Dyshidrotic eczema (pompholyx): treatment, causes and triggers

The NHS says the main treatments are moisturisers (emollients) used every day to stop the skin becoming dry, and steroid creams and ointments (topical steroids) used for a few weeks at a time to reduce irritation and soreness.

If the blisters leak fluid, the NHS says a GP may suggest soaking your skin in potassium permanganate solution, which helps dry the blisters and reduces the risk of infection. If the blisters become infected, a GP may prescribe antibiotics.

If symptoms are severe or treatment is not helping, a GP may refer you to a dermatologist. The NHS says a dermatologist may recommend steroid tablets, ultraviolet (UV) light treatment or other medicines such as alitretinoin, and will closely monitor progress.

NICE says alitretinoin is recommended for adults with severe chronic hand eczema that has not responded to potent topical corticosteroids. Only dermatologists, or physicians with experience in managing severe chronic hand eczema and systemic retinoids, should start and monitor it.

Do not burst the blisters, says the NHS. If itching is disturbing your sleep, a pharmacist can advise about sedating antihistamines taken before bed.

The NHS says it is not clear exactly what causes pompholyx. Certain things are thought to cause symptoms in some people, and the NHS says that if you notice something causes your symptoms, avoiding it as much as possible may help.

• Contact with strong chemicals such as soaps, cleansers and detergents.

• An allergy or sensitivity to certain metals, such as nickel or cobalt.

• Getting your hands wet regularly, for example if you are a hairdresser.

• Stress.

• Heat and sweat.

The NHS list of things thought to bring on pompholyx does not include foods, and the sources used for this page do not give dietary advice. If you suspect a food or a metal such as nickel is involved, raise it with your GP rather than cutting foods out on your own. The NHS contact dermatitis page says a GP can refer you to a dermatologist for further tests if the substance causing a reaction cannot be identified.

The NHS says the first symptom is often itchy skin with a burning or prickling feeling in the affected area. Fluid-filled blisters then appear. They are usually very itchy and may leak fluid, and may look darker on black or brown skin.

When the blisters go away, the skin may be dry, cracked and sore, and sometimes it bleeds.

Pompholyx most often affects the fingers and palms of the hands. It can also affect the toes and soles of the feet.

The NHS says symptoms usually last 2 to 3 weeks at a time. It describes pompholyx as usually a long-term condition that comes and goes over time, and says treatment can help control the symptoms.

The NHS describes pompholyx as a type of eczema with a range of possible triggers, and says that atopic eczema is not contagious so you cannot catch or spread it. Nothing in the NHS pompholyx page suggests it spreads between people.

The blisters can become infected, which is a different matter: the NHS lists blisters that are very painful, leak yellow or green pus or are covered in a yellow-brown crust as signs of infection.

The NHS says other conditions can cause sore, itchy patches or blisters on the hands and feet, including psoriasis and fungal infections like ringworm and athlete's foot. It says not to try to diagnose yourself and to see a GP if you are worried.

The NHS says your skin may get irritated easily, and suggests the following.

• Wash your hands with warm (not hot or cold) water and use an emollient soap substitute instead of regular soap.

• Wear protective gloves, ideally with a cotton lining, when using chemicals like shampoos, cleansers and detergents.

• Wear socks, tights or stockings made from cotton or silk rather than nylon.

• Wear shoes made from leather rather than plastic or rubber.

• Avoid anything you think causes your symptoms.

• The NHS contact dermatitis page adds that gloves should be taken off every now and again because sweating can make symptoms worse, and that emollients applied frequently and in large amounts help protect the skin.

The NHS says to see a GP if you think you have pompholyx, if you have pompholyx and the blisters are very painful, leak yellow or green pus or are covered in a yellow-brown crust (signs of infection), or if you have any other changes to your skin you are worried about.

The NHS says a pharmacist can help with itching that affects your sleep.

Most people are managed in primary care by a GP and pharmacist. Referral to NHS dermatology is for severe disease or disease not responding to treatment, and waiting times vary by area.

Private dermatology is also available, including assessment for contact allergy. Share your GP records and previous treatments so care stays consistent.