Pustular Eczema: Causes, Treatment, and Coping - Verywell Health

Pustular eczema is a noncontagious inflammatory skin condition characterized by itchy pustules that form into a rash. Pustules are small pus- or fluid-filled blisters. Typically, pustular eczema affects only the hands and the feet. In some cases, though, it can also affect the limbs.

This article discusses the causes, treatment, and ways to cope with pustular eczema.

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Types of Pustular Eczema

Three types of eczema can present with blisters. They include:

• Dyshidrotic: Dyshidrotic eczema appears as tiny fluid-filled blisters on the hands and feet and includes a rash that resembles tapioca pudding.
• Nummular: Nummular eczema begins as tiny sores similar to blisters that can spread and blend into larger lesions. They tend to occur after an injury to the skin.
• Weeping: Weeping eczema can develop in any type of eczema but is more likely to occur with specific types, such as dyshidrotic or nummular. The blisters that appear with this eczema can expand into crusty yellow-beige sores.

Pustular Eczema Symptoms

The main symptom of pustular eczema is the appearance of fluid- or pus-filled blisters.

Other symptoms associated with pustular eczema include:

• Intense itch
• Blisters that feel tense to the touch or are difficult to pop
• Burning or pain where the rash occurs
• Dry and peeling skin
• Cracks in the skin
• Bumps that eventually form into larger lesions

Pustular Eczema and Infection

People with pustular eczema risk developing an infection, because when the blisters heal, the skin peels and becomes tender. The dry, tender area can develop cracks, leaving open fissures on the skin prone to infection. Weeping eczema can be caused by an infection.

Causes

As with all types of eczema, the cause isn't well understood. Various factors play into the development of the skin condition, including:

• A family history of eczema or allergies
• A dysregulated immune system (when the body can't control or turn off an immune response)
• Gene mutations
• A person's environment (climate, exposure to pollutants)

Pustular Eczema Risk Factors

People may be more prone to develop pustular eczema if they:

• Have another type of eczema
• Experience high levels of stress
• Have dehydrated skin
• Have seasonal allergies
• Have excessively sweaty hands or feet

Diagnosis

Diagnosing pustular eczema relies heavily on a physical examination, and specific characteristics must be present. The essential features include the following:

• Itching sensation
• The location of the rash on the body
• The frequency of the rash

Other features used in the diagnostic process include:

• Age of onset: Typically, eczema develops in early childhood.
• History: A person with pustular eczema is likely to have a family history or personal history of the condition.
• Immunoglobulin E (IgE) levels: Eczema is affected by the immune system, so levels of a specific antibody known as IgE may be increased in people with the condition.
• Skin health: People with pustular eczema usually have excessively dry skin.
• Appearance: Different types of eczema present differently on the skin. For example, one type may not cause blisters, whereas pustular eczema does. The appearance helps determine the type of eczema as opposed to a simple eczema diagnosis

The Difference in Pustular Eczema Types

While dyshidrotic, nummular, and weeping eczema can all occur with blisters, slight differences exist. Dyshidrotic eczema has clear fluid-filled blisters, whereas weeping eczema has yellow or clear pus. The blisters in nummular eczema may have clear liquid like dyshidrotic eczema. However, the bumps and blisters can develop following an injury and on other areas of the body, such as the limbs.

Treatment

The treatment for pustular eczema varies depending on the severity and type.

Pustular Eczema Treatment by Type
Dyshidrotic eczema	Topical corticosteroids Calcineurin inhibitors Topical tacrolimus Systemic corticosteroids
Nummular eczema	Topical corticosteroids Skin hydration Bath oils Moisturizers Tar cream Tacrolimus ointment Pimecrolimus cream
Weeping eczema	Topical corticosteroids Topical calcineurin inhibitors Antihistamines Antibiotics Antifungals Antivirals Biologics Hydrating emollients Phototherapy (light therapy)

Coping

Coping with pustular eczema can be difficult. However, many people can manage their symptoms effectively with available treatments. By doing so, having the condition is that much easier to deal with.

Tips for coping with the various types of pustular eczema include:

• Moisturize regularly and more often if your skin is dry.
• Avoid flare-ups by reducing the use of harsh chemical products such as detergents and fragrances.
• Test new skin products before using them.
• Limit the time spent in water to avoid drying out the skin.
• When in a flare-up, refrain from trying to pop or scratch the blisters, as this will make things worse.
• On top of medications, using a cold compress can help with the itch sensations.

Coping by Identifying Triggers

People with eczema tend to have specific triggers that can set off flare-ups. To help cope with the condition, you can identify yours by writing down instances when you notice symptoms and what you may have been exposed to that was different. By identifying triggers, you can reduce the time spent in a flare-up and, thus, reduce the symptoms you have to deal with.

Summary

Pustular eczema is a group of skin conditions that present with pus- or liquid-filled bumps. Three types of eczema—dyshidrotic, nummular, and weeping—all present with the same blister-like lesions.

The symptoms most associated with the condition are intense itchiness, pain and burning sensations, and dry and peeling skin. The cause of pustular eczema isn't well known, but family and personal health history, genetics, and environmental factors all play a role in its development.

Treating pustular eczema revolves around the severity and type. However, the most common treatment for all types of eczema is topical corticosteroids or topical calcineurin inhibitors. To cope with your eczema, you can find a treatment that works, identify and avoid triggers, and keep your skin healthy through regular moisturizing and avoiding irritating products.

A Word From Verywell

Pustular eczema can be unsightly, uncomfortable, and hard to deal with when you're in a flare-up. The good news is that, although the condition can be severe, it is more likely to be moderate or mild and easy to treat.

There is no cure for eczema. Still, there are remedies that can help. Speak to your healthcare provider for advice and treatment options if you have pustular eczema and want to improve your symptoms.

Frequently Asked Questions

• To treat the pus-filled bumps that develop in pustular eczema, you must treat the type you have. While treatment may involve topical corticosteroids or calcineurin inhibitors, each case differs depending on the severity. If you have weeping eczema blisters, you may also have to treat an infection using antibiotics or antifungals.
  

• Pustular eczema may appear similar to other types of contagious conditions. However, it is not passed from one person to another. You cannot give nor contract pustular eczema.

• People with pustular eczema may have different triggers. Some common triggers are:
  

  • Harsh chemicals found in laundry detergent or personal care products
  • Environmental exposure
  • Other allergies
  • Sweaty or wet hands
  • Stress

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. National Eczema Association. Dyshidrotic eczema.

2. American Academy of Dermatology Association. Eczema types: Nummular eczema signs and symptoms.

3. Calle Sarmiento PM, Chango Azanza JJ. Dyshidrotic eczema: A common cause of palmar dermatitis. Cureus. 2020 Oct 7;12(10):e10839. doi:10.7759/cureus.10839

4. Frazier W, Bhardwaj N. Atopic dermatitis: Diagnosis and treatment. Am Fam Physician. 2020 May 15;101(10):590-598.

5. American Academy of Dermatology Association. Who gets dyshidrotic eczema?

6. DermNet. Guidelines for the diagnosis and assessment of eczema.

7. Lee JH, Son SW, Cho SH. A comprehensive review of the treatment of atopic eczema. Allergy Asthma Immunol Res. 2016 May;8(3):181-90. doi:10.4168/aair.2016.8.3.181

8. Leung AKC, Lam JM, Leong KF, Leung AAM, Wong AHC, Hon KL. Nummular eczema: An updated review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(2):146-155. doi:10.2174/1872213X14666200810152246

9. American Academy of Dermatology Association. Eczema types: Nummular eczema diagnosis and treatment.

10. American Academy of Dermatology Association. Eczema types: Atopic dermatitis: Tips for coping.

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.

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Pustular Eczema: Causes, Treatment, and Coping - Verywell Health