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Dyshidrotic (Vesicular) Eczema

Recurrent pruritic deep-seated vesicles on the lateral fingers, palms, and soles known as pompholyx, triggered by atopy, contact allergens, sweating, and stress, treated with topical steroids, phototherapy, and systemic agents.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Dyshidrotic (Vesicular) Eczema?

Dyshidrotic eczema, also called pompholyx or vesicular palmoplantar eczema, is a chronic relapsing inflammatory skin condition presenting with sudden eruptions of deep-seated, intensely pruritic, tapioca-like vesicles on lateral aspects of the fingers, palms, and soles. Vesicles last 2-3 weeks before resolving with desquamation; chronic disease leads to fissuring, hyperkeratosis, and onychodystrophy.

Pathophysiology is multifactorial including atopic background, contact hypersensitivity (nickel, cobalt, balsam of Peru, fragrance), hyperhidrosis, stress, and id reactions to active dermatophyte infection. There is no true sweat gland involvement (despite the name 'dyshidrotic'); rather, the vesicles arise within the thick palmoplantar epidermis. Differential diagnosis includes irritant or allergic contact dermatitis, tinea pedis/manuum, palmoplantar psoriasis, scabies, and bullous diseases.

Diagnosis is clinical, supported by KOH for tinea, patch testing for contact allergens, and bacterial culture if secondary infection is suspected. Treatment goals are symptom control, prevention of flares, and minimization of long-term complications. Therapy is stepwise: trigger avoidance, emollients, mid- to high-potency topical corticosteroids, topical calcineurin inhibitors, phototherapy (NB-UVB, hand/foot PUVA), short oral corticosteroid course, methotrexate or cyclosporine for severe cases, and dupilumab for atopic-driven recalcitrant disease.

Symptoms

Sudden eruption of deep-seated tapioca-like vesicles
Distribution on lateral fingers, palms, and sometimes soles
Intense pruritus and burning sensation
Vesicles followed by desquamation, fissuring, and lichenification
Chronic disease with onychodystrophy and nail pitting
Flares with stress, summer heat, sweating, contact allergens
Frequent association with atopy and contact dermatitis

Risk Factors

Atopic dermatitis history and family atopy
Contact allergens: nickel, cobalt, chromate, fragrance, balsam of Peru
Hyperhidrosis and occupational wet work
Tinea pedis with id reaction
Stress, anxiety, sleep deprivation
Smoking and IV gamma globulin
Hot, humid climates

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent vesicular hand or foot eruptions
  • Severe pruritus interfering with sleep or work
  • Secondary infection with crusting, pus, or pain
  • Failure of over-the-counter or topical steroid therapy
  • Suspected contact allergy needing patch testing
  • Chronic fissuring, hyperkeratosis, or nail involvement
  • Significant impact on occupation or quality of life

Treatment Methods

01
Trigger avoidance: identify and avoid contact allergens (patch testing); cotton gloves under vinyl/nitrile gloves for wet work; manage hyperhidrosis with topical aluminum chloride or iontophoresis
02
Emollients applied multiple times daily, especially after hand washing
03
Mid- to high-potency topical corticosteroids (clobetasol, betamethasone) for acute flares with tapering and intermittent use to limit atrophy
04
Topical calcineurin inhibitors (tacrolimus, pimecrolimus) for steroid-sparing maintenance
05
Phototherapy: NB-UVB or hand/foot PUVA for moderate-severe chronic disease
06
Systemic options for refractory cases: short oral corticosteroid courses for acute flares, methotrexate, cyclosporine, mycophenolate, or alitretinoin where available
07
Biologic therapy with dupilumab for atopic-driven refractory pompholyx; treat underlying tinea pedis to abolish id reaction; long-term follow-up to prevent recurrence and address occupational impact

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.