What is Dyshidrotic Eczema? Blister Rash on Hands and Feet

Dyshidrotic eczema, also known as pompholyx, is a type of eczema characterized by the presence of vesicles (small blisters) or bullae (large blisters) on the hands and feet. This is usually chronic – persistent or recurrent. These vesicles (less than 5 mm in diameter) or bullae (greater than 5mm in diameter) are not boils (abscess). Dyshidrotic eczema is not an infectious condition although it may occur in a person with a fungal or bacterial infection of the hand or feet. The rash is intensely itchy with vigorous scratching leading to rupture of blisters with cracking of the skin and fissures.

It may appear an an independent entity or occur with atopic dermatitis or contact dermatitis (allergic or primary). It may also be associated with a number of systemic, non-dermatological diseases like HIV infection. Dyshidrotic eczema may occur either on the hands or the feet or both – the palms and soles are more often affected, often with extensive involvement of the fingers when it occurs on the hand. Milder cases may resolve before vesicles rupture and therefore cracking is avoided. These cases are more likely to be noticed on the hands. Due to the psychosocial impact of this type of skin disease on the hands, many patients will seek medical attention as soon as possible. However, it may be just as common on the feet although not noticed or even reported in the early stages.

Picture from Wikimedia Commons

Causes of Dyshidrotic Eczema

The exact cause of dyshidrotic eczema is unknown. It may be seen in up to 20% of patients with persisting skin diseases, particularly the other types of eczema, as well as in patients with skin infections. Prolonged tinea pedis (athlete’s foot – fungal infection of the feet) may result in dyshidrotic eczema both on the feet and hands although the skin of the hands are not infected.

It is believed that dyshidrotic eczema is a combination of type I and type IV hypersenstivity reactions. Read more on types of allergic reactions. This is further supported by the presence of  dyshidrotic eczema in asthmatics, patients with hay fever, after exposure to chemical like nickel (known sensitivity like with costume jewelry) and IV immunoglobulin infusions.  It may also be seen in HIV positive patients (after asymptomatic phase) and those on highly active antiretroviral therapy (HAART).

Dyshidrotic eczema may also be seen at times of emotional stress. Although not conclusively substantiated, it is only triggered by emotional stress in people with a history of allergic conditions (personal or family history of atopy) or existing tinea pedis. Therefore pre-existing contributing factors need to be present. It is also interesting to note that monozygomatic twins are equally affected by dyshidrotic eczema which indicates a genetic component, although this may be associated with familial atopy.

In the absence of other pre-existing factors, contact dermatitis needs to be considered as it is widely associated with dyshidrotic eczema, especially in the chronic occupational setting. Food and drug-related allergies are less common but have also been noted as possible triggers of dyshidrotic eczema.

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  • Chris

    I suffer from this in a few bad way both on hands and feet … What is best treatment as gp help is not working and hasn’t for past two years … Having this problem causes alot of stress I also have pictures I have takin of different stages I could show u thanks

  • gar

    I have had these symptoms for several years. I used a cream called “gelmicin” and after about 5 days all symptoms subsided. the blisters healed and have not returned. It’s been about two months now. Not one break out. The flaky dry skin is almost completely gone. I hope this helps.

    • Hi Gar. Thank you for your input. Hopefully it will assist some of the readers.

      • Nat George

        I’m 31 and have suffered with this since I was about 13 — the first few years it broke out on my hands and I narrowed it down to pencil use since that is what we used in middle school. Once I switched to pens, it went away and I haven’t broke out on my hands in many years.

        My feet are another matter — when I buy new shoes it is hit or miss if I will break out — I generally avoid synthetic lined shoes and wear leather combat or cowboy boots. I find that if new shoes or boots smell like chemicals (most all sneakers and many cheaply tanned leather boots) I will break out horribly. If they smell like oil tanned leather they will be fine — I don’t know “what” the chemical is that they put in most new shoes, but I know I’m ultra sensitive to it. I’ve tried wearing two and 3 pairs of socks until the shoes no longer have a chemical smell — it rarely works — if I try washing them in water it makes it even worse since I think the chemicals soak into the padding. The only solution I have found is to wear high quality boots that smell like oil tanning when they are new, and in the case of shoes for working out etc. I let a close friend borrow and wear them in for me for 2-3 months first before I start wearing them — that seems to get the chemicals out.

        I wish I could figure out ‘what’ the chemical is — I’ve went to a number of dermatologists and the best they could do is patch testing with various slivers of shoe fabric and leather — but so far haven’t been able to find one who can do a chemical analysis of what exactly the allergen is. I’m thinking it is either nickel or chromium. Whatever it is, they all tell me there is no allergy shot for it, and no way to reduce my sensitivity to it because even though they don’t know exactly what I’m allergic to, they do know it isn’t like a pet or pollen allergy that they can create a shot for.

        Even with taking these precautions sometimes I just break out on my feet due to stress and occasionally my fingers. I swear the things spread if they break open — they just magically pop up, sometimes in clusters. The itching is beyond intense and I’ve popped them on many occasion since the pain outweighs the itching… I’ve found that soaking my feet in VERY warm (basically hot) water is soothing.

        After much trial and error, my dermatologist prescribed Clobetasol 0.25% cream ‘as needed’–it’s a high powered steroid but it seems to halt the breakouts and helps them heal in 1-2 weeks vs a month without it.

        What is most annoying about this is that there is no ‘cure’–and even the dermatologists at the University of Washington have basically threw up their hands and told me they don’t know what causes it and the best they can do is throw steroids at it and try to avoid the itching…. Grrrrrr — If you have something that has really worked, I’d love to hear it.