Eczema is not a single skin condition, but rather a family of conditions that cause the skin to become swollen, irritated, and itchy, according to the National Eczema Association (NEA). It is very common, with more than 31 million Americans having some form of eczema, the organization reports. One symptom, blisters, occurs in response to inflamed or damaged skin, explains Peter Lio, MD, a dermatologist at Northwestern Memorial Hospital in Chicago. They are essentially bubbles filled with fluid. “This fluid, referred to as serous fluid, is ultimately a blood filtration product and is similar to when there is swelling in an area such as a swollen ankle after a sprain,” he says. “In the skin, the fluid can be very concentrated around blood vessels and can be superficial enough to cause tiny blisters rather than just swelling of an area.” Once a blister forms, it takes time for the body to reabsorb this fluid, “usually through the lymphatic system,” Dr. Lio says. “Sometimes, however, they are very tense and superficial, and simply rupture, releasing the fluid outside of the skin and then needing to heal.” While blisters may be common with eczema, simply getting blisters does not mean you have the skin condition. Eczema blisters can also form after an allergic reaction, in response to an environmental irritant, or from an infection.
Types of Eczema Commonly Associated With Blisters
Eczema blisters are associated with multiple types of eczema, and they can show up differently depending on the cause.
Dyshidrotic Eczema
This form of eczema, also called pompholyx, foot-and-hand eczema, palmoplantar eczema and vesicular eczema, is seen on the hands and feet, and is more common in women, according to the NEA. Usually, small deep blisters, called vesicles, form on the palms of the hands, soles of the feet, and sides of the fingers, the NEA reports. The blisters are extremely itchy and cause scaly skin patches that flake constantly. As a result, dry skin and painful fissures can form. Common triggers for dyshidrotic eczema include stress, seasonal allergies, or humid weather that makes the palms sweat, says Evan Rieder, MD, a dermatologist at NYU Langone Health in New York City. Metals, especially nickel, as well as jobs that involve getting the hands wet frequently, such as hairstyling, can also trigger the rash and accompanying blisters, according to the NEA. First-line eczema treatments for dyshidrotic eczema include cool compresses and corticosteroid creams or ointments. “Usually we do need to use a more powerful topical corticosteroid, because the skin on the hands and feet — where we usually find this type of eczema — is very thick and can impede penetration of the medications,” Lio says. “We often use soaks such as Burow’s solution to help soothe and dry out the blisters, and then have the patients apply the topical corticosteroid twice daily to the area.” Dermatologists may gently drain larger blisters with a sterile needle to relieve pain, says the National Eczema Society. Other medications, like antihistamines, may be prescribed to relieve itchiness especially at night, according to the American Academy of Dermatology (AAD).
Allergic Contact Dermatitis
If you’ve ever brushed up against poison ivy, poison oak, or poison sumac and broken out in a blistery, itchy rash, you’ve experienced allergic contact dermatitis. Usually, people develop small lines of eczema blisters where the leaves rubbed against them a day or two after the skin is exposed, according to the NEA. Other common culprits are metals (especially nickel) and fragrances. These blisters may break open and dry up as a small crust. Treatment for eczema due to allergens involves thoroughly washing the skin to remove any trace of the substance that is irritating you. Also, try to avoid anything that you know causes a rash or eczema blisters to break out, the NEA recommends. Sometimes, the best treatment for contact dermatitis is simply leaving the area alone. But with more severe reactions, doctors may prescribe either steroid creams or lotions, or oral medications to reduce inflammation and other symptoms, according to the Cleveland Clinic.
Irritant Contact Dermatitis
Acids, solvents, harsh soaps, or detergents can aggravate the skin and cause irritant contact dermatitis. Irritant contact dermatitis is treated the same way as allergic contact dermatitis. As for prevention, Lio notes that even washing your hands frequently can lead to irritant contact dermatitis. “During the COVID-19 pandemic, it has been an incredibly common complaint in our office,” he says. The reaction usually resembles a burn, but eczema blisters may also bubble up immediately, especially if the irritant is strong. The rash is typically more painful than itchy, according to the Cleveland Clinic. As mentioned, try to avoid any known irritants to help prevent eczema blisters. Also, use lukewarm water and moisturize after washing your hands to help reduce potential discomfort, according to the American Academy of Dermatology. RELATED: 7 Types of Eczema and What They Look Like One particularly dangerous infection is called eczema herpeticum — the result of atopic dermatitis and contact with the herpes simplex 1 virus (HSV-1), the virus that causes cold sores and some cases of genital herpes, according to the NEA. The infection can occur when someone with even mild eczema has skin-to-skin contact with HSV-1. Many watery eczema blisters break out and are very itchy. The infection spreads fast, leading to fever and flu-like symptoms, and the fluid inside the blisters turns to yellow pus. If the infection is untreated, it can eventually affect vital organs and ultimately lead to death, although that’s rare, the NEA says. Treatment for eczema herpeticum consists of antiviral medications and painkillers as needed. Infections from the Staphylococcus aureus bacteria (staph) can also cause pus-filled blisters and honey-colored crusting over the skin, according to the Mayo Clinic. Treatment of a staph infection includes antibiotics and drainage of blisters or wounds. Signs an eczema blister has become infected include “red color, warmth to the touch, whitish liquid drainage, and swelling,” Rieder says. Furthermore, “if the blister is large or painful or spreading, or you see redness and swelling underneath that is spreading, and certainly if you get a fever, you should be seen promptly by your doctor,” says Dr. Kassouf. RELATED: Your Everyday Guide to Living Well With Eczema
How to Help Prevent Eczema Blisters From Popping Up
Eczema blisters can sometimes be unavoidable, but sticking to your eczema treatment plan can help keep them at bay. Take medication as prescribed and keep your skin properly moisturized. Scratching will only make the condition worse and invite infection, according to the Cleveland Clinic, so try to resist the temptation. Additional reporting by Regina Boyle Wheeler.
