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Eczema dyshidroticum · Pompholyx
Deep-seated, water-clear blisters on the sides of the fingers that do not burst but peel in collarettes after one to two weeks — and return in bouts.
Also known as: dyshidrosis · pompholyx · vesicular hand eczema · sago-grain blisters
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Water-clear blisters the size of sago grains sit on the sides of the fingers, in the palm and on the soles. They lie under a thick horny layer and therefore do not burst but dry up. After one to two weeks the skin above them peels in collarettes and shreds, and beneath it is red, thin and tender. The name misleads: it has nothing to do with the sweat glands, even though warmth and sweating favour the bouts.
The course in bouts is typical. One bout lasts two to three weeks and can repeat after weeks to months, often in spring and summer. The itch usually comes before anything visible: it burns and itches on the sides of the fingers before anything can be seen there. Unlike hand fungus, almost always both hands are involved, often strikingly mirror-image.
Several things set it off and keep it going at once: wet work and frequent hand washing, soaps and disinfectants, work under rubber gloves, nickel and cobalt where a contact allergy exists, warmth, and in some people a fungus on the feet to which the hands answer with blisters without being infected themselves. That is why the feet belong in the picture in every stubborn case.
The nails join in when the inflammation reaches the nail fold. Transverse ridges and dents appear that grow out with the nail, and with longer-lasting inflammation the plate can lift from the free edge. To be told apart: hand fungus — by a scale sample, not by eye —, the pustular form of psoriasis with its sterile pustules, and scabies, which itches mostly at night and prefers other places.
Blisters and scaling look alike in eczema and fungus, but the treatments are opposite. A scale sample settles it in minutes — and it belongs before the first steroid ointment.
On the palm the horny layer is thick; too weak an ointment does not get through. The usual approach is a strong enough ointment over a few days to two weeks during the bout rather than a weak one over months. Strength and duration are the doctor’s call — but the rule behind it explains why months of weak creaming achieve nothing.
Rubber gloves protect from the water and trap the moisture underneath. A cotton glove beneath and wearing times under twenty minutes at a stretch make the difference. Wash hands in lukewarm water with a mild product, then cream at once.
In some cases the hand answers a fungus on the foot without being infected itself. Treat the foot and the bouts on the hand stop. It is the one route where the cause sits somewhere else entirely from the picture.
A patch test on the back shows after two to three days whether a contact allergy plays a part. Nickel sits in tools, keys, coins and jewellery, cobalt in paints, cement and leather. Without that result, avoiding is guesswork.
They are protected under the thick horny layer. Opening them makes a doorway for bacteria and lengthens the bout. Greasy care and the short, strong ointment work faster than any opening.
Small as sago grains, deep in the skin, firm — they do not press away and do not burst by themselves. That depth is what sets them apart from the superficial blisters of other rashes.
A day or two beforehand it burns and itches on the sides of the fingers with nothing to be seen. Anyone who knows this can catch the bout before it shows.
The dried blisters come away as round collarettes and shreds; beneath lies thin red skin that cracks and burns. That is not the start of something new but the end of the bout.
The key difference from hand fungus, which almost always stays on one hand. Both hands involved in the same places speaks for eczema and against a fungus.
When the bout reaches the nail fold, nail formation is disturbed for days. The ridge forms where the nail was being made at the time and travels out with it — its position tells when the bout was.
The clustering is part of the picture. Noting the bouts over a few months — season, gloves, new product, demanding weeks — often finds the trigger faster than any examination.
Neither proof nor diagnosis. A raised value fits a general tendency to allergy present in some of those affected; a normal value rules nothing out. The triggers are found by the patch test, not by blood.
In eczema with a low starting value an improvement has been measured in studies. Dyshidrotic eczema is not separately studied; it is measured because a shortfall is common in winter and simple to correct.
For the renewal of the outer skin and the healing of the cracks after peeling. A shortfall does not make this eczema but delays the closing of the fissures.
Two portions of oily sea fish a week supply the amount in question. The effect on eczema is small and slow and does not replace care on the surface — it works over months, not days.
In eczema with a low starting value an improvement has been measured — 20 to 50 µg (800 to 2000 IU) a day over eight to twelve weeks. Without a measured shortfall the benefit is not established.
Demanding weeks often come before this eczema — that is described and regularly reported by those affected. The pathway behind it is not cleanly measured; the observation still helps, because it makes the bouts predictable.
Cools and eases the itch briefly. On the split, thin skin after peeling it often stings — greasy ointments carry more there than gels.