Dyshidrotic eczema (pompholyx) is an uncomfortable but manageable skin condition. This article summarises the care and treatment options dermatology offers today — from basic daily care to procedures prescribed by a doctor. It is not a guide to self-treatment; the aim is to help you understand the options and have an informed conversation with your dermatologist.
Dyshidrotic eczema (pompholyx) is a chronic, itchy skin reaction with small blisters on the palms, fingers and soles; the exact cause is unknown. The foundation of care is emollients and — during a flare — topical corticosteroids prescribed by a doctor. For more severe forms, phototherapy, calcineurin inhibitors, short courses of oral corticosteroids or alitretinoin may be used; for resistant chronic hand eczema, the topical JAK inhibitor delgocitinib has recently been approved in the EU. Prevention matters: avoid irritants, avoid nickel and cobalt in sensitive individuals, and reduce stress.
What is dyshidrotic eczema
Dyshidrotic eczema, medically known as pompholyx, is an itchy, chronic and recurrent skin reaction on the palms, fingers and soles. It typically presents as small, deep-seated, 1–2 mm fluid-filled blisters that resolve after several weeks as the skin begins to peel. The exact cause is unknown and — contrary to an older theory — is not related to blockage of the sweat glands [1].
Foundation of care: emollients and moisturising
The first step in care is emollients (moisturisers). They should be used regularly and in place of soap, so the skin does not dry out and the disrupted skin barrier can recover. Emollients are the foundation on which any further measures are built [2].
Topical corticosteroids
During a flare, topical corticosteroids are the foundation of medical care. They help reduce inflammation and speed the healing of cracks. They are usually prescribed in short courses to minimise the risk of side effects [2][3]. The length of the course and the strength of the preparation are always decided by the doctor, based on the extent and severity of the condition.
Topical corticosteroids belong in a doctor's hands. Do not adjust the length of the course or the strength of the preparation yourself — that is for the dermatologist to decide.
When topical treatment isn't enough
For more severe or unresponsive forms, the dermatologist has further options: short courses of systemic (oral) corticosteroids for very severe outbreaks, calcineurin inhibitors, phototherapy (PUVA or narrowband UVB), and — in adults with severe eczema not responding to potent topical corticosteroids — oral alitretinoin (Toctino) [2][4]. Potassium permanganate soaks are sometimes used as well [5].
Newer options for resistant cases
For resistant (recurrent) cases, the literature describes improvement with dupilumab [4]. For chronic hand eczema — which includes the vesicular (dyshidrotic) form on the hands — the topical JAK inhibitor delgocitinib (Anzupgo®) has also been approved in the EU, for adults in whom topical corticosteroids are insufficient or unsuitable [6]. These are specialist procedures tied to a specific indication.
Triggers and prevention
Limiting triggers plays an important role. It is advisable to avoid irritants (harsh soaps, solvents, detergents), and in sensitive individuals also contact with nickel and cobalt, to follow a hand-care routine, and to reduce stress, which can worsen flares [4]. If there are signs of infection (yellow fluid, increasing redness, pain, swelling, crusting), see a doctor [7].
How gentle daily care can help
Alongside medical treatment, gentle daily skin care is a support. Selected products in the EPIDERMA® range with the patented Betuldiol® complex are gentle and suitable for sensitive skin. They do not replace medical treatment but complement it as part of ordinary daily care and moisturising. We always recommend discussing your approach with your dermatologist.
For supporting the skin from within: DermBalance Complex® — a food supplement with zinc, omega-3, turmeric and probiotics. Zinc contributes to the maintenance of normal skin.
Learn more about DermBalance Complex®Food supplement. Not a substitute for a varied diet. Not suitable for pregnant or breastfeeding women or children under 12.
Frequently asked questions
It is a chronic, recurrent condition with an uncertain cause. The aim of care is to manage flares, speed healing and prevent recurrences — not a one-off removal. In many people the condition alternately improves and returns [1].
The foundation is regular use of emollients and — during a flare — topical corticosteroids prescribed by a doctor. Only when that is not enough do further procedures come into play [2].
Topical corticosteroids are usually prescribed in short courses to minimise risks. The length and strength are always decided by the doctor [2][3].
With any blistering outbreak that does not improve, recurs or shows signs of infection (pus, increasing pain, swelling, crusts). The specialist will assess the appropriate treatment, including phototherapy or stronger preparations [3][4].
References
[1] DermNet (Jain MA, Jarrett P). Dyshidrotic eczema (Pompholyx, Vesicular Hand Eczema). dermnetnz.org/topics/dyshidrotic-eczema
[2] National Eczema Society. Pompholyx (dyshidrotic) eczema. eczema.org
[3] NHS / nidirect. Pompholyx (dyshidrotic eczema). nidirect.gov.uk
[4] Medscape / eMedicine. Dyshidrotic Eczema (Pompholyx) Treatment & Management. emedicine.medscape.com/article/1122527-treatment
[5] National Eczema Society (UK). Pompholyx / dyshidrotic eczema — potassium permanganate soaks. eczema.org.uk
[6] Dermatology Times. FDA Approves LEO Pharma's Delgocitinib for Chronic Hand Eczema (also notes the earlier European Commission approval, 2024). dermatologytimes.com
[7] Patient.info (clinically reviewed). Pompholyx: Causes, Symptoms and Treatment. patient.info
MUDr. Jiří Skalický
Founder of EPIDERMA®
This article is for educational purposes and does not replace medical consultation. Discuss the treatment of dyshidrotic eczema with a dermatologist.