What is this rash? A gentleman in his 40s came to the office complaining of a chronic intermittent rash on his hands. He will get dry, peeling skin and blisters that will burst, and then the skin eventually seems to improve. No over the counter lotions or creams have been helpful. This is dyshydrotic eczema, which is actually quite common. It is chronic in nature, and causes small, itchy blisters and dry, peeling or cracked skin mostly on the hands, fingers, and feet. It can be triggered by anything that is an allergy for that person, including food allergies, environmental allergies, or substances that touch the skin. Frequently sweaty or wet hands and feet can also trigger this. For treatment, it is a good idea to eliminate the triggers and to keep the hands and feet dry and cool. Over the counter treatment include topical moisturizing creams, topical steroid creams, and oral anti-histamines. Prescription, higher-dose steroid creams, like clobetasol, or even oral prednisone may be warranted. Over the years, we have even had patients request a successful intramuscular shot of steroids to keep the treatment effective longer through a more difficult season. Medications, such as methotrexate or dupixent or even phototherapy using UVB light have been used for more difficult cases. It is important to recognize the chronicity of this rash and the need to discover and reduce the triggers, along with good skin care and then finding what treatment works best.