Acute palmoplantar eczema is a special type of dermatitis on the hands and feet characterized by small itchy or painful blisters. Severe flares can make everyday activities like washing dishes or walking difficult, but treatment can help stop a current flare and prevent a future flare.
Itchy Hands or Feet – a condition with many names
Many names are used for acute palmoplantar eczema. Some common terms include:
- Foot-and-hand eczema
- Vesicular eczema
- Dyshidrotic dermatitis
- Cheiropompholyx (affects the hands) or Pedopompholyx (affects the feet)
What are the symptoms?
The hallmark of palmoplantar eczema is the development of tiny blisters, or vesicles, on the palms, soles and fingers (often the side of the finger). It is common for itching to present before vesicles appear. Once vesicles are present, pain and burning are common. Typical vesicles are 1-2mm in size, but occasionally they can be 1cm or larger (called bullae).
Vesicles will spontaneously clear in 2-3 weeks at which point the affected skin often cracks and peels. For many people, palmoplantar eczema is a chronic condition – recurrent attacks are very common.
What causes palmoplantar eczema?
Currently the cause of palmoplantar eczema is not known, but it is likely caused by a combination of factors. Factors thought to play a role include:
- History of atopic dermatitis (eczema)
- Exposure to irritants or allergens, often metals
- Fungal skin infections (like ringworm)
- Excess sweating of the palms or soles
How is it diagnosed?
A history of quickly forming vesicles that cause itch and pain combined with the skin’s appearance is often sufficient for a correct diagnosis. Skin biopsies are typically not needed. In cases that don’t respond to standard treatment, your physician may order additional tests to rule out a fungal or bacterial infection.
What is the treatment?
Appropriate treatment can stop blister formation, clear current blisters and reduce itch and pain. Treatment involves a three-pronged approach:
- Restore the skin barrier with basic skin care techniques
- Identify and avoid irritants
- Treat current skin inflammation
Restoring the skin barrier
Basic skin care techniques are necessary to restore the skin barrier and reduce irritation.
- Basic cleansing care
- Use lukewarm water and soap-free cleansers
- Pat hands dry to avoid irritation
- Immediately after each washing and drying, apply hand cream or an emollient (petroleum jelly)
- Avoid frequent washing, as water itself can exacerbate symptoms
Identifying and avoiding irritants
Irritants and allergens play a role in promoting palmoplantar eczema. Therefore, avoiding irritants and allergens and other contributing factors (such as smoking) is important for treatment and prevention. In difficult cases, patch testing may be used to identify specific allergens that may be exacerbating palmoplantar eczema.
Common irritants to avoid can include many daily household products (fragrant body and hair products, cleaning solutions) and even foods, such as citrus. Easy changes to housework and daily errands can help ensure adequate protection from irritants.
- Get the right glove for the job:
- Vinyl gloves –for all wet work and chores
- Choose gloves that have a soft lining, or wear additional cotton glove layer for added protection.
- Protective gloves – for rough chores like gardening
- Warm gloves – for cold weather
- Vinyl gloves –for all wet work and chores
For many individuals, exposure to metals (especially nickel) can also exacerbate palmoplantar eczema. Some studies suggest people with palmoplantar eczema are more likely to have a nickel contact allergy and should avoid using items containing nickel. Although the data is not conclusive, some studies suggest certain individuals may also be sensitive to ingestion of foods high in nickel such as tomatoes and dark chocolate (to learn more about a nickel allergy diet, read our article here).
Treating skin inflammation
Treating skin inflammation and itch with soaks and topical steroids are the first steps to get symptoms under control. In more severe cases of palmoplantar eczema, additional treatments may be necessary.
- Compresses and soaks
Cold compresses are a low-cost way to relieve itch. Soaks and wet wraps of dilute aluminum acetate, potassium permanganate or vinegar solutions may also alleviate itch in some people. Affected hands or feet are either directly soaked in the solution or a wet compress can be used (soak a towel in the solution and apply the towel to the affected area). These treatments can be used for 15 minutes, up to four times a day.
- Topical steroids
In cases that do not respond to basic skin care and avoidance of irritants, topical steroids can provide relief by directly decreasing skin inflammation. Your doctor can prescribe the correct strength and regimen for your skin. Typically, high dose steroid creams are prescribed for application twice a day for 2-4 weeks.
- Additional treatments
- Antibiotics or antifungal medications are used if there is a concurrent infection.
- Antihistamines may be prescribed for severe itch.
- In severe or recurrent cases, the following may be prescribed by a specialist:
- Oral steroids
- Ultraviolet light (UV) light therapy
- Immunosuppressive drugs (azathioprine, methotrexate)
The bottom line
Palmoplantar eczema is often a recurrent condition that can severely affect one’s quality of life due to severe itch and pain.
- Tiny blisters on the palms, soles and fingers are the hallmark of palmoplantar eczema
- Treatment involves a three-pronged approach:
- Restoring the skin barrier with basic skin care techniques
- Identifying and avoiding irritants
- Treating skin inflammation with soaks or topical steroids
- “Dyshidrotic Eczema. “ American Academy of Dermatology. 2015. https://www.aad.org/public/diseases/eczema/dyshidrotic-eczema
- Lofgren SM., Warshaw EM. Dyshidrosis: epidemiology, clinical characteristics and therapy. Dermatitis 2006; 17: 165-180.
- Wolff, K., Johnson, RA., Suurmond, D. “Dyshidrotic Eczematous Dermatitis.” Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. McGraw-Hill. 5th Ed. 2005.
- Wollina, U. Pompholyx: A review of clinical features, differential diagnosis, and management. Am J Clin Dermatol 2010; 11:305-314.