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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



Pompholyx

What is pompholyx?

Pompholyx is a common type of eczema affecting the hands (cheiropompholyx), and sometimes the feet (pedopompholyx).

Pompholyx is also known as dyshidrotic eczema or dyshidrosis.

What causes pompholyx and who gets it?

Pompholyx may be related to sweating. It most often affects young adults.

What are the clinical features of pompholyx?

Pompholyx presents as recurrent crops of deep-seated blisters on the palms and soles. They cause intense itch and/or a burning sensation. The blisters peel off and the skin then appears red, dry and has painful fissures (cracks).

Severe pompholyx around the nail folds may cause nail dystrophy, resulting in irregular ridges and chronic paronychia (nail fold swelling).

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Pompholyx

More images of pompholyx ...

How is pompholyx diagnosed?

The clinical presentation is typical. If suspicious of a fungal infection (tinea pedis), skin scrapings should be taken for mycology.

Complications of pompholyx

Secondary infection of pompholyx with staphylococcal bacteria is not infrequent. The result is pain, redness, swelling and crusting or pustules.

Infected pompholyx
Infected pompholyx

Aggravating factors

As in other forms of hand dermatitis, pompholyx is aggravated by contact with irritants such as water, detergents and solvents. Contact with them must be avoided as much as possible and protective gloves worn to prevent additional irritant contact dermatitis.

People with pompholyx that are found to be allergic to nickel must try to avoid touching nickel items.

Treatment of pompholyx

Treatment varies with the stage of the disease.

Cool compresses

Soaks or compresses using weak solutions of Condy's crystals (potassium permanganate), aluminium acetate, or vinegar in water, are applied for 15 minutes four times a day. This will dry up blisters. Compresses are not suitable for dry eczema.

Emollients

Emollients or hand creams, eg. dimeticone barrier cream, should be applied liberally and frequently to keep the skin soft.

Topical steroid

Potent topical steroids should be applied to the affected areas nightly under occlusion (eg covered with food wrap). They help reduce inflammation and itching. The more potent products should not be used for more than two weeks unless your doctor advises otherwise. Steroid creams are used when the skin is blistered or weeping. Steroid ointments are used for the chronic dry stage.

Antibiotics

Antibiotics such as flucloxacillin should be prescribed by your doctor for any secondary infection.

Systemic steroids

Systemic steroids are prescribed by tablet or injection for severe cases. The condition clears dramatically but may recur just as severely after the medication is stopped. Long term treatment with systemic steroids is rarely advisable because of undesirable side effects.

PUVA therapy

PUVA therapy can be useful in selected cases. This is a special kind of ultraviolet (UV) treatment. Several times weekly the affected areas are soaked in a special solution (psoralen), before exposure to long wave UV light. Treatment is usually continued for several months. Usually the measures described result in satisfactory control. Sooner or later the eruption subsides and disappears.

Other medications used occasionally for pompholyx include;

What is the outlook for pompholyx?

Pompholyx may occur as a single episode but it often runs a chronic course. It can reappear in hot weather or after a period of nervous tension, worry or stress. Unfortunately pompholyx does not have any quick sure cure.

Related information

On DermNet NZ:

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Author: Amanda Oakley, Dermatologist, Hamilton New Zealand. Updated July 2014.

DermNet NZ does not provide an online consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.