Blisters on Hands and Feet: Fungal Infections vs. Dyshidrosis

Blisters on hands and feet?

Hello, Doctor.
I originally had athlete's foot and onychomycosis.
Last November, I took oral medication for over three months, and my onychomycosis has mostly improved, with only a small area remaining on my big toe.
Before taking the medication, I frequently developed clear blisters under the skin on my fingers and toes, particularly on the soles and edges of my feet (which are less prone to growth).
These blisters were not itchy, and if I didn't apply any medication, they would harden and gradually heal within a few days, but new ones would appear in different areas.
The doctor said this issue was dyshidrotic eczema.
However, after taking the medication, these blisters stopped appearing.
Does this mean it was a fungal infection, or could it be that it was winter and dyshidrotic eczema didn't flare up? After stopping the medication in February, I started developing blisters on my hands again in March.
My feet would develop both subcutaneous blisters and raised blisters, generally distributed as single lesions.
They were also painless and non-itchy, and would heal on their own.
This has been recurring until now.
In March, I consulted another dermatologist and used an antifungal cream for over a month, but the condition worsened while using it, so I stopped.
I am really concerned about whether this is a fungal infection, as I fear transmitting it to my child.
I constantly wash my hands and disinfect the floors, etc.
However, after I finished the oral medication, my 10-year-old child developed a blister on one foot.
The doctor prescribed an antifungal cream (from the same clinic I visited in March), but it got worse with more blisters and severe peeling while using it.
I was worried about a recurrence, so I applied the cream to all affected areas and persisted for nearly two months.
The cream was called Renmin Beishun, and I used it along with another ointment called Jianjiang Cream.
Eventually, the peeling made the skin look thin, soft, and red, and the blisters mostly disappeared.
After using it for so long, I decided to stop the medication.
During this period, I visited the same clinic three or four times.
After stopping the medication, my skin appeared to improve more and more until it healed completely.
I continued to wear slippers and used kitchen paper towels to dry my feet after showering.
However, in August, two of my toes started peeling again, and after the peeling healed, I developed raised or subcutaneous blisters again.
I also noticed that these two toenails seemed to be thickening and flaking, but they were also painless and non-itchy.
I suspect onychomycosis, and I feel like my life has become bleak.
This time, I consulted another doctor who said it was dyshidrotic eczema, and after applying treatment for two to three days, it mostly improved (though I didn't apply it regularly), but a new subcutaneous clear blister appeared.
Doctor, could you please clarify whether this is a fungal infection or dyshidrotic eczema? I am exhausted from worrying about transmission, and the stress is overwhelming.
My obsession with cleanliness has made my family resentful, and I feel mentally unwell.
I have been treating for a fungal infection because I fear transmitting it to my child, and I have had this fungal infection for over a decade.
But why did my child get infected after I completed the oral medication? I apologize for the lengthy message, and I greatly appreciate your help in answering my questions.

Ms. Li, 30~39 year old female. Ask Date: 2022/08/31

Dr. Wu Yuxin reply Dermatology

Based solely on the literal description, it is not possible to determine whether it is a fungal infection or dyshidrotic eczema.
Moreover, during the summer, Taiwan's hot and humid climate often sees both conditions coexisting and can easily lead to recurrent episodes.
It is advisable to consult a dermatologist for an accurate diagnosis.
One should understand that just because the previous diagnosis was a fungal infection, it does not mean that it will always be a fungal infection; this time it could be dyshidrotic eczema, and vice versa.

Reply Date: 2022/08/31

More Info

Understanding the distinction between fungal infections and dyshidrosis (also known as pompholyx) is crucial for effective treatment and management, especially when dealing with recurrent skin issues like blisters on the hands and feet.
Fungal infections, such as those caused by dermatophytes, can lead to conditions like athlete's foot (tinea pedis) and nail fungus (onychomycosis). These infections thrive in warm, moist environments and are often characterized by symptoms such as itching, redness, and scaling. Blisters may form in response to the infection, particularly in areas where the skin is compromised. In your case, the history of athlete's foot and onychomycosis suggests a predisposition to fungal infections, which could explain the recurrent blisters.

On the other hand, dyshidrosis is a type of eczema that typically manifests as small, itchy blisters on the palms of the hands and soles of the feet. These blisters can be triggered by various factors, including stress, sweating, and exposure to certain metals or allergens. Unlike fungal infections, dyshidrosis is not caused by a pathogen but rather is an inflammatory skin condition. The blisters associated with dyshidrosis are often not painful and may resolve on their own, but they can recur, especially during warmer months or periods of increased stress.

In your situation, the fact that the blisters are not itchy and tend to resolve on their own suggests that they could be related to dyshidrosis rather than a fungal infection. However, the recurrence of blisters, especially after stopping antifungal treatment, raises the question of whether there is an underlying fungal component that has not been fully addressed.

The observation that your child developed similar blisters after you completed your antifungal treatment is concerning. It suggests that there may be a transmissible fungal element at play, especially if your child has been in close contact with your feet or shoes. However, it is also possible that your child is experiencing dyshidrosis or another skin condition unrelated to your fungal infection.

To clarify the diagnosis, it would be beneficial to conduct a thorough examination by a dermatologist. They may recommend a potassium hydroxide (KOH) test or a fungal culture to definitively rule out or confirm a fungal infection. If a fungal infection is confirmed, appropriate antifungal treatment can be initiated. If dyshidrosis is diagnosed, treatment may involve topical corticosteroids to reduce inflammation and manage symptoms.

In terms of prevention and management, maintaining good foot hygiene is essential. This includes keeping your feet dry, wearing breathable footwear, and avoiding walking barefoot in communal areas. If you suspect that your home environment may harbor fungal spores, regular cleaning with antifungal solutions can help mitigate the risk of reinfection.

It's understandable that the stress of managing these skin conditions can take a toll on your mental health and family dynamics. Open communication with your family about your concerns and the steps you are taking to manage the situation can help alleviate some of that stress. Additionally, consider seeking support from a mental health professional if you find that your anxiety about the infections is significantly impacting your quality of life.

In summary, distinguishing between fungal infections and dyshidrosis is key to effective treatment. A dermatologist's evaluation will provide clarity on your condition, allowing for targeted treatment and management strategies. Remember to prioritize both your physical and mental well-being as you navigate this challenging situation.

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