Pompholyx accounts for 5-20% of all cases of hand eczema. In 80% of cases only hands are involved, while in 10% only the feet and in other 10% of cases both palms and soles are involved.
Causes of Pompholyx
In most cases the exact causes cannot be verified for the pompholyx eruption. The following associations have been noted in many cases:
- Dyshidrotic eczema: An increased activity and blockage of sweat glands have been hypothesized, but histopathological studies have not found any consistent relationship to prove this theory. Hence the term dyshidrosis is considered a misnomer by many dermatologists.
- A personal and family history of atopy is found in majority cases of pompholyx.
- Primary irritants, like solvents, soluble oils, detergents etc.
- Contact allergens like dyes, dichromates, perfumes, fragrances, balsam of Peru, nickel etc have been shown to produce pompholyx eruptions.
- Ingested metals like nickel, chromium and cobalt.
- Medications like neomycin, aspirin, oral contraceptives and even cigarette smoking have been implicated as causing pompholyx.
- Fungal and bacterial infections elsewhere on the body produce pompholyx like ide eruptions on the hands and feet. Once the infectious foci are treated, the pompholyx disappears spontaneously.
- Emotional stress often precipitates pompholyx eruptions in susceptible individuals.
Being a major cause for hand eczema, finding and eliminating potential culprits of pompholyx will help get rid of the hand eczema properly.
Signs and Symptoms of Pompholyx
Pompholyx can occur at any age, but the commonest age group is between 10-40 years. Pompholyx is characterized by sudden eruption of deep seated, tense, fluid filled blisters, mainly on the sides of fingers and toes. In severe cases, the palms and soles are also involved. Small blisters (vesicles) may coalesce to form large bullae. Compared to other acute eczemas, there is no redness of the involved skin in pompholyx.
A sensation of heat or prickling of the palms and soles may precede the eruptions. This may be followed by severe itching while the vesicles are erupting.
The vesicles start drying up spontaneously and heal with peeling of the superficial skin in 2-3 weeks. Some patients get recurrent attacks which may come and go seasonally for years. Pompholyx is more common in summer.
Fungal infections, palmoplantar psoriasis, palmoplantar pustulosis, herpetic whitlow and certain bullous skin diseases like pemphigoid, linear IgA disease and pemphigoid gestationis may mimic pompholyx.
Treatment of Pompholyx
- The first step in management of pompholyx, of course, is the identification and elimination of any obvious cause of the eruption.
- In the acute eruptive stage, rest and bland soothing applications are advised.
- If the feet are involved, bed rest is preferable.
- Soak the hand and feet in Burow’s solution (aluminum acetate 1%) or potassium permanganate solution (1:8000) for 10-15 minutes 3-4 times a day.
- Large blisters may be aspirated with sterile needle by a doctor.
- Your doctor will also prescribe antibiotics if superadded bacterial infection is suspected.
- Once the eruption subsides, the soaks should be replaced with topical zinc cream or oily calamine lotion.
- Topical steroids (super potent and potent strengths) are effective in sub acute and chronic rashes of pompholyx.
- Tar preparations, topical psoralens followed by UVA exposure etc. are also beneficial in chronic hyperkeratotic phase of pompholyx.
Reference
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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