Little, fluid-filled blisters called dyshidrosis to develop on the palms of the hands and the sides of the fingers. On occasion, the soles of the feet are also impacted. The blisters that develop as a result of dyshidrosis often last three weeks and cause excruciating itching. Your skin could seem scaly once the dyshidrosis blisters have dried up. Usually, the blisters return before your skin has fully recovered from the first round.

Adults with dyshidrotic eczema (DE) or acute palmoplantar eczema frequently develop hand dermatitis. It makes up between 5 and 20% of the causes of DE. This condition affects the hands and soles and is vesiculobullous. It is an intraepidermal spongiosis of the thick epidermis in which edema build-up results in the development of tiny, tight, transparent, fluidfilled vesicles on the lateral sides of the fingers that can become big and form bullae. The vesicles may resemble "tapioca pudding" because of their potentially deep-seated look. Lesions may spread to the palmar region in extreme instances, affecting the entire palmar aspect of the hand.

A recurring, acute rash with vesicles and bullae in the fingers that extend to the palmar surfaces of the hands suggests the diagnosis, which is primarily clinical. We describe a case of DE that was diagnosed clinically thanks to the lesions' distinctive "tapioca pudding" look on the palmar side of the hand.

Creams or ointments that you massage on the afflicted area are the most common form of treatment for dyshidrosis. Your doctor could advise corticosteroid drugs like prednisone or injections if the condition is severe. Other names for dyshidrosis include pompholyx and dyshidrotic eczema.

Dyshidrosis: Causes

Dyshidrosis' precise etiology is unknown. It may be connected to atopic dermatitis, often known as eczema, as well as other allergic diseases including hay fever. When a person has nasal allergies, their eruptions may be seasonal.

Dyshidrosis: Symptoms

The clinical sign of DE is a rapid eruption of painful vesicles, especially on the lateral and dorsal surfaces of the fingers, hands, and feet. The vesicles can consolidate into bullae and are deep-seated, multilocular, and have a distinctive "tapioca pudding" look. As a result, DE is mostly diagnosed through clinical means. There is a chance of secondary infection of the lesions.

Seldom is a skin biopsy necessary, and when it is, it is typically done because the condition has not improved after therapy or because the differential diagnosis suggests an infection. Spongiosis is the major pathologic finding.

Dyshidrosis: Risk Factors

Several factors play an important role in the development of dyshidrosis which includes −

  • Stress. There seems to be a higher prevalence of dyshidrosis during periods of mental or physical stress.

  • Being exposed to certain metals. They often occur in an industrial context and include nickel and cobalt.

  • Delicate skin. The likelihood of developing dyshidrosis is higher in people who itch after coming into touch with particular irritants.

  • Dermatitis atopy. Some atopic dermatitis sufferers may get dyshidrotic eczema.

Dyshidrosis: Diagnosis

The diagnosis of dyshidrosis is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

Your doctor can typically identify dyshidrosis through a physical examination. Dyshidrosis cannot be definitively diagnosed by a lab test, but your doctor may recommend tests to rule out other skin conditions that present with comparable symptoms.

For instance, the type of fungus that causes an athlete's foot may be determined using a scrape of your skin. By exposing small sections of your skin to different chemicals, you can identify your skin's allergies and sensitivities.

Dyshidrosis: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

The treatment of acute eruptions and long-term maintenance are the main goals of DE management. The severity of the manifestation determines how acute DE should be treated. The Dyshidrotic Eczema Area and Severity Index (DASI) score, which takes into account the number of vesicles, the intensity of erythema, pruritus, and other factors, can be used to evaluate severity. The DASI score is not widely used in medical practice, nevertheless.

Mild to severe instances often present with lesions that do not cover the entire palmar or plantar surface, few crops of vesicles, minor erythema, non-disabling pruritus, and little to no pain or discomfort. Topical corticosteroids and calcineurin inhibitors are used to treat mild to moderate instances of the condition. Mometasone and topical tacrolimus have also been utilized as treatments. Systemic corticosteroids are used to treat serious illnesses.

When there is no progress after two to four weeks of sufficient therapy, DE treatment is deemed resistant. Skin patch testing, skin biopsy, and further workup for viral, bacterial, and fungal infections can all be taken into consideration when the differential diagnosis is unclear. In cases with resistant DE, topical psoralen and ultraviolet A treatment (PUVA) may be employed. Botulinum toxin usage in DE for the treatment of instances with refractory pruritus may be appropriate.

  • Corticosteroids. High-potency lotions and ointments containing corticosteroids may hasten the blisters' healing. Absorption can be enhanced by wrapping the treated area in plastic wrap. To improve the absorption of the drug, moist compresses may also be used following the administration of a corticosteroid. Your doctor could advise corticosteroid drugs, such as prednisone, in severe instances. Steroid usage over a long period might have negative side effects.

  • Phototherapy. If previous therapies don't work, your doctor can suggest a unique form of light therapy that combines exposure to UV light with medications that make your skin more susceptible to the effects of this sort of light.

  • Immunosuppressive creams. Those who desire to reduce their exposure to steroids may benefit from medications like tacrolimus and pimecrolimus. An increased chance of skin infections is one of these medications' adverse effects.

  • Injections of botulinum toxins. Injections of botulinum toxin may be suggested by some medical professionals to treat severe dyshidrosis.

Possible home remedies include −

  • Using compressions. Using cold, wet compresses might help lessen the irritation.

  • Using anti-itch medication. Itching can be relieved with over-the-counter antihistamine drugs like loratadine or diphenhydramine.

  • Making use of witch hazel. Healing might be sped up by soaking the afflicted regions in witch hazel.

Dyshidrosis: Prevention

There is no known technique to avoid dyshidrosis because the reason is often unknown. You may assist prevent the illness by controlling stress and limiting exposure to metal salts, such as cobalt and nickel.

The skin may also be protected by using good skin care techniques. They consist of −

  • Washing your hands with gentle soaps and lukewarm water, thoroughly drying your hands, and moisturizing often

  • Putting on gloves


The most typical cause of hand dermatitis is DE. As it is mostly a clinical diagnostic and biopsy is only performed on patients with refractory illness or suspected secondary infections, it is essential to identify the disorder by its clinical symptoms. To distinguish these illnesses from other ailments, it's crucial to be able to recognize the "tapioca pudding" look of the vesicular lesions in these disorders.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 17-Apr-2023


Kickstart Your Career

Get certified by completing the course

Get Started