Dyshidrotic Eczema / Pompholyx
Dyshidrotic eczema, also called pompholyx, is a distinct form of eczema in which deep, intensely itchy blisters erupt suddenly, mostly on the palms, the soles and along the sides of the fingers and toes.
The old term "dyshidrosis" came from the mistaken idea that the condition was caused by faulty sweat glands. Modern dermatology research has shown that pompholyx is actually a cell-mediated immune inflammation of the epidermis, closely linked to a weakened skin barrier, allergens (such as metal allergy or fungal infection), psychological stress and an unbalanced skin microbiome.
At Haute-Derma, our pompholyx treatment plans aim to bring quick relief and lasting protection to the sensitive skin of the hands and feet.
How Dyshidrotic Eczema Develops
The blisters and itch of pompholyx result from a chain of events in the skin:
- Spongiosis (fluid between skin cells): Pro-inflammatory cytokines cause fluid to leak from superficial blood vessels into the spaces between epidermal keratinocytes. Once enough fluid collects, it pushes the cells apart and forms deep blisters held firmly beneath the thick skin of the palms and soles (rice-grain-like and hard to burst).
- Multiple triggers: Flares are often set off by internal or external factors such as prolonged psychological stress, contact with metals (nickel, cobalt, chromium), allergy to harsh cleaning chemicals, or a fungal infection (tinea) on nearby skin.
- The itch–scratch–chronic inflammation cycle: Intense itching drives scratching, which bursts the blisters and damages the skin barrier. This lets bacteria in and, over time, leads to thickened, cracked and lichenified skin in the chronic stage.
Stages and Clinical Features
| Clinical stage | What the skin looks like | What is happening in the skin |
|---|---|---|
| Acute vesicular phase | Tiny, deep, tense blisters like sago grains, with intense itching and burning on the palms or soles. | Marked spongiosis with fluid collecting under the epidermis; little damage to the surface yet. |
| Subacute / desquamative phase | Blisters burst or dry up, leaving peeling, red, sore skin with painful shallow cracks. | The epidermis is regenerating and the intercellular lipid barrier is badly damaged. |
| Chronic lichenified phase | Thick, rough skin with deep painful fissures and loss of the normal skin lines. | Chronic keratinocyte overgrowth, disrupted collagen and a general loss of elasticity. |
Diagnosis and Assessment at Haute-Derma
Because pompholyx tends to come back, our dermatologists at Haute-Derma carry out a thorough assessment before treatment:
- Clinical examination and differential diagnosis: We distinguish pompholyx from conditions that look similar, such as allergic contact dermatitis, fungal infection of the nails, hands or feet (tinea manuum/pedis) and palmoplantar pustular psoriasis.
- Patch testing: Recommended for persistent, recurrent pompholyx to pinpoint contact allergens such as nickel, fragrances or industrial chemicals.
- Skin barrier assessment: We measure hydration and transepidermal water loss (TEWL) on the hands and feet to plan the right barrier repair.
Multimodal Treatment at Haute-Derma
At Haute-Derma, pompholyx treatment is tailored to the stage of the disease:
- Controlling acute flares: Standard topical anti-inflammatory and immunosuppressive treatments (such as a short course of a medium- to high-potency corticosteroid, or a calcineurin inhibitor), combined with a gentle antiseptic solution, quickly settle the inflammation and stop the intense itch.
- Phototherapy (NB-UVB): For chronic, frequently relapsing pompholyx that responds poorly to standard creams, narrowband UVB light safely modulates the local immune response and suppresses chronic inflammation.
- Barrier repair and regeneration: Once the acute stage has passed, we prescribe specialized moisturizers rich in ceramides and free fatty acids, combined with micro-injections of bioactive compounds (PDRN or exosomes), to rebuild the protective lipid layer and restore soft, healthy skin on the hands and feet.
