Dyshidrotic eczema, also called pompholyx or dyshidrosis, is a type of eczema that affects the palms of the hands and soles of the feet. It’s possible to have more than one type of eczema, so someone may have dyshidrotic eczema along with one or more other types.

Dyshidrotic eczema is most common in adults between the ages of 20 and 40. It’s usually chronic, though episodes or flare-ups may come and go quickly.

To learn more about dyshidrotic eczema — including its causes, symptoms, and treatment options — MyEczemaTeam spoke with Dr. Brian Kim. Dr. Kim is vice chair of research and site chair of Morningside and Mount Sinai West, in the Kimberly and Eric J. Waldman Department of Dermatology. He is also director of the Mark Lebwohl Center for Neuroinflammation and Sensation and lead of the Allen Discovery Center for Neuroimmune Interactions at the Icahn School of Medicine at Mount Sinai.

Symptoms of Dyshidrotic Eczema

Dyshidrotic eczema happens on the hands and feet. The main symptom is intense itching, which often starts suddenly. This is followed by small, deep-seated blisters called vesicles. Over time these vesicles may join together and form larger ones.

The vesicles usually last a few weeks before they dry out. Then, the affected skin starts to peel. This can leave the area feeling sore and tender for a while. Sometimes, the skin may crack, which increases the risk of skin infections.

Dyshidrotic eczema, like other forms of atopic dermatitis, can be stubborn. “It’s very chronic and relapsing,” Dr. Kim explained.

The itching caused by dyshidrotic eczema is usually very intense. It can get so bad that it interferes with everyday life. Dr. Kim called itching “the most bothersome symptom” for people with dyshidrotic eczema.

Dr. Kim’s research focuses on understanding and preventing itching, which is closely linked to inflammation. He studies what’s known as the itch-scratch cycle: When the immune system becomes active, it creates inflammation. This triggers proteins called cytokines to interact directly with the nervous system, which causes itching. Scratching the skin makes inflammation worse, which causes additional cytokines to be released — and even more itching. As Dr. Kim put it, “scratching leads to inflammation that leads to itch.”

Diagnosis of Dyshidrotic Eczema

Dyshidrotic eczema is usually diagnosed by a dermatologist. Your dermatologist will examine your skin, ask about your symptoms, and rule out other skin conditions before making a diagnosis.

If you have small, itchy blisters with no clear cause, you may have dyshidrotic eczema. “The reality is there aren’t that many infections that lead to blisters,” Dr. Kim said. Still, only a doctor can make a definite diagnosis of dyshidrotic eczema.

Causes of Dyshidrotic Eczema

Many people wonder, “What causes dyshidrotic eczema?” According to Dr. Kim, classic eczema (also called atopic dermatitis) “can always evolve into all these different variants” of the skin condition, including dyshidrotic eczema. Because of this, you may have eczema for years before it shows up as dyshidrotic eczema.

Several factors may lead to atopic dermatitis and dyshidrotic eczema. You don’t have to experience all of the causes of dyshidrotic eczema, but you’ll likely experience at least one.

Inflammation

Doctors don’t fully understand what causes the different types of eczema, but they know inflammation plays a key role in the skin condition.

Inflammation happens when certain kinds of immune system cells invade the skin and start to damage tissue. This inflammation causes the burning, itching, and blisters seen in dyshidrotic eczema.

Exposure to Certain Substances

In some cases, dyshidrotic eczema may be triggered by exposure to certain metals — especially nickel, chromium, and cobalt.

“There are certain things that will trigger people and set different people off,” Dr. Kim said.

Some people with dyshidrotic eczema have higher-than-normal levels of immunoglobulin E in their bloodstreams. This can be a sign of an allergic reaction. Immunoglobulin proteins are proteins that help the immune system find and destroy foreign substances in the bloodstream.

Stress

Stress — and the strong emotions that often come with it — can have a major effect on inflammatory skin conditions. One reason may be because stress affects how well the skin’s antimicrobial barrier works against bacteria and other irritants.

The relationship between stress, the immune system, the nervous system, and hormones is complex and still being studied. These systems all play a role in inflammation.

Is Dishydrotic Eczema Caused by Stress?

Stress can trigger dishydrotic eczema in some people. However, you don’t have to be under significant stress to develop the condition. Researchers still don’t fully understand how or why stress leads to dishydrotic eczema in some cases but not others.

Weather and Seasonal Changes

Extreme temperatures, like very hot or very cold, and extreme levels of outdoor moisture levels, such as very humid or very dry weather, can trigger eczema symptoms. Seasonal allergies have also been found to trigger different forms of eczema.

Damp Skin

In some cases, dyshidrotic eczema may be triggered by having wet hands or feet for long periods. This moisture could be caused by sweat or by frequent handwashing, swimming, or water exposure due to work or hobbies.

Dr. Kim sees many cases of dyshidrotic eczema develop “when people have clammy, sweaty hands.”

Treatments for Dyshidrotic Eczema

There’s no cure for dyshidrotic eczema, but the right treatment can help reduce itching and prevent future flare-ups. It’s important to find the dyshidrotic eczema treatment that works best for you. Dr. Kim noted that many people he treats eventually find relief and say, “I didn’t realize how miserable I was.”

Dr. Kim has studied medications that “anesthetize the nerves,” so people feel less need to scratch. This can stop the itch-scratch cycle before it causes more skin damage.

Until those drugs are approved, there are several treatment options for dyshidrotic eczema. Many are the same as those used for atopic dermatitis. At Dr. Kim’s clinic, he explained, the providers “use a lot of the same tools and coach people the same way, regardless of their kind of eczema, for the most part.”

Moisturization

Keeping the skin moisturized is one of the most important skin care steps in managing eczema. Moisturizing helps prevent dryness, which can help manage itchy blisters.

When in doubt, Dr. Kim said that Vaseline (petroleum jelly), which you can get over the counter at your local drugstore, “is probably still the best moisturizer in the world.”

Topical Corticosteroids

A common first treatment for atopic dermatitis is a corticosteroid cream or ointment applied directly to your skin, called a topical treatment. This prescription medication can reduce inflammation and help blisters heal faster. It should be applied after moisturizing.

Oral Corticosteroids

If your dyshidrotic eczema is severe or if you experience frequent flares, you may be prescribed oral steroids. These medications reduce inflammation throughout the body, including in the skin.

However, Dr. Kim cautioned that “oral steroids are generally discouraged and only used in very unique, severe, refractory cases.”

Immune System Inhibitors

Your dermatologist may prescribe a cream with calcineurin inhibitors. These medications change how the immune system works, and help reduce eczema flare-ups.

These creams are only for people older than 2 years of age. While using them, you should avoid exposure to sunlight, as your skin may become more sensitive.

Certain other medications that affect the immune system may also be prescribed if your dyshidrotic eczema won’t go away. These include methotrexate, biologics, or Janus kinase (JAK) inhibitors.

Light Therapy

If your dyshidrotic eczema doesn’t improve with other treatments, your dermatologist may suggest phototherapy. This treatment exposes the affected skin to natural sunlight or controlled doses of ultraviolet A light (UVA), or ultraviolet B (UVB) light.

Many people with dyshidrotic eczema find light therapy helpful, but it usually needs to be repeated regularly. However, long-term use of phototherapy can age your skin prematurely and may increase your risk of skin cancer. Your dermatologist can help you decide if this treatment is right for you.

Antibiotics

Sometimes, dyshidrotic eczema can lead to a bacterial infection. Signs include swelling, crusting, or pus-filled blisters. If this happens, your dermatologist may prescribe oral antibiotics to treat the infection.

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Have you been diagnosed with dyshidrotic eczema? Have you found effective ways to treat this condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.