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Health condition · Clinically reviewed

Dyshidrotic eczema, the tapioca-blister rash on palms and soles - and how to settle it.

Pompholyx is common, itchy and often stress-linked. A structured plan - triggers, emollients, a short course of a potent steroid and, when needed, phototherapy or dupilumab - beats a shelf full of unlabelled tubes.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including patch testing, phototherapy and dupilumab for refractory disease.

Key facts

Dyshidrotic eczema at a glance.

The essentials, in plain English - what it is, what triggers it, and how it is treated in the UK today.

  • What it is

    Recurrent vesicular hand and foot eczema - deep, itchy, tapioca-like blisters on palms, soles and the sides of the fingers.

  • Other names

    Pompholyx, dyshidrotic eczema, vesicular palmoplantar eczema - all describe the same condition.

  • How common

    Affects around 1 to 2 per cent of the population, slightly more women than men, peak in the 20s to 40s.

  • The name misleads

    Despite the word dyshidrosis, sweat glands are not the primary problem - it is an inflammatory eczema, not a sweating disorder.

  • Common triggers

    Stress, hot and humid weather, nickel and cobalt allergy, atopic tendency, wet work and fungal id reactions.

  • Foundation therapy

    Emollients plus a short course of a potent topical corticosteroid - with trigger avoidance underpinning everything.

Why this guide matters

Three ideas that shape every plan.

Dyshidrotic eczema responds to a small number of well-chosen moves, done consistently. These three shape the rest of the page.

  • Triggers do most of the work

    Stress, wet work and a nickel or cobalt allergy drive many flares - fixing those beats bigger doses of medication.

  • Potent steroids, used briefly

    A short course of a potent topical steroid, applied properly, calms a flare faster than weeks of a weak one.

  • Chronic disease deserves specialists

    Refractory hand and foot eczema now has real answers - phototherapy, dupilumab and JAK inhibitors change lives.

How the diagnosis is made

From first blisters to a clear plan.

The steps a UK GP or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Trigger review - stress, seasonality, occupation, wet work, gloves, metal exposure and any personal or family atopy.

  2. 02

    Assessing

    Skin examination

    Deep-seated, clear vesicles in crops on palms, soles and the sides of the fingers - often symmetrical and intensely itchy.

  3. 03

    Assessing

    Rule out mimics

    Contact dermatitis, tinea manuum or pedis, scabies, palmoplantar psoriasis and impetigo can all look similar early on.

  4. 04

    Confirming

    Skin scrapings and KOH

    Sent to lab to rule out a fungal infection - especially if only one hand or foot is involved.

  5. 05

    Confirming

    Patch testing

    Referral to dermatology for a standard series - nickel, cobalt, chromium, fragrances and preservatives are the usual suspects.

  6. 06

    Preparing

    Selective bloods

    Not routine - considered where a systemic driver is suspected, such as HIV or a connective tissue disorder.

  7. 07

    Preparing

    Specialist dermatology referral

    For severe, refractory or scarring disease - and to consider phototherapy, systemic therapy or a biologic.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What pompholyx actually looks like.

Deep vesicles, intense itch and painful peeling - and, over time, chronic thickening. And the features that mean it is time to escalate.

  • Deep-seated vesicles

    Tiny, 1 to 3 mm clear blisters buried in the skin of the palms, soles and sides of the fingers - the classic tapioca-pearl look.

  • Intense itch and burning

    Often the first symptom - an itch that appears hours before the vesicles become visible.

  • Painful desquamation

    As vesicles resolve the skin peels in sheets - dry, cracked and sore, sometimes more troublesome than the blisters themselves.

  • Chronic thickening

    With repeated flares the skin becomes lichenified, hyperkeratotic and prone to painful fissures.

  • Symmetrical distribution

    Both hands, both feet - a symmetrical pattern is typical and helps distinguish it from tinea or contact dermatitis.

  • Seasonal and stress-linked flares

    Spring and summer flares are common, and stress is the single trigger patients report most often.

  • Young and middle-aged adults

    Most people present between their 20s and 40s - it can occur in children but far less commonly.

  • Red flag - superinfection

    Yellow crusting, spreading redness, pain out of keeping with the rash or fever needs same-day antibiotics.

Treatment

How dyshidrotic eczema is treated in the UK.

A ladder that starts with triggers and emollients, moves through a potent topical steroid and, when needed, brings in phototherapy, systemic therapy or dupilumab.

  • Trigger avoidance

    Identify and avoid known allergens, protect hands from wet work with cotton liners under nitrile or vinyl gloves, and use stress-reduction strategies.

  • Emollients

    Applied liberally and often - a petrolatum-based occlusive at night and a lighter cream by day - the quiet foundation of every plan.

  • Potent topical corticosteroid

    Clobetasol 0.05 per cent or betamethasone 0.05 per cent for acute flares - short two-week courses, occasionally under occlusion for stubborn patches.

  • Topical calcineurin inhibitor

    Tacrolimus or pimecrolimus as a steroid-sparing option - useful for maintenance and thinner skin sites.

  • Phototherapy

    Narrowband UVB or PUVA delivered in a dermatology unit - a good option for chronic or refractory hand and foot eczema.

  • Systemic therapy

    Short-course oral prednisolone for severe flares, then steroid-sparing agents like methotrexate, azathioprine, ciclosporin or mycophenolate.

  • Dupilumab and JAK inhibitors

    Dupilumab is increasingly used for refractory dyshidrotic disease, and JAK inhibitors like upadacitinib or baricitinib are a specialist option.

  • Botulinum toxin (selected)

    Intradermal palms and soles to reduce sweat-driven flares - reserved for patients where hyperhidrosis is a clear trigger.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Eczema - atopic and hand.

  • British Association of Dermatologists (BAD). Guidance and patient leaflets on hand eczema and pompholyx.

  • European Academy of Dermatology and Venereology (EADV). Hand eczema guideline.

  • Primary Care Dermatology Society (PCDS). Pompholyx clinical overview.

Red flags

When pompholyx needs urgent attention.

Most dyshidrotic eczema is manageable in primary care. These are the situations that are not - and where a specialist opinion is needed.

  • Bacterial superinfection

    Yellow crust, spreading warmth, pain out of proportion or fever needs prompt antibiotics - flucloxacillin or fusidic acid depending on culture.

  • Eczema herpeticum

    Sudden painful punched-out erosions with systemic upset - an emergency needing urgent dermatology and aciclovir.

  • Failure of first-line therapy

    If potent topical steroids and emollients are not enough after four to six weeks, ask for a specialist opinion.

  • Occupational impact

    When the rash is stopping someone working - or wet work is clearly driving it - occupational health input matters.

  • Suspected contact allergy

    A pattern that flares with jewellery, tools, cosmetics or workplace exposures deserves patch testing before more medication is added.

  • Fungal look-alike

    One-sided hand or foot disease, or a scaly ring pattern, needs skin scrapings to rule out tinea manuum or pedis.

  • Psychological burden

    Visible hand disease affects work, relationships and mood - low mood or anxiety deserves proper support alongside skin treatment.

  • Suspected systemic driver

    Persistent, atypical or explosive disease with systemic features may warrant screening for HIV or connective tissue disease.

  • Deep painful fissures

    Cracks that will not close, bleed or interfere with grip need protective dressings, potent steroid and sometimes systemic therapy.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - protect the barrier, track your triggers, treat stress as a driver and refuse to accept chronic disease.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits, kept up for months, do more than a heroic week that does not last.

  1. 01 Barrier

    Protect the barrier

    Cotton liners under nitrile or vinyl gloves for wet or dirty work, and emollient applied every time hands are washed.

  2. 02 Triggers

    Track your patterns

    A simple diary of flares, jobs done, foods, stress and weather often surfaces a trigger no one had spotted.

  3. 03 Stress

    Treat stress as a driver

    Sleep, exercise and a proper approach to stress are as much a part of care as any cream - the skin listens.

  4. 04 Escalate

    Do not tolerate chronic disease

    If flares keep coming or fissures never heal, ask for dermatology - phototherapy, dupilumab and JAK inhibitors have changed outcomes.

Frequently asked

Everything we get asked about dyshidrotic eczema.

Quick answers on triggers, patch testing, topical steroids, phototherapy and dupilumab.

  • What is dyshidrotic eczema?

    It is a recurrent form of eczema affecting the palms, soles and the sides of the fingers, with deep itchy vesicles that look like tapioca pearls. Also called pompholyx or vesicular hand and foot eczema.

  • Is it caused by sweat?

    Not directly. The old name dyshidrosis suggested a sweat-gland problem but sweat glands are not the primary driver. Sweating and heat can trigger flares in some people, but the underlying process is inflammatory eczema.

  • What triggers a flare?

    Stress is the trigger most people report. Contact allergens like nickel, cobalt and chromium, fragrances and preservatives, wet work, seasonal heat, and sometimes a fungal infection elsewhere on the body can all set it off.

  • How is it treated?

    A short course of a potent topical corticosteroid for the acute flare, liberal emollients, and identifying and avoiding triggers. Calcineurin inhibitors, phototherapy, systemic therapy and dupilumab are used for more stubborn disease.

  • Do I need patch testing?

    If flares keep coming despite good treatment - or if there is any pattern suggesting a contact allergy - yes. Patch testing in a dermatology unit is the only way to identify or rule out the common metal and preservative allergens.

  • When should I see a specialist?

    When first-line topical treatment is not enough after four to six weeks, when fissures or superinfection keep recurring, or when the condition is affecting your work, sleep or mood. Dermatology can add phototherapy, systemic therapy or a biologic.

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