Dyshidrotic Eczema (Pompholyx): Pictures, Causes & Treatment
Dyshidrotic eczema — also called pompholyx — is a form of eczema that produces crops of small, deep, intensely itchy blisters on the sides of the fingers, the palms and the soles. Episodes typically last two to four weeks, ending with peeling and cracking, and they often recur in warm weather or during periods of stress.
Medically reviewed by Dr. Celina Kazumi Iwasa, MD · Last reviewed 2026-08-23
Quick answer
Dyshidrotic eczema is a blistering form of eczema that causes crops of small, deep, very itchy blisters on the sides of the fingers, palms and soles, followed by peeling and cracking. Triggers include sweating, stress, nickel and cobalt contact, wet work and fungal infection elsewhere on the body. Treatment uses potent topical steroids, cool soaks, emollients and trigger avoidance; severe cases may need oral treatment or phototherapy.
What dyshidrotic eczema looks like
The blisters sit deep in thick palm and sole skin, so they look like tapioca or sago grains under the surface rather than fragile surface blisters. Itch and burning usually start before the blisters are visible, and the episode finishes with sheets of peeling skin.
Common locations
- Sides of the fingers (the most typical site)
- Palms of the hands
- Soles of the feet and sides of the toes
- Occasionally the fingertips and nail folds
- Usually symmetrical on both hands or both feet
Typical signs
- Crops of firm, deep, 1–3 mm clear blisters
- Intense itch or burning, often preceding the blisters
- Blisters merging into larger fluid-filled areas in severe episodes
- Peeling, dryness and painful cracks (fissures) as it resolves
- Nail ridging or pitting when the nail folds are involved
On brown and Black skin
The blisters themselves look the same on all skin tones because palm and sole skin has less pigment, but the surrounding inflammation may appear brown or violet rather than red, and darker marks often persist for weeks after the episode clears.
Causes and triggers
Dyshidrotic eczema is multifactorial. Most people have an underlying tendency to eczema, with episodes precipitated by sweating, irritant exposure or contact allergy.
| Trigger | Why it matters |
|---|---|
| Sweating and heat | Episodes cluster in warm weather and in people whose hands and feet sweat heavily (hyperhidrosis). |
| Stress | One of the most consistently reported triggers, often with a lag of a few days. |
| Nickel and cobalt | Contact with — and in some people dietary intake of — nickel and cobalt can precipitate flares; patch testing identifies this. |
| Wet work and detergents | Frequent handwashing, cleaning products and glove occlusion strip the barrier on the hands. |
| Fungal infection elsewhere | Athlete's foot can provoke a sympathetic blistering reaction on the hands (an id reaction). |
| Atopic background | Personal or family history of eczema, asthma or hay fever raises the likelihood and the recurrence rate. |
Conditions that look similar
Blisters on the hands and feet have several causes, and treatment differs — a fungal infection treated with a strong steroid will get worse.
| Condition | How to tell it apart |
|---|---|
| Tinea (fungal) infection | Often one hand and both feet, scaling with a defined border; a skin scraping settles the question. |
| Contact dermatitis | Matches the shape and site of contact with a substance, and improves away from the exposure. |
| Palmoplantar psoriasis | Thick red plaques with silvery scale and sterile yellow-brown pustules rather than clear blisters. |
| Scabies | Intense night itch with burrows between the fingers and involvement of wrists, waistline and genitals. |
| Hand, foot and mouth disease | Sudden oval blisters on palms and soles with mouth ulcers and fever, usually in children or their carers. |
Treatment options
Treatment aims to settle the current flare quickly and reduce how often episodes return. Palm and sole skin is thick, so treatment is more intensive than for eczema elsewhere.
Potent topical steroids
Short courses of potent or very potent topical steroid — sometimes under occlusion overnight — are the mainstay for an active flare, prescribed and supervised by a clinician.
Cool soaks and drying
Cool compresses or dilute potassium permanganate soaks (as advised) reduce itch and dry weeping blisters in the acute phase. Do not deliberately burst blisters.
Emollients and barrier care
Thick emollients applied many times a day, especially during the peeling phase, prevent painful cracking. Use cotton-lined gloves for wet work and avoid soap on the hands.
Treat triggers
Treat athlete's foot promptly, manage excessive sweating, and consider patch testing if flares are frequent — nickel and cobalt avoidance helps a meaningful subgroup.
Severe or resistant disease
Options include topical calcineurin inhibitors, hand and foot phototherapy, oral steroid courses for severe flares, and systemic immunomodulators under dermatology supervision.
When to see a doctor
See a clinician for a first episode, for any severe or painful flare, and if the diagnosis is uncertain — fungal infection and psoriasis need entirely different treatment.
Red flags
- Yellow crusting, pus, increasing pain, warmth or fever (secondary infection)
- Blisters merging into large painful bullae limiting hand or foot use
- Flares recurring every few weeks despite treatment
- Nail changes developing alongside the rash
- Rash interfering with work, sleep or the ability to grip or walk
Frequently asked questions
What triggers dyshidrotic eczema?
Common triggers are heat and sweating, emotional stress, wet work and detergents, contact with nickel or cobalt, and a fungal infection such as athlete's foot elsewhere on the body. Many people have an underlying atopic tendency, and flares often follow a trigger by several days.
How long does a dyshidrotic eczema flare last?
A typical episode lasts two to four weeks. Blisters appear over a few days, remain for one to two weeks, and the skin then peels and can crack painfully for another week or two. Prompt treatment shortens the itchy phase and reduces cracking.
Should I pop dyshidrotic eczema blisters?
No. Popping the blisters opens the skin to bacterial infection and delays healing. Very large painful blisters can be drained safely by a clinician. Use cool compresses, prescribed topical treatment and thick emollients instead.
Is dyshidrotic eczema contagious?
No. It is an inflammatory eczema, not an infection, and cannot be passed to anyone else. Fungal infections and hand, foot and mouth disease can look similar and are contagious, which is one reason a first episode is worth having examined.
Is dyshidrotic eczema caused by stress?
Stress is one of the most frequently reported triggers, but it is not the sole cause. It appears to act on top of an existing tendency alongside sweating, irritant exposure and contact allergy. Managing stress helps many people reduce flare frequency but rarely eliminates episodes on its own.
What is the fastest way to treat pompholyx?
The fastest route is a prescribed potent topical steroid started early in the flare, combined with cool compresses, frequent thick emollients, avoiding soap and wet work, and treating any athlete's foot. Persistent or severe cases benefit from dermatology review for phototherapy or systemic treatment.
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Check your skin nowRelated guides
- Dyshidrotic eczema: full clinical A–Z entry
- Eczema (atopic dermatitis)
- Contact dermatitis
- Dyshidrotic eczema in the dermatitis hub
- Skin rash types: identify a rash by pattern
This page is for general information and does not replace a medical consultation. If you are worried about a skin change, see a qualified clinician.