Dyshidrotic eczema, also called pompholyx, is a form of hand eczema with small, deep, very itchy blisters on the palms, the sides of the fingers and sometimes the soles. Flares are linked to sweating, stress, wet work, nickel allergy and atopic dermatitis.
Key symptoms
- Sudden intense itch or burning on the palms and sides of the fingers
- Tiny clear blisters that look like tapioca under the skin
- Peeling, cracking and painful skin as the blisters dry
- Recurrent flares, often in warm weather
What you find on exam
- Deep-seated small vesicles on the palms, sides of the fingers and soles
- Scaling, fissures and redness in later stages
- Nail changes if the skin around the nails is involved
- Check the feet for tinea, which can trigger a reaction on the hands
Tests
- Clinical diagnosis
- KOH prep of skin scrapings to rule out fungal infection
- Patch testing if a contact allergy, such as nickel, is suspected
- Culture if painful pustules or crusts suggest infection
Treatment basics
- Potent topical corticosteroids such as clobetasol during flares
- Frequent thick emollients and gentle cleansers; cotton gloves under vinyl gloves for wet work
- Cool compresses or soaks for itchy blisters
- Steroid-sparing options: topical tacrolimus; phototherapy or systemic therapy for severe cases
- Avoid triggers such as irritants, nickel and heavy sweating
Red flags
- Pus, honey-colored crusts or spreading redness (bacterial infection)
- Clustered, painful punched-out erosions (eczema herpeticum)
- Severe cracking that prevents work or daily activities
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.