Photo Rounds

Itchy rash on sides of fingers

A 24-year-old woman asked her family physician (FP) to take a look at the itchy rash on the sides of her fingers. She said that any contact with water (such as washing dishes) made it worse. She’d had the rash for a month, but had experienced it on and off over the previous 2 years. The itching was more severe at night and when the patient felt stressed. No one else in her family had this condition.

What’s your diagnosis?


The FP recognized the multiple tapioca-like vesicles on the sides of the patient’s fingers as pompholyx, also known as dyshidrotic eczema. One of the classic findings of dyshidrotic eczema is the vesicles that resemble the small spheres in tapioca pudding. (The FP considered scabies, but ruled it out because no one in the family had a similar rash and there were no signs of any burrows.)

The term “pompholyx” means bubble, while the term “dyshidrotic” means “difficult sweating,” as problems with sweating were once believed to be the cause of this condition. Some dermatologists prefer the name “vesicular hand dermatitis.” Regardless of the terminology, this can be a very mild condition that is a minor nuisance or a very severe chronic condition that impairs the patient’s quality of life.

The FP explained that dyshidrotic eczema is not curable and may be worsened by stress and substances that come into contact with the hands. He discussed the possibility of avoiding washing the dishes and other “wet work,” but the patient said that wasn’t possible, so he told her to use nitrile gloves with cotton liners. (Using gloves without cotton liners often leads to sweating in the gloves that can worsen dyshidrotic eczema.)

The FP prescribed 0.1% triamcinolone cream to be applied twice daily. During a follow-up visit one month later, the patient’s rash had improved considerably. She was still working on lifestyle changes to minimize her contact with water and other substances. If the patient’s condition hadn’t improved with basic treatment, she would have been referred to a dermatologist for patch testing to rule out contact dermatitis.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Hand eczema. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill;2013:597-602.

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