Pompholyx

What is pompholyx?

Pompholyx is a type of eczema which affects the hands and feet, causing tiny blisters and irritation. (Eczema is a condition causing skin inflammation; there is a separate leaflet about it.) Pompholyx is also known as 'dyshidrotic eczema' or 'vesicular eczema of the hands and feet'. Other names are 'cheiropompholyx' if it affects the hands, or 'pedopompholyx' if it affects the feet.

What causes pompholyx?

The exact cause is not known (as with eczema). However, there seem to be some factors which might be involved in causing or triggering this condition. These are:

• Metals such as nickel or cobalt (either on the skin, or in food).
• An antibiotic called neomycin (this is not often used).
• Certain chemicals, for example, perfumes.
• Fungal infection of the skin (see below).
• Emotional stress.

Pompholyx may be aggravated by anything which is 'irritant' to the skin, such as detergents, various 'solvent' type chemicals, and water (if there is frequent or prolonged contact with water).

Who gets pompholyx?

Pompholyx probably affects about 1 in 20 of people who have eczema on their hands. It is less common after middle age and in older people.

What are the symptoms of pompholyx?

At first, there are tiny blisters in the skin of the hands or feet. They are located on the palms or fingers of the hands (often on the sides of the fingers), and on the soles or toes of the feet. The blisters may feel itchy or 'burning'. Sometimes the small blisters can merge to form larger ones.

As the blisters start to heal, the skin goes through a 'dry' stage where there are are cracks or peeling skin.

If there is severe pompholyx near the fingernails or toenails, then the nails may have ridges, or there may be swelling at the base of the nail (called 'paronychia').

Sometimes the blisters or skin cracks can get infected. If so, there may be pus (yellow fluid) in the blisters or cracks. Or, there may be increasing redness, pain, swelling or crusting of the affected skin. See a doctor urgently if you have these symptoms or if you suspect an infection.

How is pompholyx diagnosed?

It is diagnosed by the medical history and the appearance of the skin.

What is the treatment for pompholyx?

As with eczema, there is no absolute cure for pompholyx, but it does respond to treatments. Possible treatments are:

Compresses or soaks

These are used when there are blisters, or if the skin is wet and 'weepy'. Do not use them if the skin is dry. They help dry out the blisters and oozing, and have an antiseptic action.

How do I make a compress or soak?

One of the following solutions (liquids) can be used as a soak or compress. Use it for about 15 minutes, four times daily. Either soak your hands or feet in the solution, or get a clean cloth such as an old sheet or towel, soak the cloth in the solution (this makes a compress) and put it on the affected skin.

• A "weak solution" of vinegar. The strength is not specified other than as 'vinegar in water'.
• Burow's solution. This is a solution of aluminium acetate in water. It comes as a powder to which you add water. Follow the instructions to make a 1:40 solution (the 1:40 is the strength of the solution). At present, it does not seem that Burow's solution is available in the UK. In other parts of the world it can be obtained under the brand name of Domeboro - for details see http://www.bayercare.com/Domeboro_faqs.cfm
• Potassium permanganate solution. Note: this will stain skin and clothing. Potassium permanganate is available without prescription from pharmacies in the UK. It comes in the form of crystals, as a solution (liquid) or as dissolvable tablets. You will need to add water. If using crystals, drop 4 or 5 crystals into a litre of water. If using the tablets or liquid, follow the instructions to make a 0.01% solution (do not use the original liquid undiluted).

Moisturisers and barrier creams

As with eczema generally, moisturising creams or ointments are helpful for dry skin, peeling or cracked skin, and to act as a barrier against water or chemicals. There are many different brands, which can be bought over the counter or prescribed. See your pharmacist or doctor for suggestions. There is a separate leaflet on emollients (moisturisers) for eczema.

Steroids

Steroids can be helpful because they reduce inflammation - this can reduce irritation and help the skin to heal. Steroids are best used as short-term treatments or in low doses, because side-effects may occur with long-term use of high strength steroids.

The usual steroid treatment for pompholyx is a short course (about 2 weeks) of a high-strength steroid cream or ointment, used on the affected areas of skin. If your skin is blistered or weeping (wet), a cream type will work best. For dry or thick skin, ointment works better. High-strength steroids should not be used for more than about 2 weeks without medical advice.

Rarely, in severe cases of pompholyx, steroid tablets may be used. They are effective, but again, may have side-effects, so are only used if really necessary.

Antibiotics and antifungal treatment

If there are signs of infection (as above), an antibiotic can help.

There are also reports that some cases of pompholyx improve if fungal infections of the feet are treated. (This type of infection is common and is usually a mild condition - it is often known as 'athlete's foot'. The medical name is 'tinea pedis'.) Antifungal creams such as clotrimazole or terbinafine can be used to treat this infection.

Other treatments

If pompholyx is severe or persistent, there are other treatment options. These will usually need to be discussed with a specialist, or in the UK may only be available from a dermatologist (skin specialist).

Ultraviolet light therapy

This is called 'UV therapy' or 'PUVA therapy'. The treatment is ultraviolet light on the skin. It is usually given as a course of treatment at a hospital outpatient clinic.

Medication affecting the immune system

There are other medications which can help. These work by affecting the immune system to reduce inflammation. Examples are methotrexate, azathioprine and dapsone tablets. Another type is medication called 'tacrolimus' or 'pimecrolimus' in ointment form. All these may have serious side-effects, so the pros and cons of using them have to be considered. Sometimes, they are used to help reduce the amount of steroid medication that is needed.

Botulinum toxin

Some cases of pompholyx have improved after injections of botulinum toxin into the skin. Botulinum toxin is a substance that affects the nerves in the skin. We do not know exactly why this works for pompholyx - possibly, it works by affecting the sweat glands, reducing sweat and moisture in the skin.

Testing and treating for possible trigger factors

A type of skin testing called 'patch testing' can be used, to see if particular substances such as nickel, perfume components, etc., cause a strong reaction in the skin. If so, you may be advised to try avoiding contact with these substances, to see if this improves the pompholyx.

There has also been some research testing sensitivity to metals by mouth (instead of on the skin). For example, giving oral doses of nickel and then observing the skin reaction. Reports suggest that in some cases, diet changes such as reducing nickel in the diet, can help. We do not know whether this is relevant to the majority of people who have pompholyx.

What is the outlook for pompholyx?

The time course of pompholyx varies for each individual. In some people it clears up in about 3-4 weeks. In others, it can be more persistent (doctors call this a 'chronic' form).

Further help and information

National Eczema Society

Hill House, Highgate Hill, London, N19 5NA
Helpline: 0870 241 3604 Web: www.eczema.org

Pompholyx.co.uk

A patient website offering Information, advice & support for pompholyx sufferers.
Website www.pompholyx.co.uk