Pompholyx (dyshidrotic eczema)

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 fluid.

What causes 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 does it last?

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) and 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

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

Your GP will probably prescribe a strong steroid cream to use 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 to 15 minutes once or twice a day for up to 5 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 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).

A dermatologist may recommend one of the following treatments:

• phototherapy – controlled exposure to ultraviolet (UV) light
• steroid tablets or very strong steroid cream
• immunosuppressant creams or ointments, such as pimecrolimus or tacrolimus
• immunosuppressant tablets or capsules, such as ciclosporin or azathioprine
• alitretinoin capsules – medication that helps improve severe eczema affecting the hands when other treatments haven't worked

Similar skin conditions

Conditions that can look similar 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