Dyshidrotic Dermatitis | Visual Dermatology Atlas

Illustration of the main clinical features of dyshidrotic eczema (pompholyx): deep “tapioca-like” vesicles, palmoplantar involvement, intense pruritus, mild erythema, and scaling during the resolution phase. Flares may be triggered or worsened by heat and

General info +

AKA: Pompholyx

• Recurrent, intensely pruritic vesicular dermatitis affecting the hands and/or feet.
• Associated with atopy, allergic contact dermatitis, and hyperhidrosis.
• Potential triggers or aggravating factors include heat, sweating, emotional stress, irritants, and frequent water exposure.
• Typically occurs in recurrent flares, with spontaneous resolution over approximately 2–3 weeks, often followed by scaling.
• Recurrences are common; secondary bacterial infection may occur.

Symptoms / presentation +

• Often sudden onset.
Intense pruritus ± burning sensation, which may precede the skin lesions.
• Recurrent episodes of vesicles lasting several weeks.
• Pain may occur with significant fissuring.
• Assess for a history of atopy, contact allergy, hyperhidrosis, or dermatophyte infection.

Clinical exam +

• Small, deep-seated, firm vesicles, often clustered.
• Characteristic “tapioca-like” appearance.
• Vesicles initially contain clear fluid.
• Vesicles may coalesce into larger bullae in severe cases.
• Usually minimal surrounding erythema.
• Resolution is typically followed by scaling/desquamation.
• Chronic disease may cause fissuring ± lichenification.
• Yellow crusting, pustules, or oozing should raise suspicion for secondary bacterial infection.

Distribution +

• Lateral aspects of the fingers +++
• Palms +++
• Soles +++
• Toes may also be involved.
• Usually bilateral and symmetric.

Dermoscopy +

• Deep translucent yellowish or whitish vesicles.
• Minimal or absent background erythema.
• Whitish scaling during the resolution phase.
• Superficial fissures may be seen in chronic disease.
• No specific vascular pattern.

Diagnostic +

• Primarily a clinical diagnosis.
• Patch testing if allergic contact dermatitis is suspected or in chronic/recurrent disease.
• KOH preparation or fungal culture if tinea manuum or tinea pedis is suspected.
• Bacterial culture if there are signs of secondary infection.

Differential diagnosis +

• Allergic or irritant contact dermatitis
• Tinea manuum / tinea pedis
• Palmoplantar psoriasis / palmoplantar pustulosis
• Scabies
• Herpetic whitlow
• Atopic hand dermatitis
• Keratolysis exfoliativa
• Autoimmune blistering disorders, less commonly

Treatment plan +

• Avoid irritants, frequent water exposure, and identified contact allergens.
• Frequent use of emollients and appropriate hand protection.
• Vesicular phase: wet compresses/dressings; large bullae may be drained while preserving the blister roof.
• Potent to superpotent topical corticosteroids are first-line for flares.
• Example: clobetasol propionate 0.05% once or twice daily for 7–14 days, followed by reassessment.
• Severe or refractory disease: phototherapy (e.g., PUVA) or specialist-directed systemic therapy may be considered.
• Antibiotics only when there is clinical evidence of secondary bacterial infection.
Identify and treat any associated dermatophyte infection.

References +

DermNet — Dyshidrotic eczema (pompholyx)
American Academy of Dermatology (AAD) — Dyshidrotic eczema
UpToDate — Chronic hand eczema
Bolognia JL, Schaffer JV, Cerroni L. Dermatology. Elsevier.