Pompholyx is a type of eczema where there are itchy blisters on the
hands and feet, followed by inflamed and dry skin. It can be a
temporary condition, or in some cases is more persistent. There are
various treatments that can help.
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).
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 25 Jul 2008
