hot and humid out (and UVA rays are strong), while others experience flares when the temperature drops and gets cold.
There are a variety of factors that may dictate who develops dyshidrotic eczema.
If you are going to develop it, it’ll most likely begin between 20 and 40 years of age. Genetics may also play a role in dyshidrotic eczema. If you have one or more blood relatives with it, there’s a higher chance you could also have it.
A few other factors that may contribute to its development are:
- you’re already living with another type of eczema
- you’ve worked, or currently work, as a mechanic or metalworker (because of the contact to certain metals like nickel)
- you have a history of working with cement (which can contain both cobalt and nickel)
- you already deal with seasonal allergies
- you’re living with asthma
- you have occasional bouts of allergic sinusitis
Dyshidrotic eczema in children
Eczema, or atopic dermatitis, is more common in children and infants than in adults. About 10 to 20 percent have some form of eczema. But many will outgrow atopic dermatitis or eczema by adulthood.
Conversely, dyshidrotic eczema can also affect children, but it’s rare.
The first symptoms of a dyshidrotic eczema flare may be a burning, itching sensation without any visual clues.
Tiny, itchy blisters might then develop, most likely on your:
- sides of fingers
In severe cases, the blisters can expand to the back of hands, limbs, and feet.
These tiny blisters can grow together and form larger areas that are very itchy, red, and raised. If the skin becomes infected, the blisters can become painful and ooze pus.
Typically, dyshidrotic eczema heals on its own in 3 to 4 weeks, but as the blisters heal, they can cause your skin to become very dry and peel. Individuals with a darker skin tone may develop dark spots where the blisters have healed.
If you’ve been dealing with red, itchy skin for more than a week, it’s a good idea to seek out your doctor or dermatologist, because many skin conditions can cause blisters.
During your visit, your doctor will most likely take a look at your skin and ask you if you’ve noticed a pattern around your blisters — like if you’ve started using different products or have felt particularly stressed — and if your jobs or hobbies include coming into contact with metals.
If your doctor believes your dyshidrotic eczema could be due to an allergy, they may do an allergy test.
If your case is severe or if the symptoms have been long-lasting, you may be prescribed medication.
The severity of your outbreak and other personal health factors determine which treatments your doctor might suggest. It also may be necessary to try more than one treatment before finding one that works.
Treatments for mild outbreaks
Pimecrolimus cream, tacrolimus ointment, or Eucrisa, are typically used to treat atopic dermatitis. But they have also been shown to be effective for dyshidrotic eczema.
For mild flare-ups, your doctor may recommend:
- a moisturizer that’s very emollient to help relieve the dryness
- a prescription corticosteroid that helps heal the blisters and reduces inflammation
- anti-itch medication in the form of a pill or cream
Treatments for more severe outbreaks
More severe outbreaks might require possible treatments like:
- antifungal medications, if the eczema seems tied to a fungal infection
- steroid tablets or creams
- immunosuppressant creams or ointments
- UV light therapy
- botulinum toxin injections (botox) if the dyshidrotic eczema seems to be triggered by extreme sweating
While home remedies may not be as effective as a doctor-recommended medication, they can help ease symptoms.
You can start with cold compresses, soothing the area every 15 minutes. You can also soak the affected areas for 15 minutes — your doctor may know some good inflammation-lowering medicated soaks.
Find ways to relieve stress. Since dyshidrotic eczema can be triggered by stress, using techniques like meditation can help provide a dose of calm for your mind and body.
If your hands are affected, make sure to remove rings and jewelry whenever you wash your hands so water doesn’t linger on your skin. If you notice that a certain personal care product like a new bar of soap seems to have been the cause of your blisters, stop using it for a few weeks and see if the inflammation and itching die down.
Keep the affected area well moisturized at all times. Try to maintain your fingernails so they’re short enough to not break the skin if/when you scratch. This can help you avoid infection.
Nickel and cobalt are natural elements that can be found in a lot of foods, like:
- brazil nuts
- dried fruit
If your doctor suspects your dyshidrotic eczema flares are caused by a nickel or cobalt allergy, they may recommend a low cobalt/nickel diet.
The most likely way your dermatologist will recommend you follow this specialized diet is through a point system. The higher the amount of nickel or cobalt, the higher the points value for that food or beverage. You’ll be instructed to count your points.
But because there are many healthy foods that include these natural elements, you should not try to do this points-based diet on your own.
The main complication of dyshidrotic eczema is usually the discomfort from itching and the pain from the blisters.
This discomfort can sometimes become so severe during a flare that you’re limited in how much you use your hands, or even walk. There’s also the possibility of getting an infection in these areas from over-scratching.
In addition, your sleep may be disrupted if the itching or pain is severe.
Because the causes are unknown and the triggers are so personal, there’s no one way to completely prevent or control outbreaks of dyshidrotic eczema.
But you can keep your symptoms from barreling out of control by understanding your specific triggers, strengthening your skin by applying moisturizer daily, keeping your stress in check (when possible), and staying hydrated.
Typically, flares of dyshidrotic eczema will disappear in a few weeks without complications. If you do your best to avoid scratching the affected skin, it may not leave any noticeable marks or scars.
If you scratch the affected area, you may experience more discomfort, or your outbreak may take longer to heal. You could also develop a bacterial infection as a result of scratching and breaking your blisters.
Although your outbreak of dyshidrotic eczema may heal completely, it can also recur. Working with your dermatologist to come up with a personalized treatment plan — whether it’s short- or long-term — is the best way to keep this skin condition from disturbing your daily life.