Dyshidrotic Eczema

What dyshidrotic eczema looks like

• clusters of tiny blisters (1 to 2 mm) under the skin, often described as "tapioca pudding" or "sago grains"
• mostly on the sides of the fingers, the palms and soles
• intense itching or burning, often before the blisters appear
• larger blisters can merge in severe cases
• after about 3 weeks, the blisters dry, leaving peeling, scaly, sometimes cracked skin
• nail changes, such as ridges or pitting, with repeated flares near the nails

Causes and triggers

The exact cause is unknown. Despite the name, it is not a disorder of the sweat glands, though sweating can worsen it. Common triggers:

• stress
• sweating, heat and humidity, with flares often in spring and summer
• wet work and frequent hand washing
• metal allergy, particularly nickel and cobalt, including in food in some sensitive people
• seasonal allergies and atopic dermatitis
• fungal infection elsewhere (an "id reaction" to athlete's foot)
• IV immunoglobulin treatment and some medicines
• smoking

It is most common between ages 20 and 40 and in people with other forms of eczema or allergies. It is not contagious.

Conditions that can look similar

Diagnosis

A doctor or dermatologist usually diagnoses it by examining the skin. Tests may include:

• skin scraping to check for fungal infection
• patch testing to find contact allergies such as nickel, if flares are frequent
• swab if infection is suspected

Treatment

During a flare

• Potent topical steroid creams or ointments, applied once or twice daily for up to 2 to 4 weeks. Hands and feet have thick skin and need stronger steroids than the face.
• Cold compresses or soaks for 15 minutes several times a day to ease itch and dry blisters. Soaking in dilute potassium permanganate or aluminum acetate (Burow's solution) can help dry weeping skin.
• Do not pop blisters, which increases infection risk. A doctor can drain very large ones.
• Antihistamines at night may help sleep but do not treat the eczema itself.

Between flares

• moisturize several times a day with a thick, fragrance-free cream or ointment, especially after washing
• wash with lukewarm water and a gentle, soap-free cleanser, and dry thoroughly
• wear cotton-lined gloves for wet work and cleaning
• manage stress and sweating
• avoid known allergens, including nickel if patch testing is positive

Severe or persistent cases

• topical calcineurin inhibitors (tacrolimus) or crisaborole
• phototherapy (PUVA or UVB) to the hands and feet
• short courses of oral steroids for severe flares
• oral treatments such as alitretinoin (available in some countries), methotrexate or other immune medicines
• botulinum toxin injections for those whose flares are triggered by heavy sweating
• dupilumab or JAK inhibitors for people who also have significant atopic dermatitis

Outlook

Dyshidrotic eczema often comes and goes for years. Many people learn to recognize early itching and treat promptly to shorten flares. Some cases fade over time.

Frequently asked questions

What causes dyshidrotic eczema?

The exact cause is unknown, but flares are often triggered by stress, sweating, heat, wet work, metals such as nickel, seasonal allergies and fungal infections. People with atopic dermatitis or allergies are more prone to it.

How do I get rid of dyshidrotic eczema fast?

A potent steroid cream from your doctor, cold compresses and frequent moisturizing can calm a flare within days to weeks. Avoid scratching and popping the blisters. Severe flares may need a short course of oral steroids.

Is dyshidrotic eczema contagious?

No. It cannot spread to other people. However, blisters that become infected with bacteria need treatment, and fungal infections that can mimic or trigger it can be contagious.

Should I pop dyshidrotic eczema blisters?

No. Popping blisters increases the risk of infection and can make itching worse. Let them dry naturally, and use cold compresses and prescribed creams. A doctor can drain large, painful blisters safely.