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Itchy little blisters on the fingers
Dyshidrosis: deep blisters on palms and soles, in waves, often at the change of season.
Dyshidrosis presents with small, deep, intensely itchy blisters on the sides of the fingers, on the palms and on the soles — what those affected almost always describe as little blisters on the hands. They have a characteristic appearance, like tapioca grains beneath the skin: they are seen through the surface rather than raised, because the skin at those sites is thick.
The course comes in waves. An acute phase with intense itching and blisters, then their resolution with peeling in sheets that leaves the skin thin and sensitive, and finally a quiet period before the next episode. Many patients report seasonality, with flares in spring and summer.
The name is a misleading legacy: it was thought to depend on the sweat glands, and it does not. Today it is considered a form of eczema, and this changes how it is approached. The useful part of the visit is to look for accompanying factors — stress, sweating, contact with irritants or allergens, foot mycosis — because in a proportion of patients the picture is linked to a contact sensitisation, and in that case testing changes the pathway.
Looking at the feet when the problem is on the hands
This is one of the checks patients do not expect and that is done anyway at the visit. A foot mycosis can be accompanied by a blistering reaction on the hands, and in that case treating only the hands leaves the picture unresolved: you go on treating the effect while the cause stays where nobody looked. It is not the explanation for every case of dyshidrosis — many have no fungus behind them — but it is a check that costs thirty seconds and occasionally changes the whole pathway.
How it shows
- Small, deep blisters on the sides of the fingers, palms or soles
- Intense itching, often preceding the appearance of blisters
- Peeling in sheets during the resolution phase
- Thin, sore skin after peeling
- An episodic course, with quiet periods
- Seasonal flares or flares in periods of stress
How we proceed
- 1Dermatological visit: sites, appearance of the blisters, course over time
- 2Inspection of the feet, even if the patient reports only the hands
- 3Review of occupational and domestic contacts
- 4Patch testing where sensitisation is suspected (Siena clinic)
- 5Treatment of the acute phase and a strategy for recurrences
Available treatments
- Dermatology visit
- Patch testing
- Treatment of the acute phase
- Scheduled follow-up
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Frequently asked questions
Can I pop the blisters?+
Better not. Opening them removes the covering that protects the base, exposes a surface that stings and increases the risk of superinfection, without shortening the episode. The relief is immediate but brief, and the price is paid in the following days. If blisters are large and very painful, management is decided at the visit rather than with a needle in the bathroom.
Is it caused by stress?+
Many patients recognise a link with tense periods, and as a trigger that is plausible. It is not the sole cause, though, and does not explain the picture on its own: there are components linked to contact with substances, to sweating and to individual predisposition. Blaming everything on stress has the practical effect of skipping the part of the assessment that might identify something genuinely actionable.
Is it contagious?+
No. Dyshidrosis is an eczematous reaction, not an infection: it is not transmitted by contact or through objects. The appearance of the blisters can suggest otherwise, and it is one of the commonest questions, especially from people who work with the public or with food.
Related reading
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