Dyshidrotic Eczema (Pompholyx): Symptoms, Causes and UK Treatment Guide

Dyshidrotic eczema, medically referred to as pompholyx, is a common type of dermatitis that specifically affects the hands and feet. Unlike atopic eczema, which can appear anywhere on the body, pompholyx is localised to the palms, the sides of the fingers, and the soles of the feet. It is characterised by the sudden eruption of small, fluid-filled blisters that are often described by patients as 'intensely itchy' or 'burning'.

In the UK, this condition is particularly prevalent during the spring and summer months. While the exact cause remains unknown, it is thought to be related to a combination of genetic factors, immune system overactivity, and external triggers. According to NHS guidance, pompholyx can affect people of any age, though it most commonly starts in adults under the age of 40.

The symptoms of dyshidrotic eczema usually follow a distinct cycle. The first sign is often a prickling or burning sensation in the skin, followed by:

• Tiny Blisters: Small vesicles (about the size of a grain of rice) appearing in clusters.
• Intense Itching: The itchiness is often severe and can disrupt sleep.
• Pain and Redness: Larger blisters may merge, causing significant discomfort and inflammation.
• Scaling and Cracking: As the blisters dry out, the skin may peel, flake, or develop painful cracks (fissures).

It is important not to pop the blisters, as this increases the risk of a secondary bacterial infection, such as staphylococcal infection, which may require antibiotics.

While the root cause is not always clear, several factors are known to trigger a pompholyx flare-up. In line with NICE (National Institute for Health and Care Excellence) evidence, common triggers include:

• Emotional Stress: High levels of anxiety or prolonged stress are frequent precursors to an outbreak.
• Sweating (Hyperhidrosis): The condition is often worse in hot weather or for those whose hands and feet sweat excessively.
• Metal Allergies: Exposure to nickel, cobalt, or chromium (often found in jewellery, tools, or even certain foods) can trigger a reaction.
• Irritants: Frequent contact with water, detergents, or solvents (common in hairdressing or cleaning professions).

Emollients and Moisturisers

The foundation of any eczema treatment is the frequent use of emollients. These are non-cosmetic moisturisers that help repair the skin barrier. You should use them throughout the day and as a soap substitute, as standard soaps can further irritate the skin.

Topical Corticosteroids

For active flares, a GP will typically prescribe a potent or very potent topical steroid cream or ointment. These help to reduce inflammation and stop the itching. Following NICE guidelines, these should be used sparingly for short bursts (usually 7 to 14 days) to avoid skin thinning.

Managing the Itch

To manage the discomfort, you may use cool compresses or soak the affected area in a dilute solution of potassium permanganate, which can help 'dry out' the blisters and prevent infection. Antihistamines may also be recommended, particularly at night, to help you sleep if the itching is severe.

If you are struggling to manage your symptoms with over-the-counter creams, it may be time to speak to a GP online. An online consultation is a convenient way to have your skin assessed via high-quality photos and a video call.

A GP can provide a private prescription for stronger steroid treatments that are not available in pharmacies without a doctor’s assessment. Furthermore, if your condition is impacting your ability to work—for example, if you work in manual labour or healthcare and cannot use your hands comfortably—an online GP can provide medical advice and, where appropriate, a sick note for your employer.

If your eczema is persistent and does not respond to standard treatments, a GP can also facilitate a referral to a dermatologist for advanced therapies such as PUVA (phototherapy) or alitretinoin.