Pompholyx (dyshidrotic) eczema

Pompholyx eczema (also known as ‘dyshidrotic eczema’) is a type of eczema that affects the hands and feet. This condition can occur at any age but is usually seen in adults under 40, and is more common in women. Fifty percent (50%) of people with pompholyx have atopic eczema as well, or a family history of atopic eczema.

Symptoms

Intensely itchy, watery blisters, affecting the sides of the fingers, the palms of the hands and soles of the feet.

Some people have pompholyx eczema on their hands and/or feet with other types of eczema elsewhere on the body.

The skin is initially very itchy with a burning or prickling sensation.

Then comes a sudden crop of small blisters (vesicles), which turn into bigger, weepy blisters, which can become infected.

When the skin is infected, there is inflammation, irritation/pain, swelling and pustules.

Peeling can occur when the skin dries out

People of any skin colour can experience skin that is red or darker than the surrounding skin along with dry with painful cracks

Pompholyx eczema can also affect the nail folds and skin around the nails, causing swelling (paronychia).

Pompholyx eczema can coexist with fungal infections, so assessment should include checking for the presence of any fungal infection on the hands and/or feet.

Triggers

The exact cause of pompholyx eczema is not known. However, it’s thought that the following can aggravate this condition:

Stress - Worry can make the condition worse, or more long-lasting. Any sources of concern should be addressed, if possible.
Metal - Sensitivity to metal compounds (such as nickel, cobalt or chromate)
Overheating - Heat and sweating can aggravate this condition. 
Hot or cold water - Use lukewarm water for washing as very hot or cold water may irritate the skin. Remember to use an emollient as a soap substitute. 
Detergents- Try to avoid direct contact with these by wearing 100% cotton gloves under rubber or plastic gloves when carrying out household tasks. When shampooing your hair, wear cotton gloves under waterproof gloves, as above. If possible, when the pompholyx is active, ask someone else to do the shampooing for you – and the housework, too!

View all triggers

Common treatments

The following treatments are recommended to treat Pompholyx (dyshidrotic) eczema.

Emollients - These are a first-line treatment and should be used for moisturising and washing.
Topical steroids - Pompholyx eczema needs to be treated with topical steroids to reduce inflammation and heal cracks.

Treatments for severe eczema

For cases of more severe eczema that do not respond to first-line treatments, the following options are recommended:

Immunosuppressants - Alitretinoin (known as Toctino) is an oral treatment for adults with severe eczema who have not responded to potent topical steroids.
Oral steroids - Occasionally, for very severe outbreaks of pompholyx eczema, a short course of oral steroid tablets is prescribed. 
Phototherapy (UVB or PUVA) - Phototherapy using either UVB or UVA rays administered by a special foot/hand light box, may be recommended if this treatment option is available locally to you.
Potassium permanganate soak - If your skin is weeping, oozing and crusting, a potassium permanganate soak may be advised. See our FAQ's below for more guidance on how this is applied.

All treatments

FAQs

If itchiness is interfering with sleep, sedating antihistamines may be helpful at night (but will cause unwelcome drowsiness if taken during the day). Remember, antihistamines in eczema aid sleep rather than actively treat itch. 

Large blisters may be gently drained by using a large sterile needle. Very gently make a small jagged tear in the blister (a pin-prick hole will not be effective as it will not release fluid and will seal up very quickly). Make sure you do not remove the ‘roof’ of the blister – this protective layer of skin needs to stay in place, otherwise soreness can increase, healing can be delayed and there is a risk of infection. 

Socks, tights and gloves made from cotton, bamboo or silk (as close to 100% of these different materials as possible) can be used to protect the skin. Synthetic materials such as nylon are less absorbent and do not generally allow the skin to ‘breathe’ in the same way. 

Bandaging or wrapping the hands and/or feet can also help protect the skin. Covering the skin can bring some relief as well as ensuring that creams and ointments are given the maximum opportunity for absorption. If paste bandages or wet wraps are used, you should consult a healthcare professional about their suitability, how to put them on, and how to use them with creams and ointments. Any weeping blisters should be covered with a non-stick dressing, to prevent tearing the blister roof. 

For severe cracks, a healthcare professional may prescribe a steroid impregnated tape to protect them and speed up healing.  

If you have painful cracks post-blister stage, Extra Thin Duoderm is a helpful hydrocolloid dressing that you can cut to shape and put on cracks. It can be left in place undisturbed for a few days. Speak to a healthcare professional before using Duoderm on an area you are treating with topical steroids, because when you closely cover skin that is being treated by a topical steroid, this will make the topical steroid more potent. 

Footwear should be kept dry and permeable to the air. Avoid plastic or rubber shoes, or any other type of footwear likely to cause sweating. Light shoes with cotton linings are preferable to shoes with synthetic linings. 

Potassium permanganate soaks come in the form of a ‘tablet’, solution or crystals. It’s for external use only, which means it should never be put in the mouth or swallowed. It’s usually obtained on prescription (generally as Permitabs) but can be bought over the counter from a pharmacy. We recommend speaking to a healthcare professional before using it.

Potassium permanganate soaks can be used once or twice a week.  To prepare the soak, wear gloves and line a clean container with a white bin liner. Potassium permanganate will stain the skin and the container so it’s a good idea to apply petroleum jelly (Vaseline) to the nails beforehand to prevent staining. Add one tablet to 4 litres of warm water and dissolve fully - the water should be light pink, like rosé wine. Soak the hands and/or feet in this solution for 10-15 minutes, rinse off in water with emollient, pat dry with a clean towel and moisturise after with emollient. When the acute flare of pompholyx subsides, the soaks should be stopped (usually after 3-7 days). 

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Pompholyx (dyshidrotic) eczema factsheet