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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Pompholyx is distinctive in sharp close-up photos plus video, and a potent steroid cream, soaks for weeping blisters and emollients are prescribed; infected blisters with spreading redness or fever, or blistering beyond the hands and feet, need in-person care.
- What it is: a blistering form of hand and foot eczema, making up about 1 in 5 cases of hand eczema and affecting mostly adults between 20 and 40; it is not an infection and cannot be passed on by touch or towels.
- How long: a flare of pompholyx runs 2 to 4 weeks from the first itch, through blisters, drying and peeling, to healed skin; flares recur every few weeks to months for years in many people before settling.
- Triggers: heat and sweating, stress, wet work and detergents, nickel and cobalt contact, a fungal foot infection setting off blisters on the hands, and smoking; fixing the triggers matters as much as the cream.
- Strength matters: palm and sole skin is the thickest on the body, so mild hydrocortisone rarely penetrates it; a potent steroid used correctly for 2 to 4 weeks, with cotton gloves overnight, is the usual effective first treatment.
- Emergency: call 112 for widespread blistering with mouth or eye involvement, facial swelling, difficulty breathing, or fever with confusion or rapid breathing.
Get in-person care instead if the blistered skin is weeping pus, crusting golden, increasingly painful or spreading hot redness up the hand or foot, especially with fever: infected pompholyx can escalate. Sudden widespread blistering beyond the hands and feet, blisters in the mouth, or blistering after starting a new medicine also need in-person assessment the same day.
Can an online doctor treat pompholyx?
Usually, yes. Pompholyx is visually distinctive: crops of small, deep-seated, intensely itchy blisters on the palms, sides of the fingers or soles. Clear photos plus a video consultation can often provide enough information to confirm it and prescribe treatment at the right strength. Infected, unusually severe or diagnostically unclear cases need in-person care.
It is also a condition where under-treatment is the norm. The skin of the palms and soles is the thickest on the body, so the mild hydrocortisone people buy first rarely touches it, and weeks of half-working cream erode confidence that anything works at all. A consultation with a licensed doctor on Mobi Doctor gets the strength and the plan right from the start.
How an online consultation helps with pompholyx
- A recognisable pattern on photos: deep small blisters along the sides of the fingers and on palms or soles are exactly what a sharp close-up shows, and the pattern separates pompholyx from its look-alikes.
- Honesty about steroid strength: palm and sole skin usually needs a potent steroid, used properly for a short course, not a mild cream used timidly for months. The doctor explains the strength, the duration and the exit plan.
- Trigger detective work: sweat, heat, stress, wet work, nickel contact and fungal foot infections all feed pompholyx. The consultation hunts your likely drivers instead of shrugging at bad luck.
- Infection caught early: blistered, cracked skin on working hands is a door for bacteria. You learn precisely which changes mean infection and what to do the same day.
📷 Take daylight close-ups with the blisters in sharp focus: the sides of your fingers, the palm, and the soles if affected, plus one wider shot of both hands. Photograph early, because pompholyx changes stage: fresh blisters look different from the peeling, cracking phase that follows, and both stages inform the plan.
What the doctor checks in an online pompholyx consultation
The assessment is built around confirming the diagnosis and finding what is driving the flares. The doctor will typically assess:
- The blisters themselves: size, depth and position, because small deep blisters on the sides of the fingers, palms and soles are the signature of pompholyx.[2]
- The stage: fresh crops, merging blisters, or the later peeling and painful cracking, which need different care.
- The rhythm: one-off flare or repeated crops, and whether they track heat, summer, stressful periods or particular work.
- Your feet, even if the problem is your hands: a fungal foot infection can drive blistering on the hands (an id reaction), and treating the feet is then part of curing the hands.[1]
- Contact with water and irritants: wet work, frequent hand washing, gloves worn for long shifts, solvents and soaps, the classic occupational load of nurses, hairdressers, cleaners, mechanics and kitchen staff.
- Nickel and cobalt exposure: jewellery, keys, coins, tools and some occupational materials, because metal allergy is a recognised trigger in some people.[2][4]
- What you have already used: which steroid, what strength, how long and how applied, since "treatment failure" is often a strength or duration problem rather than a wrong diagnosis.
- Infection signs: weeping, golden crusts, pus, spreading redness or pain out of proportion.
What does pompholyx look like?
Pompholyx starts with burning or intense itching, then crops of small, deep-seated, fluid-filled blisters, often compared to tapioca pearls, appear on the palms, the sides of the fingers or the soles. The blisters sit under thick skin, so they feel firm, resist bursting and are often maddeningly itchy rather than painful at first.[2]
The typical cycle of a flare
Over 2–3 weeks the blisters gradually dry and the skin peels, sometimes leaving tender, cracked, red areas that hurt more than the blisters did, particularly across finger creases and pressure points of the sole. Then the skin recovers, until, for many people, the next crop arrives. Doctors call the same condition dyshidrotic eczema or vesicular hand eczema; it is a form of eczema, it is not contagious, and scratching does not spread it, though it does invite infection.
Who gets it and why
Pompholyx most often starts in adults under 40 and is more troublesome in warm months. There is no single cause; instead a set of recognised triggers stack up: sweating and heat, emotional stress, prolonged contact with water and detergents, nickel or cobalt allergy, and fungal infection elsewhere, usually the feet.[1] Part of the consultation is working out which of those apply to you, because each one you can act on lowers the frequency of flares.
Is it pompholyx or something else?
Blistered, itchy hands and feet have several causes worth separating. Ordinary eczema tends to be dry, red and cracked rather than studded with deep blisters, and often lives in the elbow and knee creases too. A fungal infection usually scales and spreads at the edges, classically affecting both feet and just one hand, and needs antifungal rather than steroid treatment. Intense night itch with tiny bumps in the finger webs, and itchy people in your household, points to scabies rather than pompholyx. Yellowish pustules rather than clear blisters, above all in a smoker, suggest palmoplantar pustulosis, which belongs with a dermatologist. The close-up photos usually settle it, and honest uncertainty is itself an answer: when the picture does not fit, the doctor says so and arranges skin scrapings or in-person review instead of guessing.
Which pompholyx treatment might the doctor recommend?
Pompholyx treatment follows the stage and severity of the flare and what is driving it. This is the framework the doctors use, aligned with the cited guidance:[1]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| First or mild crop of itchy blisters on palms, fingers or soles | A potent topical steroid for a short defined course, plus generous emollients | Usually yes | Not settling after two weeks of correct treatment, or the diagnosis is unclear |
| Recurrent crops with an identifiable trigger pattern (sweat, wet work, nickel) | Treat the flare and build a trigger plan; consider patch-testing referral for suspected metal allergy | Usually yes | Patch testing for contact allergy is done in person |
| Weeping, crusting or increasingly painful blisters | Assessment for secondary infection; antibiotics only when there are signs of bacterial infection | Often yes | Spreading hot redness, fever or feeling unwell: same-day in-person care |
| Severe blistering making gripping or walking impossible | Potent or very potent treatment, sometimes a short oral steroid course, and early dermatology involvement | Case-dependent | Severe or repeatedly disabling flares merit dermatology referral |
| Blistering on one hand with scaly feet | Check for a fungal driver before steroids; antifungal treatment if confirmed | Assessment yes | Skin scrapings to confirm fungus are taken in person |
Not sure which row fits your hands or feet? A doctor can tell you in one consultation.
See available times →Treatment options for pompholyx (dyshidrotic eczema)
What you can do yourself
Leave the blisters intact: the roof of a blister is the best dressing there is, and piercing it invites infection. Cool compresses calm the itch, and a plain, greasy emollient used several times a day, and always after water, supports the skin through the peeling phase. Cut the water burden where you can: lukewarm washing, pat dry between fingers, cotton gloves under waterproof ones for wet work, and a change of socks whenever feet get sweaty. If nickel is your suspected trigger, an honest audit of daily metal contact (keys, coins, tools, jewellery) is worth an afternoon. Pharmacy hydrocortisone 1% is usually too weak for palm and sole skin, which is not a reason to double up on it but a reason to get the right strength prescribed.[1]
Prescription treatment
A prescription is never issued without a consultation. After assessment, first-line pompholyx treatment is usually a potent topical corticosteroid for a short, defined course, long enough to clear the flare and short enough to keep thin-skinned areas safe; the doctor is explicit about where to apply it, for how long, and when to stop or step down.[1] Weeping blisters may earn drying soaks first, and a confirmed fungal driver is treated with antifungals, not more steroid. A sedating antihistamine for a few nights can rescue sleep while the itch peaks. Secondary bacterial infection is treated with antibiotics only when there are actual signs of it, such as spreading redness, pus or crusting; antibiotics do nothing for sterile blisters. For severe or constantly relapsing pompholyx, options such as short oral steroid courses, phototherapy or specialist tablets exist through dermatology referral.[3][5]
Living and working with pompholyx
Recurring pompholyx is, for many people, an occupational disease in all but name: wet work, gloves and detergents keep re-priming the skin. Small process changes carry real weight: cotton liners under occlusive gloves, swapping soap for a soap-free cleanser, moisturising at every break, and treating athlete's foot promptly so it cannot restart hand flares.[1] In pregnancy, topical steroid treatment is commonly still usable with adjustments the doctor explains, so mention pregnancy or breastfeeding at the start. For travellers, sweaty shoes and hot climates are classic flare setups; a consultation while away means a proper plan and, when appropriate, a prescription at a pharmacy near you rather than two weeks of guessing. Between flares, keep a tube of your prescribed treatment in reserve as agreed with your doctor, because starting on day one of a crop consistently beats starting on day five.
When pompholyx is treated online, and when you need in-person care
Treated online: typical pompholyx flares on hands or feet needing properly potent treatment; recurrent crops needing a trigger plan; early secondary infection suitable for tablets; flares where a fungal driver is suspected and treatable; and reviews when treatment is not tracking to plan.
In-person care: suspected contact allergy needing patch testing, which is an in-person investigation; severe or repeatedly disabling flares needing dermatology options such as phototherapy or specialist tablets; blistering with spreading redness and fever, the same day, because infected hands and feet escalate; blistering that does not fit pompholyx on photos, where scrapings or biopsy settle it; and widespread blistering beyond hands and feet or involving the mouth, urgently. Pompholyx is one of many skin conditions the doctors assess online, and the line between the two lists is applied honestly.
When to get in-person care
Get same-day in-person care if redness is spreading up the hand or foot, the skin is hot and increasingly painful, or you develop fever: an infected hand can deteriorate quickly (see the cellulitis page for what spreading skin infection looks like). Call 112 immediately for widespread blistering with mouth or eye involvement, facial swelling, difficulty breathing, or fever with confusion or rapid breathing.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Upload your skin photos, then speak to a licensed doctor: a private video call: you describe what you feel, the doctor asks what matters, and you agree the right plan together.
- Leave with your plan: everything agreed before you hang up: your plan, and a prescription to use at a pharmacy near you where medication is clinically right for you. If your doctor decides you need to be seen in person, you get a full refund.
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Frequently asked questions about pompholyx (dyshidrotic eczema)
What is pompholyx?
Pompholyx, also called dyshidrotic eczema or vesicular hand eczema, is a form of eczema in which crops of small, deep, intensely itchy blisters appear on the palms, the sides of the fingers and sometimes the soles. The blisters dry and peel over two to four weeks, the skin can crack and become sore, and the pattern tends to return in flares. Pompholyx is not an infection.
What causes pompholyx?
The exact cause of pompholyx is not known, but it is a form of eczema that runs in atopic families and is set off by triggers: heat and sweating, emotional stress, frequent wet work, soaps and detergents, contact with nickel or cobalt (including in the diet for a few people), a fungal infection on the feet provoking blisters on the hands, and smoking. Flares are commonest in spring and summer.
What does pompholyx look like?
Pompholyx starts with burning or itching, then clusters of tiny, deep, tapioca-like blisters appear on the palms, the sides of the fingers or the soles, sometimes merging into larger blisters. Over two to three weeks they dry, the skin peels and cracks, and painful fissures can form. Golden crusting, pus or spreading redness mean the pompholyx has become infected.
Can an online doctor prescribe pompholyx treatment in Europe?
Yes, after a consultation. A prescription is never issued without one: the doctor assesses your pompholyx from photos and history by video first, then prescribes a suitably strong topical steroid, soaks for weeping blisters and an emollient when they fit. Any prescription can be used at a pharmacy near you, and infected or very extensive pompholyx is directed to in-person care.
Is pompholyx contagious?
No. Pompholyx is a form of eczema, not an infection, so you cannot pass it on by touch, sharing towels or preparing food. The exception worth knowing: if the blisters become infected with bacteria, that infection needs treatment, and if a fungal foot infection is driving the pompholyx, the fungus, though not the pompholyx itself, can spread.
Should I pop pompholyx blisters?
No. The blister roof protects the raw skin underneath, and piercing a pompholyx blister trades a few days of tightness for a real infection risk in skin you use all day. Very large, tense blisters that make gripping or walking impossible can be drained with a sterile needle by a doctor, leaving the roof in place, but ordinary blisters are left alone and allowed to dry.
Why did hydrocortisone from the pharmacy not work on my pompholyx?
Because palm and sole skin is the thickest on the body, and mild hydrocortisone rarely penetrates it in useful amounts. Pompholyx usually needs a potent steroid used correctly for a short course, often under cotton gloves overnight to help it absorb. Under-strength cream used for weeks is the commonest reason pompholyx seems untreatable, and it is the easiest to fix.
Is pompholyx the same as eczema?
Pompholyx is a specific form of eczema, defined by deep itchy blisters on the palms, fingers or soles. It behaves differently from ordinary eczema in one important way: the thick skin it affects needs stronger treatment, and the blisters themselves need drying rather than only moisturising. Ordinary atopic eczema, contact dermatitis and pompholyx can coexist on the same hands.
How long does a pompholyx flare last?
A pompholyx flare typically lasts two to four weeks: itching and blistering in the first week, drying and peeling in the second and third, and healed skin by the fourth. Flares recur every few weeks to months in many people, and the tendency often settles over years. A flare still blistering after four weeks of potent steroid, or one that keeps returning monthly, needs a trigger review and sometimes specialist treatment.
What can I do at home for pompholyx?
At home, soak weeping pompholyx blisters in a diluted antiseptic soak as advised to dry them, apply the prescribed steroid cream and cover with cotton gloves overnight, moisturise thickly between flares, use a soap substitute, wear cotton-lined gloves for wet work and washing-up, avoid scratching and popping, keep hands cool, and treat any athlete's foot, since it can be the hidden trigger.
Why does my pompholyx keep coming back, and how can I prevent it?
Pompholyx is trigger-driven, and untreated triggers reload it: heat and sweating, stress, wet work and detergents, nickel contact, smoking, or a quietly persistent fungal foot infection. Prevent flares by protecting hands from water and detergents, moisturising daily even when clear, managing stress and sleep, stopping smoking, and asking about nickel patch testing; some people also benefit from a short preventive steroid course at the first itch.
Is pompholyx different in pregnancy, in wet-work jobs or in children?
In pregnancy, pompholyx can flare with hormonal change and sweating and is treated with moderate steroid creams in short courses, which the doctor agrees with you. In hairdressers, nurses, cleaners and caterers, wet work drives pompholyx and gloves, emollients and sometimes an occupational health review matter most. In children pompholyx is uncommon and is assessed in person, because Mobi Doctor sees adults only.
- Pompholyx: Clinical Knowledge Summary, NICE Clinical Knowledge Summaries, revised 2023.
- Pompholyx (dyshidrotic eczema), DermNet New Zealand Trust, reviewed 2023.
- Hand dermatitis, DermNet New Zealand Trust, reviewed 2022.
- Contact dermatitis, DermNet New Zealand Trust, accessed August 2026.
- Interventions for hand eczema (CD004055), Cochrane, Cochrane Collaboration, 2019.
- Pompholyx (dyshidrotic eczema), NHS, National Health Service (UK), reviewed July 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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