Pompholyx (dyshidrotic eczema) is a type of

eczema that causes tiny blisters to develop

across the fingers, palms of the hands and
sometimes the soles of the feet.
It can affect people of any age, but it's most often
seen in adults under 40.
Pompholyx can sometimes be confused with similar-
looking conditions. See your GP if you have any sort
of blistering skin condition.
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.
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.
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