Dyshidrotic eczema causes sudden crops of very itchy, tiny, deep “tapioca” blisters on sides of fingers, palms, and soles. It flares with stress, sweat, nickel sensitivity, or seasonal changes.
Signs and symptoms
- Intensely itchy, pinhead-sized blisters that can merge into larger patches.
- Skin may become red, cracked, and painful as blisters dry and peel.
- Flares can recur in cycles, especially in spring/summer or with sweaty hands/feet.
Triggers to watch
- Heat and sweating, frequent wet work.
- Nickel/cobalt exposure (coins, costume jewelry, watchbands, keys), rubber accelerators in gloves.
- Harsh soaps/cleansers; stress.
Home care and first-line treatment
- Cool compresses 10–15 minutes to calm itch and dry blisters.
- Thick, fragrance-free emollients frequently; ointments at night.
- Avoid hot water; use gentle cleansers; pat dry.
- Short, clinician-directed courses of medium-to-high potency topical steroids for active red/itchy patches on hands/feet.
- For sensitive areas or frequent flares: steroid-sparing creams (tacrolimus/pimecrolimus) can help.
If blisters are severe or frequent
- Tape occlusion over steroid for a few nights can boost effect (per clinician guidance).
- Consider phototherapy or short courses of oral anti-inflammatories in stubborn cases.
- For heavy sweating component: antiperspirants on palms/soles at night or iontophoresis devices may reduce triggers.
- Patch testing for metal/rubber allergies if recurrences persist.
Infection watch
- Look for increasing pain, yellow crust, pus, or red streaks—seek care; may need antibiotics.
Everyday prevention
- Cotton glove liners under nitrile gloves for wet work; change sweaty gloves often.
- Identify and reduce metal contact (nickel keys/coins); coat items or switch materials if possible.
- Stress management and regular moisturization lower flare frequency.
When to see a clinician
- Frequent, severe, or job-limiting flares.
- Cracks that won’t heal or signs of infection.
- To discuss allergy testing, phototherapy, or advanced treatments if topicals aren’t enough.
Quick toolkit
- Cool compresses
- Mid/high-potency steroid for flares (hands/feet)
- Thick ointment at night
- Nickel/rubber avoidance plan
- Iontophoresis/antiperspirants if sweat-driven