Dyshidrotic Eczema (Pompholyx): Causes, Symptoms, and Treatments

Have you ever washed your hands so much that they became red, chapped, irritated, and studded with tiny blisters? Or noticed little red bumps pop up on your toes? Are they so intensely itchy that it’s distracting? 

This could be dyshidrotic eczema, and while it’s typically controlled with topical options and changes in hand or foot hygiene habits, this type of eczema can lead to skin infection. 

This article will help you understand more about this skin condition, including what hand and foot eczema look and feel like, common eczema causes, how to relieve eczema symptoms, and the best ways to prevent flare-ups in the future. 

What Is dyshidrotic eczema?

Dyshidrotic eczema goes by many different names: 

• Pompholyx
• Vesicular eczema
• Dyshidrosis 

All of these terms reference the same skin condition. “Dyshidrotic eczema is a type of eczema that is very specific to the hands and the feet,” says Rachel Day, MD, FAAD, Chief Medical Officer at Zest Dermatology.  Dyshidrosis on the hands and feet appears as small, itchy blisters that can cause a lot of discomfort and frustration.  

Although we tend to use eczema as a single term, it’s actually the name for a group of inflammatory skin conditions that most commonly cause itch, dryness, and rashes.

Your hands are vulnerable to pompholyx because you clean them often, and regular exposure to wet environments or harsh soaps or sanitizers can disrupt the skin barrier–skin’s outer layer that serves to protect it–resulting in itchiness and rashes. 

Feet–your soles and toes–are also frequently affected because the skin here is often exposed to sweat and then trapped in shoes, leading to skin barrier disruption–and resulting itchy, irritated blisters.

Recognizing the symptoms of pompholyx

Dyshidrotic eczema typically affects the palms of the hands or soles of the feet, as well as fingers and toes. “It tends to affect the lateral sides of the fingers, and many times the fingers will be the first area affected by dyshidrosis,” says Dr. Day. 

Here are the common signs and symptoms of pompholyx:

• Deep-seated, fluid-filled blisters. (These are called vesicles.)
• Extreme itchiness. 
• Burning.
• Redness, scaliness, and peeling.
• Dryness.
• Cracking.

Itchy hand eczema or scratchy feet may not sound like a big deal, but it can be a pretty disruptive force in your life–even if the condition is not widespread. “You can have one finger involved, but the itchiness and discomfort can be very consuming,” says Dr. Day. 

Common triggers and causes of dyshidrotic eczema

Although the exact cause isn’t known, the main contributor to dyshidrotic eczema is a disrupted skin barrier. 

“Imagine a riverbed where all the water has been evaporated by the hot sun. The riverbed is dry and cracked. Your skin is the same way,” explains Dr. Day. “After water evaporates on skin, the natural oils are stripped away–and skin is like that dry, cracked riverbed,” she says.

Once the skin barrier is damaged, moisture can easily escape and irritants can enter, which leads to inflammation–and a potential flare-up of dyshidrosis.

Not everyone will develop pompholyx, but several factors make you more susceptible to these incredibly itchy blisters on fingers or toes, says Dr. Day:

• History of atopic dermatitis (the most common type of eczema) where the skin is dry, itchy, and erupts in rashes. One small study suggests that pompholyx may even develop as an individual’s atopic dermatitis is improving, which can come as a surprise.
• History of seasonal allergies.
• Sensitivity to nickel, a metal frequently used to make jewelry. (You may notice that you develop a rash around a finger from wearing a ring, for example.)
• A job or lifestyle that involves regularly washing your hands or using hand sanitizer, both of which can degrade the skin barrier, drying out your skin. This is often seen in healthcare workers, childcare providers, and food service industry professionals.
• The season. We all have different dyshidrotic eczema triggers. For some it’s the heat, humidity, and chlorine skin is frequently exposed to during the summer. For others, it may be the dryness of winter that leads to skin barrier problems. 
• Stress. How you feel on the inside can affect your immune system health–and therefore your skin. 

Effective treatments for dyshidrotic eczema

First, when it comes to treating pompholyx, don’t hesitate to seek a consultation with a dermatologist. “We use our hands all the time, so it can impact someone’s day-to-day life,” says Dr. Day. A trusted skincare provider can give you personalized recommendations based on your lifestyle, profession, and preferences. 

There are a few goals for treatment for dyshidrotic eczema: 

1. Restore the skin barrier, which will help prevent excess moisture loss and stop irritants from entering the skin. 
2. Cracked skin can also lead to infection, and infection prevention is another important aim in treatment.
3. Maintain healthy, moisturized skin to prevent dyshidrosis from returning.

Here are the treatment options dermatologists recommend for pompholyx:

Soothe your skin

Applying cool compresses a few times per day can help get rid of eczema blisters, recommends the National Eczema Association (NEA). 

This can also feel nice on irritated skin, offering some much-needed eczema relief and a break from scratching, which can further inflame skin and may contribute to infection.

Apply a topical steroid

The blisters and itchiness are signs of inflammation. A topical steroid works by reducing inflammation to promote skin healing. 

Although you can purchase topical steroid creams or ointments over-the-counter, Dr. Day recommends seeing your provider for a prescription. “We tend to use higher-strength topical steroids on the hands because the medication gets removed pretty easily as we’re constantly using our hands all day. 

A higher-strength prescription will deliver the highest anti-inflammatory signal to the skin,” she explains. Because it comes off easily, you’ll likely need to apply this prescription cream twice a day.

Practice proper and frequent moisturization

Find a hand moisturizer that contains emollients, which are types of ingredients that soothe skin and keep it moisturized. 

These products attract moisture and form a film on top to seal skin hydration. Aim for a cream formula over a lotion, since a cream’s thicker consistency is a more effective hydrator. Many ingredients are considered emollients, including ceramides and petrolatum, and you can also look for hand creams labeled “repairing,” which refers to its ability to help repair the skin barrier. 

Try phototherapy

Phototherapy is a type of light therapy that employs specific wavelengths of UV light to modulate your immune system and reduce inflammation. 

It’s also been found to decrease itch (and therefore improve quality of life) after four weeks of treatments for a variety of skin conditions, according to a study in Photodermatology, Photoimmunology & Photomedicine  published in 2024. You’ll need multiple sessions and this treatment should be done under medical supervision.

Ask about systemic medication

Certain medications that affect the immune system may be recommended, especially if your symptoms are severe and can’t be controlled with the eczema treatments above. 

Those include oral medications like corticosteroids (short-term), JAK-inhibitors, methotrexate, or injectable medications like dupilumab (Dupixent). 

‍Research suggests that dupilumab is well-tolerated and effective in reducing the symptoms of pompholyx, including redness and itching, with 40% of the small treatment group (15 total patients) experiencing a complete clearing of the skin condition. Talk to your dermatology provider about what treatment is right for you. 

How to manage flare-ups and prevent recurrence

Unfortunately, there’s no cure for dyshidrotic eczema, so the focus is on flare-up prevention. “I explain to patients that if they’ve ever developed it, they have a vulnerability to get it again,” says Dr. Day. 

“You can go a long time without a flare-up, but that doesn’t mean you can’t have another in the future. Maintaining your skin barrier is important in defending against the next flare,” she says. Eczema flare-ups can go away on their own, but there are many things you can do to prevent symptoms of chronic eczema from popping up in the first place:

• Use gentle skincare: When possible, wash up with gentle, fragrance-free soaps and use non-alcohol hand sanitizer. If you’re washing dishes, wear gloves to protect your hands.
• Dry well and moisturize: After washing your hands or feet, gently pat them dry. Next, apply a moisturizer right away while skin is still slightly damp for better absorption. “This prevents the water on the hands from evaporating from the skin’s surface, which ultimately breaks down the skin barrier,” says Dr. Day. “If you are washing your hands 20 times a day, you should be applying moisturizer 20 times a day,” she says.
• Practice healthy feet habits: Wearing moisture-wicking socks, changing socks throughout the day (if needed), and walking in well-fitting shoes can help keep your feet dry and prevent rubbing that harms the skin barrier.
• Practice healthy jewelry habits: Rings can trap moisture against the skin, so remove them (if possible) before washing and then put them back on once the skin is dry.
• Treat related medical conditions: If you have underlying conditions, including seasonal allergies or atopic dermatitis that predispose you to pompholyx, work with your healthcare provider to get the right treatment to make sure these are well-controlled. 
• Manage stress: Many people notice that they have stress-induced eczema. You can’t eliminate stress, but finding effective ways to manage the stress in your life can go a long way. That may include regular exercise, a yoga practice, frequent walks outside, connecting with loved ones, or relaxing while watching a favorite show.
• Connect with a dermatology provider: If you have frequent flare-ups of dyshidrotic eczema, talk to a skin care professional for customized guidance. This isn’t something you have to manage alone or “just get through the flare.” They can help you draw up a plan that takes your skin needs and lifestyle into account to find the most effective treatment (and prevention) for you.