Pompholyx (dyshidrotic eczema)

About pompholyx

Pompholyx can affect people of any age, but it's most often seen in adults under 40.

It can sometimes be confused with similar-looking conditions.

Signs and symptoms of pompholyx

Pompholyx usually starts as intense itching and burning of the skin on the hands and fingers. The palms and sides of the fingers (and sometimes the soles of the feet) then erupt into tiny itchy blisters that may weep (leak) fluid.

In severe cases, the blisters may be quite large and may spread to the backs of the hands, feet and limbs.

The skin can sometimes become infected. Signs of an infection can include the blisters becoming very painful and oozing pus or becoming covered in a golden crust.

The blisters will usually heal within a few weeks. The skin tends to become dry and crack or peel as it starts to heal.

Causes of pompholyx

It's not clear exactly what causes pompholyx, but it may be triggered or made worse by:

• a fungal skin infection – this may be on the hands or at a distant site from the blisters (such as in between the toes) and will need treating
• a reaction to something that has touched your skin – such as certain metals (particularly nickel), detergents, household chemicals, soap, shampoo, cosmetic products or perfume
• stress
• sweating – pompholyx is more common in spring and summer, in warmer climates, and in people with hyperhidrosis (excessive sweating)

How long pompholyx lasts

In many cases, pompholyx will clear up on its own within a few weeks. The treatments below may help relieve your symptoms in the meantime.

Sometimes pompholyx may just occur once and never come back. But it often comes and goes over several months or years. Any of the triggers mentioned above can cause it to flare up again.

Occasionally, pompholyx can be more continuous and difficult to treat.

Treatments for pompholyx

Protecting your skin

You should try to avoid contact with anything that might irritate your skin, including soaps, shampoos and other household chemicals.

Use an emollient as a soap substitute (see below). You should wear cotton-lined gloves when you're at risk of contact with other potentially irritating substances, such as when washing your hair or doing housework.

Don't burst the blisters – let them heal on their own. If they're particularly big, your GP may be able to drain them.

Treating the symptoms

You should see your GP if you have any sort of blistering skin condition.

The main treatments your GP may recommend to treat the symptoms of pompholyx are similar to those used when treating atopic eczema, including:

• emollients (moisturisers) – use these all the time and instead of soap to stop your skin becoming dry
• steroid cream – this reduces the inflammation and irritation and helps the skin to heal

If your GP prescribes a steroid cream, it will probably be for a short period of time, to minimise risk of steroid side effects. You may be advised to wear cotton gloves at night to help the cream sink into the skin.

You can also try:

• soaking your hands in a dilute solution of potassium permanganate (1:10,000) for 10-15 minutes once or twice a day for up to five days
• antihistamines to relieve the itching and help you sleep if the itchiness is keeping you awake at night

These treatments are available from pharmacies without a prescription. Your pharmacist can advise you whether they're suitable for you and how you should use them.

Antibiotics may be prescribed if your skin becomes infected.

Specialist treatments

If your pompholyx keeps returning or is severe and doesn't get better with the above treatments, your GP may refer you to a specialist in treating skin conditions (dermatologist).

The dermatologist will discuss with you the most appropriate treatment options for your condition. These may include phototherapy and more potent medication, such as immunosuppressants.

Similar skin conditions

Conditions that can have a similar appearance to pompholyx include:

• bullous impetigo – a contagious skin infection that mainly affects children and causes sores and blisters
• bullous pemphigoid – a blistering skin condition that tends to affect the elderly
• contact dermatitis – a type of eczema caused by skin contact with a substance that causes irritation or an allergic reaction
• hand, foot and mouth disease – a viral infection that mainly affects young children, which can cause small blisters to develop on the fingers and palms of the hands
• herpetic whitlow (whitlow finger) – an abscess (collection of pus) at the end of the finger that can cause it to become suddenly red, swollen, painful and blistered
• pustular psoriasis – an uncommon type of psoriasis that causes pus-filled blisters to appear on your skin

• Find out more about pompholyx (dyshidrotic eczema) on the NHS website

More useful links

• How to use your health services