Pompholyx Eczema Treatment: Dyshidrotic Hand Eczema Cases

What Is Hand Eczema, aka Pompholyx or Dyshidrotic Eczema?

Hand Eczema is also called Pompholyx Eczema or Dyshidrotic Eczema.

It is a commonly recurring eczema associated with excessive hand washing, use of sanitizers, and emotional stress. While hand eczema does affect those suffering from atopic dermatitis, what is most surprising is that many patients coming in have no history of eczema.

What happens is that these bumps start to appear, and then they start looking like mini-bubbles (these are called vesicles) on the palms of the hands. The webbings between the fingers are often affected too, and the lesions tend to be very itchy.

The acute eruption is followed by a dry desquamating phase, which can then be followed by new vesicular eruption. It usually starts from one hand, but the lesions seem to “spread” from one hand to another. The hands are involved most of the time, while the feet are affected only 10% of the time. Postpartum mums are often affected, because of all the bottle washing, and a compromised immune system as their bodies gradually recover from the physical stress of pregnancy and delivery.

What Is Pompholyx Eczema Called in Chinese?

In Chinese medicine the condition is 汗疱疹 (hàn pào zhěn) — literally “sweat blister rash”. You may also see 出汗不良性湿疹 used for dyshidrotic eczema in clinical writing.

The name is not just a translation. It carries the traditional reading of the condition:

• Fluid should be moving and dispersing. It should not be accumulating under the skin.
• That is the same picture we treat as Damp accumulation.
• This is why the herbal strategy below is built around draining Damp rather than simply suppressing inflammation.

Does Pompholyx Eczema Spread?

This is the question we are asked most, usually with real alarm, so here is the direct answer.

• It is not contagious. You cannot pass pompholyx to your child, your partner or a colleague. It is not a fungus and not an infection.
• But it does extend. It commonly starts on one hand and appears on the other within weeks, and it can move from the fingers to the palms, the webbing, and occasionally up to the forearms.
• Feet are involved about 10% of the time, usually the soles and the sides of the toes.
• Scratching does move it along. Breaking a vesicle spreads fluid and inflammation across the surrounding skin, and broken skin invites secondary bacterial infection, which is what turns a manageable flare into a painful one.

So when patients say it is spreading, they are describing something real. What is spreading is the inflammatory process, not an organism passing from person to person.

Dyshidrotic Eczema Healing Stages: What Recovery Looks Like (See Above)

Pompholyx runs in a cycle, and knowing which part of it you are in stops a lot of unnecessary panic. The photographs further down this page follow real patients through it.

1. Vesicular stage. Deep, tapioca-like blisters appear on the palms, sides of the fingers and the webbing. Intensely itchy, often before anything is visible.
2. Weeping stage. Vesicles break, the skin oozes, and this is when secondary infection is most likely. This is also the stage where creams and ointments make least sense.
3. Desquamating stage. The skin dries and peels in sheets. It looks alarming and it is the stage nearest recovery.
4. Fissuring and repair. New skin underneath, often tight and cracking at the finger creases. Uncomfortable, but this is healing.
5. Either resolution, or a new crop. A fresh vesicular eruption can begin before the last one has finished peeling, which is why it feels endless.

In our clinic we can usually tell within days of starting treatment how a patient is responding. After that, recovery is slow and steady rather than dramatic — and the goal is to lengthen the gap between crops, not to abolish the cycle overnight.

Can Pompholyx Eczema Be Cured?

An honest answer, because the internet is unhelpful on this one.

• Many patients do reach long remission — years without a crop. Two of the cases on this page did exactly that.
• The tendency does not vanish. Stress, a season of heavy hand-washing, pregnancy or a hormonal shift can bring it back, sometimes after a decade of quiet.
• Some patients respond better than others. We say this plainly to every patient who walks in.

What treatment realistically achieves is shorter, milder flares that clear faster, and much longer gaps in between. For most people that is the difference between a condition that runs their life and one they manage.

Who Gets Pompholyx Hand Eczema?

Two groups turn up in my clinic far more often than any other. Both do the same thing to their hands all day.

Postpartum mums

• Bottle washing, steriliser handling, nappy changes — hands wet and re-dried dozens of times a day
• Detergent contact with every wash
• Broken sleep and physical recovery from delivery, which lowers the threshold for a flare
• It often begins somewhere between the second and sixth month, when the washing routine is heaviest

Healthcare and service workers

• Nurses and doctors — hand hygiene protocol means washing or sanitising between every patient
• Dentists and dental assistants — the same, plus hours inside gloves
• Hairdressers — shampoo, dyes, bleach, and wet hands most of the shift
• Kitchen and F&B staff — washing, prepping, gloves pulled over already damp hands
• Cleaners and anyone handling detergents without gloves

The pattern is identical in all of them: repeated wet-dry cycling, detergent, and occlusion. Not one exposure that caused it — the same hands going through the same cycle several hundred times a week.

It is also why this is mostly a hand condition. Feet are involved about 10% of the time, and when they are, closed shoes and trapped sweat are usually part of the story.

Is It Pompholyx or a Fungal Infection?

Worth settling early, because many patients arrive having treated the wrong thing for months.

• Pompholyx is not an infection. It is an inflammatory reaction in the skin, so an antifungal cream has nothing to act on
• Athlete’s foot and pompholyx can look similar on the feet — both scale, both itch, both peel
• Tinea usually starts between the toes and spreads outward, often on one foot. Pompholyx typically starts as deep, small blisters along the sides of the fingers or toes, frequently on both sides at once
• One real exception: a fungal infection on the feet can set off a genuine pompholyx reaction on the hands, called an id reaction. There, treating the foot fungus does help the hands — but the hand rash itself is still not fungal
• If you have used an antifungal for several weeks with no change, that is useful information. It points away from fungus

Worth having looked at rather than guessed, because the two are treated in opposite directions.

Case of Mother with Pompholyx Eczema

“I have been suffering from eczema since young, My condition was ok except dryness every year end before Chinese New Year. in 2010, I had my right fingers flare up , I thought it could be due to stress and constant washing as I was taking care of my son myself. it went off after I started work. In 2012 I had itchy rashes on my body during my second and third trimester of my pregnancy but it went off after I delivered my baby.

My eczema returned when my gal was 7th month when I faced extreme stress at work. It started on my old spot, right fingers and spread from 2 fingers to all fingers. I faced another wave of stress when my gal had high fever persistently for 9 days and my I encountered full blown eczema spreaded from right to my left fingers , and my face too.

I thought I have lived with eczema for decades but this round I couldnt take the itch anymore. The constant itch just made me want to chop my fingers off really! I decided to seek medical treatment. I am grateful that my fellow members from the eczema support group recommended me to Mark.

Mark was very patient when listening and diagnosing my condition. I had my first ever acupuncture session done by Mark and it was simply amazing that I could feel the Qi flowing through my body. I felt the energy too when he performed craniosacral treatment on me!  

I diligently used the herbal wash to soak my hands twice a day and washed my face with the solution too. My face healed pretty fast after 2 weeks and my fingers recovered 80 to 90% within a month!

I heeded his professional advice by avoiding allergen food and to keep my body warm as I have a cold constitution. I am still taking oral medication by Mark as I wanted to balance my constitution. I believed that the herbs had helped warm my body and my body would then have the energy to heal my eczema.

I brought my son to him too for his contact dermatitis on his forehead. He recovered very fast too. My daughter’s eczema on her ear is more tricky, she hasnt recovered but I think the oilment provided by Mark is useful for her.

I brought her to Mark for tuina and craniosacral session and it was great! she had so much poo one day after the session. I plan to bring her to see Mark every month for health maintenance. I would like to thank Mark very much for helping me through my crisis.”

Successful Treatment of Pompholyx Eczema

i started seeing Doc Mark since december last year for my pompholyx eczema. thankfully, my sessions with him had been beneficial, as the acupunture helped reduce my inflammed skin. he also prescribed different herbs that are tailored to my body’s needs. now, we’re working on my hormonal acne. he really knows his stuff, & a funny guy to boot! very patient with me too as i am forever scared of the needles! definitely recommend him to others who are seeking a natural way in their healing journey.

I have had moderate to severe pompholyx all throughout my twenties. After a remission of 2 years, the pompholyx returned, worse than ever (I suspect Topical Steroid Withdrawal had a part to play). It had spread all over the back of my hands. They looked disgusting and awful, and my fingers were so swollen I couldn’t open or close them. I was miserable and life came to a halt because I couldn’t do anything without excruciating pain – not even simple things like washing my hair, brushing my teeth, or eating. 

I have never been one to turn to TCM treatments, but after learning about TSW, I decided to put a stop to steroid usage once and for all, and seek an alternative treatment. At this point, i came across Mark on the internet and decided to give it a shot. 

It was the best decision I’ve had ever made.

Within 4 weeks of herbs and 4 acupuncture sessions, I regained use of my hands again. The bleeding, peeling, cracking and blistering were largely gone. The inflammation had receded and I could touch and hold things at last. I am now 6 weeks in and my hands are 80% healed. I no longer need to take herbs, and will have acupuncture just once a month. I can’t be any more grateful to Mark for returning my life to me again –  the ability to hold and touch things with my hands is priceless, and no price is too high to pay for this.

Healing is also an emotional and mental process, and Mark has been there with me every painful step of the way, helped ease my anxieties and worries, and pulled me through the first few weeks of treatment when things were at its worst.

We See Hand Eczema All The Time.

TCM Treats Hand Eczema In New Mums.

I asked her to come back for one last acupuncture treatment 2 weeks later if she felt it would be helpful, or not to come back at all if she felt confident enough in the progress.

The patient is a good responder to acupuncture, and that actually helps me a lot as a practitioner. Why? Because when a patient responds well to acupuncture’s anti-inflammatory and immuno-modulatory effects, it mitigates the intensity of any acute flare, and allows the herbs to continue its positive effects.

Herbs also worked well for her because her presentation matches a certain profile in the TCM framework. She was presenting primarily with Damp Accumulation secondary to Spleen Deficiency. In the terms of herbal treatment, as soon as the acute flare was out of the way, we slowly shifted the prescription to one that fortified her Spleen (the Spleen as understood in Chinese medicine). This type of herbal intervention at the end-stage also helps with gut recovery, and gut recovery is the cornerstone of treatment in many cultures of traditional medicine.

There are some patients who present with an intense pompholyx flare, but do not respond as well to acupuncture treatment.  There are others who have more complicated presentation e.g. someone with a very deficient Spleen (TCM Spleen), who cannot handle strong herbal anti-microbials and anti-inflammatories during the acute phase of the rebound flare.

For certain, Chinese herbs and acupuncture are worth considering if you are experiencing Pompholyx Eczema aka Hand Eczema in Singapore.

What Actually Helps Between Flares

None of this replaces treatment. But the patients who do best are the ones who change the hand routine as well.

Cut the number of wet-dry cycles

• How often you wash matters more than what you wash with
• Batch the tasks — do the washing-up once, not five times
• Hand over the bottle washing and the dishes if there is anyone who can take them

Soap

• Skip foaming hand washes and antibacterial soaps — high pH, harsh surfactants
• A plain, low-pH, fragrance-free cleanser is enough
• Lukewarm water, not hot

Gloves

• Cotton liners under rubber gloves for wet work. Rubber straight onto skin traps sweat and makes it worse
• Keep glove time short. An hour inside gloves is occlusion, and occlusion is one of the triggers
• Off as soon as the task is done

Contact worth avoiding

• Gym equipment, shared handles, dusty storerooms
• Solvents, thinners, strong cleaning agents
• Nickel, if you react to it — coins, keys, tools

If your feet are involved

• Change socks during the day if they get damp
• Cotton rather than synthetic
• Give your feet time out of closed shoes

Sweat and heat

• Sweat left sitting on the skin is an irritant. Rinse with plain water and pat dry
• This is not a reason to stop exercising. It is a reason not to let sweat dry on your hands

Stress

The association is real and I see it in clinic. But “reduce your stress” is not usable advice. What is usable: a flare usually follows a stretch, not a single bad day. If you can see a heavy period coming, that is when to be strictest about everything above.

On moisturisers

• There is no blanket rule here, and I would rather you watched your skin than followed one
• Dry, settled, cracked skin: a plain emollient helps, particularly after washing
• Weeping, blistered or raw skin: usually better left alone. Cream on a weeping surface tends to sting and set it back
• Keep it simple and fragrance-free. Carrier creams oxidise, and some products carry alcohol or preservatives that reactive skin does not tolerate
• If a moisturiser is not agreeing with your skin, that is information. Don’t push through it because a rule told you to moisturise twice a day