Dyshidrotic Eczema
Inflammation, not an infection A form of eczema. The skin barrier reacts and fluid collects in the top layer, which lifts into blisters. There is nothing living in the skin, and nothing to catch.
← All comparisons
Dermapedia / CompareConditions
Dyshidrotic Eczema vs Athlete's Foot
Dyshidrotic eczema is an itchy blister rash, and it is not an infection. Deep, tiny blisters come up on the sides of the toes and the arch, usually on both feet and often on the hands as well. Athlete's foot is a fungal infection. It starts between the toes as soft, split, peeling skin, usually on one foot before the other.
At a glance
| The difference | Dyshidrotic Eczema | Athlete's Foot |
|---|---|---|
| What it is | Inflammation, not an infection | A fungus growing in the skin |
| What it looks like | Tiny deep blisters, like tapioca | White, split, peeling skin |
| What actually treats it | A steroid cream, plus barrier care | An antifungal cream |
Athlete's Foot
Side by side
The differences that matter
What it is
Dyshidrotic Eczema
Inflammation, not an infection
A form of eczema. The skin barrier reacts and fluid collects in the top layer, which lifts into blisters. There is nothing living in the skin, and nothing to catch.
Athlete's Foot
A fungus growing in the skin
Dermatophytes feed on keratin in the outer layer of skin. They arrive from a damp floor or a shared towel, and warm shoes let them settle.
How it works, illustrated
Athlete's Foot
Dry, intact skin between the toes. The outer layer is a poor place for anything to grow.
1 / 4→
Shoes, socks and sweat keep the skin between the toes wet for hours. Softened skin is what the fungus needs.
←2 / 4→
Dermatophytes feed on keratin, so they live in the dead outer layer and go no deeper. That is why an antifungal cream reaches them.
←3 / 4→
The barrier breaks down into peeling, cracking and itching, and those cracks let bacteria in. Untreated it spreads to the soles and the nails, and the nails are what reinfect the skin later.
←4 / 4
What it looks like
Dyshidrotic Eczema
Tiny deep blisters, like tapioca
Clear blisters a millimetre or two across, sitting deep in the skin so they look buried rather than raised. They dry out after a couple of weeks and the skin peels in rings.
Athlete's Foot
White, split, peeling skin
Soft white skin in the toe webs with a crack at the base. On the sole it can be dry scale over the heel and up the sides. One version does make blisters, usually on the arch.
More photographs
Athlete's Foot
Across skin tones
Athlete's Foot
Athlete's foot on light skin
This is the presentation most people picture. The skin reads pink to dull red under a layer of fine white scale, driest across the sole and the sides of the foot. The trap on light skin is that the pink is faint in the moccasin pattern, so it gets called winter dry skin and moisturized for years. The edge is what tells them apart. Plain dry skin fades out gradually. This stops at a line along the side of the foot, and the toenails are usually scaly or thickened too.
1 / 4→
Athlete's foot on medium skin
On medium skin the pink base is muted, so scale becomes the main clue and the rash is often mistaken for something else. Fine gray-white flaking on the sole gets treated as callus or eczema, and the raised scaling edge creeping onto the top of the foot gets treated as a ring of dry skin. Two checks help. Look between the fourth and fifth toes for white soggy skin or a split, and look at the toenails. Nail involvement almost always means the fungus is the cause.
←2 / 4→
Athlete's foot on brown skin
On brown skin the pink or red base is usually not visible at all, so redness is a poor thing to go by. Everything else still works: fine dry scale, white soggy skin in the web spaces, splits at the base of the toes, and a raised scaling edge moving onto the top of the foot. Because the redness appears to be missing, these infections are regularly judged milder than they are and treated for too short a time.
←3 / 4→
Athlete's foot on deep skin
After the fungus is gone, deep skin often keeps a flat dark mark where the skin was inflamed. That is post-inflammatory hyperpigmentation, a stain left by the inflammation rather than infection that is still there, and it can take several months to fade. It is a common reason people keep applying antifungal cream long after the fungus has cleared. The test is simple. Still scaling, itching or peeling means the infection is active. Flat, smooth and simply darker is a mark, and time is what fixes it.
←4 / 4
Does it itch
Dyshidrotic Eczema
Intensely, before the blisters show
Many people feel a burning itch a day before anything appears. Scratching turns the blisters into raw, weeping skin.
Athlete's Foot
Yes, and it can burn
Worst between the toes, and worst when the shoes come off.
Where it shows up
Dyshidrotic Eczema
Sides of the toes, arch, palms
Along the edges of the toes and fingers, the arch of the foot and the palms. It does not settle in the tight space between the toes.
Athlete's Foot
Between the toes, then the sole
Most often the gap between the fourth and fifth toes, spreading to the sole, the sides of the foot and the toenails.
Where it appears
Athlete's Foot
Feet, and one hand more often than two
It starts between the toes, most often in the tight web beside the little toe, and spreads to the sole, the heel and the sides of the foot. It can move to the toenails. If a hand is involved it is usually only one, from scratching the feet.
One foot or both
Dyshidrotic Eczema
Almost always both
It comes up on both sides at once, in a matching pattern. The hands are often involved in the same flare.
Athlete's Foot
Often one at first
A fungal infection has to spread from where it landed, so one foot is usually ahead of the other for a while.
What sets it off
Dyshidrotic Eczema
Heat, sweat, stress, metals
Flares follow hot weather, sweaty hands and feet, stressful stretches, and contact with nickel or cobalt in some people. It comes in waves for years.
Athlete's Foot
Damp shoes and shared floors
Gyms, pools, communal showers, and shoes that never fully dry out. It stays until it is treated.
What actually treats it
Dyshidrotic Eczema
A steroid cream, plus barrier care
A prescription steroid ointment settles a flare. Cool soaks, thick moisturizer and keeping the feet dry shorten it. Stubborn cases have other prescription options.
Athlete's Foot
An antifungal cream
Terbinafine or clotrimazole from the drugstore, twice a day. Terbinafine clears more infections and does it in about a week, where clotrimazole takes about four.
Athlete's Foot
Terbinafine cream
The most effective thing you can buy for athlete's foot, and the shortest course: once or twice a day for one to two weeks between the toes. It kills the fungus rather than just stopping it growing, which is why it works faster than the older creams. It will not clear an infected toenail, and it will not clear thick sole scale on its own.
1 / 17→
Clotrimazole or miconazole cream
The cheap, widely available option, applied twice a day for four weeks. It works well, it just takes longer than terbinafine, so the temptation to stop early is greater. Cover the whole foot and both feet, and carry on for one to two weeks after the skin looks normal.
←2 / 17→
Ketoconazole cream
Another azole cream, sold over the counter in some places and on prescription in others. It is a reasonable alternative if clotrimazole or miconazole has irritated the skin. It is no faster than they are, and the same four-week discipline applies.
←3 / 17→
Urea
A urea or salicylic acid cream thins the hard scale on the sole so an antifungal can actually reach the skin underneath. It is a helper, not a treatment: on its own it does nothing to the fungus. It is worth adding for the dry moccasin pattern, where cream otherwise sits on top of the thickened surface.
←4 / 17→
Antifungal powder and sprays
Powder keeps feet and the inside of shoes dry and lowers the amount of fungus you put back on your foot each morning. It is prevention, and it is good at it. It is not strong enough to clear an established infection, so use a cream to clear it and powder to keep it away.
←5 / 17→
Foot antiperspirant
An aluminum-based antiperspirant made for feet cuts the sweating that keeps the skin soft and the shoe damp. It treats the cause of recurrence rather than the infection itself. Useful for people who clear it every time and get it back every summer.
←6 / 17→
Tea Tree Oil
Tea tree oil has some antifungal activity and a few small studies behind it, but it clears fewer infections than the pharmacy creams and takes longer. It also causes allergic reactions on the feet often enough to matter. An antifungal cream costs about the same and works.
←7 / 17→
Vinegar and bleach soaks
Both slow fungal growth in a dish, and neither reliably clears an infection on a foot. What they do reliably is dry out and damage the skin, and cracked skin on a foot is the entry point for bacteria. This is one to skip rather than to try first.
←8 / 17→
Hydrocortisone
A steroid cream calms the itch, so it feels like it is helping, while the fungus spreads underneath with less to show for it. The rash it leaves is harder to recognize and harder to treat, and it makes a later scraping unreliable. Do not put a steroid on an undiagnosed foot rash.
←9 / 17→
Terbinafine tablets
The first-choice tablet for athlete's foot that cream cannot reach: the thick moccasin pattern, widespread infection, and infected toenails. Two weeks usually clears the skin; nails need three months and most of a year to grow out. Liver blood tests are sometimes checked, and it interacts with several common medicines, so the doctor needs your full list.
←10 / 17→
Itraconazole
An equally effective alternative, often given as short pulses rather than daily. It is chosen when terbinafine does not suit or has not worked. It interacts with a long list of other medicines, including some heart and cholesterol drugs, so it needs a proper medication review first.
←11 / 17→
Fluconazole
A once-weekly tablet, used for skin infection that has not cleared with cream when the other two do not suit. It is less effective than terbinafine for the dermatophytes that cause athlete's foot, and slower for nails. If you are pregnant or breastfeeding, ask the doctor managing your pregnancy before taking any antifungal tablet.
←12 / 17→
Griseofulvin
The oldest antifungal tablet. It still works, but it needs months rather than weeks, has to be taken with fatty food, and clears fewer infections than terbinafine. It is now mostly reserved for cases where the newer tablets cannot be used.
←13 / 17→
Ciclopirox cream
A prescription antifungal that works differently from terbinafine and the azoles, so it is a useful option when one of those has irritated the skin or has not cleared it. Applied twice a day for up to four weeks. It is no more powerful, just different.
←14 / 17→
Efinaconazole nail solution
A liquid painted on infected toenails daily for about a year, for people who cannot take antifungal tablets. It matters here because an untreated nail is the usual reason foot skin keeps getting reinfected. Cure rates are well below tablets, and it works best on nails that are only mildly affected.
←15 / 17→
Ciclopirox nail lacquer
An older nail lacquer, applied daily for up to a year with the build-up removed weekly. It clears only a small share of infected nails on its own. It is worth knowing about, but if the nails are the reason your feet keep flaring, tablets are the conversation to have.
←16 / 17→
Steroid-antifungal creams
Combination creams that mix a steroid with an antifungal are still prescribed for itchy foot rashes. The steroid takes the itch away quickly and lets the fungus spread wider and deeper, which is a common route to a longer, harder-to-treat infection. A plain antifungal is the better choice on a foot.
←17 / 17
When it needs a doctor
Dyshidrotic Eczema
If flares keep coming back
Also if the blisters are large, painful, or the skin has become raw and crusted.
Athlete's Foot
Four weeks with no change
Or if the toenails have turned thick, crumbly and yellow, which needs different treatment.
The blister version of athlete's foot is the one that fools people
Dyshidrotic Eczema
Dyshidrotic eczema arrives on both feet in a matching pattern, and the toe webs are usually clear.
Athlete's Foot
Athlete's foot has more than one shape. The common one peels between the toes. A less common one makes small blisters, usually on the arch or the instep, and that version can look almost the same as dyshidrotic eczema.
Two things separate them at home. Blistering athlete's foot usually has peeling skin somewhere else on the same foot, most often the toe webs. And it tends to be worse on one foot.
Steroid cream on a fungal infection makes it worse
Dyshidrotic Eczema
A steroid cream is the right treatment for dyshidrotic eczema. It calms the inflammation that is causing the blisters, and a flare usually settles within a week or two.
Athlete's Foot
A steroid cream on athlete's foot quiets the itch and lets the fungus spread. Steroids turn down the immune response that was holding the infection back. The rash looks better for a few days, then comes back larger, with a fainter edge that is harder to recognise.
This is the main reason a scraping is worth doing before starting a steroid on a foot rash you are not sure about.
Blisters on the hands from a fungus on the feet
Dyshidrotic Eczema
If the hands and feet both flare together and nothing on the feet looks infected, dyshidrotic eczema is more likely.
What helps either one while you work it out
Related topic illustrations
Athlete's Foot
Cellulitis
Cracks between the toes are a well-recognized way for bacteria to get into the leg, causing a hot, swollen, spreading redness that needs antibiotics. It is uncommon in healthy feet and much more likely in people with diabetes, poor circulation or a swollen leg. Treating athlete's foot promptly in those groups is mostly about closing that door.
1 / 5→
Nail Fungus (Onychomycosis)
The same fungus moves into the toenails, which become thick, crumbly and yellow-brown. Cream cannot get through a nail, so an infected nail keeps putting fungus back on the skin every time a sock goes on. It is the usual answer to why athlete's foot keeps coming back, and it takes tablets and most of a year to fix.
←2 / 5→
Eczema
Eczema on the feet blisters on the sides of the toes and the arch, which is exactly where the blistering kind of athlete's foot appears. Eczema is usually on both feet evenly, spares the web spaces, and often shows up on the hands at the same time. Athlete's foot tends to favor one foot first, starts between the outer toes, and has a scaling edge. A scraping settles it, and treating eczema as fungus wastes weeks.
←3 / 5→
Contact Dermatitis
An allergy to rubber, glue or dye in a shoe makes an itchy, scaly rash that is easily called athlete's foot. The giveaway is the shape: it sits on the top of the foot in the outline of the shoe, matches on both feet, and leaves the web spaces between the toes untouched. Athlete's foot works the other way round, starting between the toes and on the sole.
←4 / 5→
Psoriasis
Psoriasis on the sole is dry and scaly across the whole weight-bearing area, so it reads as the moccasin kind of athlete's foot. Psoriasis scale is thicker and silvery, the edge is sharply drawn, and there is usually psoriasis somewhere else, on the elbows, knees or scalp. It also does not respond to antifungal cream, which is often the moment the question gets asked.
←5 / 5
Common questions
Questions Patients Ask
How do I know if my foot blisters are eczema or a fungus?
Look at where they sit and whether both feet match. Dyshidrotic eczema comes up on the sides of the toes and the arch, on both feet at once, with clear toe webs. Athlete's foot usually peels between the toes and is often worse on one foot.
Can athlete's foot cause blisters?
Yes. One form of athlete's foot makes small blisters, usually on the arch or instep. It normally comes with peeling skin somewhere else on the same foot.
Is dyshidrotic eczema contagious?
No. It is inflammation in your own skin, not an infection, so there is nothing to pass on.
Will an antifungal cream help dyshidrotic eczema?
No. Antifungals only work on fungus. Dyshidrotic eczema needs a steroid cream and barrier care, and the antifungal will simply do nothing.
Why do I get itchy blisters on my hands when my feet are infected?
That is an id reaction, an immune response to a fungal infection elsewhere. The hands are not infected, and treating the feet usually clears them.
Can a doctor tell them apart in one visit?
Usually yes. A skin scraping looked at under a microscope takes a few minutes and shows whether fungus is present.