What is Pompholyx?
Pompholyx is an uncommon skin condition and a form of eczema. It is characterized by the onset of small blisters filled with fluid and an inflammation. The onset usually involves the palms and fingers of the hands and the soles and toes of the feet. Pompholyx is also termed as "Dyshidrosis" and "Dyshidrotic eczema".
Pompholyx causes an intense itching and the condition generally lasts for three weeks. The condition can either be acute or chronic with recurrence just before the previous blisters have fully recovered. It is not a contagious condition and is rather self-limiting although the onset can be painful once the blisters have dried and formed cracks in the skin. The condition is discomforting and can affect the quality of life and the condition is often an unsightly appearance that can affect the social interaction of an affected individual. Pompholyx equally affects both men and women with peak onset 38 years old while it may also occur in children age 4 years and above. Pompholyx usually occur during the summer months or during spring season.
Pompholyx ranked third among the most common type of eczema in the hands according to some studies. The term dyshidrosis refers to the sweat duct although Pompholyx has no clear evidence of the link or any association with it although Pompholyx can also be aggravated by excessive sweating and heat.
This skin condition that involves the hands and the feet is a form of eczema. Eczema is the general term for a many types of a chronic inflammation of the skin. It is most common in infants with onset before the child has reached the age of years. It may permanently resolve by the time the child reaches the age of 3 years in most cases while it may also recur throughout life for some patients. Eczema is not a contagious disease and is being implicated in family history of eczema and other allergic conditions. The exact cause remains unclear but important factors are being considered such as the deficiency in the function of the skin barriers associated with the aberration in the function of the immune system.
The onset of Pompholyx starts with the development of blisters in the center of the palm of the hand and the sides of the fingers. The blisters may also develop initially at the center of the soles of the feet and the sides of the toes.
The small blisters that appear are usually itchy and later develop into a blister with the following characteristics:
- Blister size is about 3mm or less similar in diameter to the width of a standard pencil lead.
- The blisters may be flushed within the skin or may have an elevation slightly above the skin.
- Small blisters will eventually form a large blister after they cluster together.
- The blisters contain serum that collects in between the irritated skin cells.
The blisters will begin to itch and may have pain. The palms of the hands or the soles of the feet whichever is affected will have a reddish discoloration and may have wetness similar to a perspiration. Later in the course, the blisters will erupt with bases that are inflamed and may possibly be associated with skin peeling or lichenification. The blisters will persist for about 3 to 4 weeks until it disappears spontaneously.
The blister outbreak may be associated with swelling of the lymph nodes. The swelling of lymph nodes may also be associated with a tingling sensation in the forearm and may also have bumps in the armpit. The nails of the fingers or the nails of the toes that are affected will in turn have a pitted appearance.
The blisters will eventually dry in a period of 3 to 4 weeks and the primary skin will have redness and tenderness. The onset of Pompholyx will then resolve but may recur rather on a regular basis such as once every 6 months or once every year depending on the exposure to triggers or may range from once every month to once every year.
The etiology of Pompholyx remains unknown while the occurrence is believed to be associated with a skin condition called atopic dermatitis. The eruptions of Pompholyx may also be associated with seasonal allergic reactions.
The episode of Pompholyx is also implicated on various factors that can trigger the eruption and such may include:
- The mental state of the affected individual who may be experiencing emotional stress, anxiety and depression that can trigger excessive sweating during these periods of mental state.
- Fungal infection like Athlete’s foot, which is believed to be the most common cause, is implicated in the vesicular eruptions.
- Exposure to contact allergens such as nickel, balsams, chromium and others can flare up the condition of Pompholyx.
- Exposure to contact irritants is also implicated on the trigger of Pompholyx.
- Various kinds of allergic reactions can also trigger the episode of vesicular eruption.
- The dehydrating effect of alcohol from too much consumption of it can aggravate the fissures and dryness of the skin affected by blisters.
- Exposure to costume and fashionable jewelries that may have a material that can irritate and aggravate the condition.
- Previous medical treatment of intravenous immunoglobulin therapy
- Infection with Human immunodeficiency virus
- Prolonged exposure under the sun especially during the summer months or during spring season.
- There have been reported cases of Pompholyx triggered by chlorinated water of the pool and treated tap water.
Certain risk factors also account for the onset of Pompholyx and this may include the following:
- Female gender as there have been reports of cases with higher incidence in women than in men.
- Regular exposure of skin to wet and water
- Emotional stress
- Summer months and spring season
- Metal salt exposure such as nickel, cobalt and chromium
- Occupational exposure for long period under the sun such as farmers and gardeners.
- Individuals with sensitive skin that are prone to rash development after exposure to contact irritants.
- Individuals suffering from atopic eczema are at risk for developing Dyshidrosis.
No laboratory test can specifically confirm the condition of Pompholyx. Blood tests may be done to isolate the other underlying condition. Culture and sensitivity test may also be done to isolate bacterial infection especially to those who remain unresponsive to previous treatments. Skin scraping is done to identify the fungus that caused the episode or triggered the onset of Pompholyx. The patch test is also considered to confirm contact dermatitis that is being implicated in the onset of Dyshidrosis.
There treatment options for Pompholyx depend on the severity of signs and symptoms. Various kinds of treatment are made available but only a few have been developed to clinically treat the condition. The treatment is directed towards the relief of symptoms manifested during the course of the condition and this may include the following:
Corticosteroid cream and ointment can hasten the desertion of blisters. This treatment facilitates the drying of crack although this can cause itchiness after the lesions has dried.
Burrow’s solution is 10% aluminum acetate in 1:40 dilution. It is a drying soak that is especially useful for oozing blisters and lesions.
Potassium permanganate in 1:10.00 dilute solutions is a popular soak for drying out the blisters or the vesicles.
Sterile syringe is used for draining the large blisters that can leave the roof intact to avoid secretion of blood and serum contained in the blister.
PUVA therapy or psoralen combined with ultraviolet A is a special kind of ultraviolet treatment that is helpful for individuals with severe Dyshidrosis. The affected part is exposed to long wave ultraviolet light but is soaked first in a special solution called psoralen prior to exposure. The blister eruptions will later subside after continued treatment for several months with improvement in the skin appearance.
Diamino-diphenyl sulfone or Dapsone is an antibacterial sulfonamide recommended for chronic cases of Pompholyx.
Cool compress with the use of Condy’s crystals, aluminum acetate or vinegar diluted in water and applied for 15 minutes will help dry out the blisters and relieve the itchiness.
Emollients applied liberally on the affected skin will help keep the skin soft and moist to prevent it from drying and avoid cracks and fissures that will cause pain.
Botulinum toxin injection is rather a new treatment option that has not been generally accepted. It is recommended by some doctors to treat severe cases of Pompholyx by injecting the experimental treatment in the affected hands or feet.
The exact etiology of Pompholyx remains unknown. This is the very same reason that no exact cure has been developed either to permanently relieve or cure the condition. Most patients are given treatment for the relief of symptoms but not for the exact cure of the condition. Some treatments however have the capacity to delay the onset and recurrence of Pompholyx.
Sanjay Ankush Alam on October 10, 2018:
I m sufferd with pompholyx from 6 month on my hands only. Pls tell me treatment
AJ on August 24, 2017:
There is no treatment you have it for life pal
Harjap on August 13, 2017:
I m sufferd with pompholyx from 1 year on my hands only. Pls tell me treatment
Sweet-Life on September 17, 2016:
I have something I want to share & hope it works for others. Although I have always been allergy prone and have very sensitive skin.... in February 2013 horrible stress & ailments began. It was a perfect storm ... dental surgery, severe grief/stress .... abrupt life changes, etc.. All I know is within one week of Feb. 7, 2013 so much went wrong no one could believe it. I broke out in hives basically on every square inch of my body... everywhere! And I mean everywhere... & inside my mouth down my throat... tongue, everything. It was life-threatening (my throat closing up rapidly from anything) & diagnosis went everywhere, too... from lichen planus to finally urticarial vasculitis - chronic urticaria with severe angioedema.... Everything in my life changed & pain was excruciating. So, since I could do nothing but resolve my condition... I no doubt tried everything from cold baths, bleach, vinegar, natural remedies, strict diet eliminating all wheat, flours, wine, cheese ... basically almost starving at times... but drinking distilled water .. & praying without ceasing. Over the years, I did get some of the outbreaks to diminish... & I avoided the obvious which would set off a new life-threatening episode .. my face swelling up so severe my eyes were completely swollen shut. The obvious triggers were - raising my blood pressure (any & all stress), talking (it raises blood pressure), parabens, all soaps & shampoos & creme rinses, bug sprays, lawn sprays, sunlight, air pollution, heat, etc... & any industrial fermentation products - which I found out is really in everything now & if you read about the practices of this in our foods - you will definitely be shocked at how much we put our bodies through .... auto-immune actually is a legitimate way the body reacts to horrible bacterial & virus onslaughts. So, along with everything else people may recommend ... yes - please try what would work for you individually & with your doctor... as many things can help with the pain & recovery including a vegetable & seed diet.
So, after several years to 2015 - I really had the angioedema & hives under pretty good control by the Grace of God .. Thank God! However, in 2015 I contracted some kind of virus from a restaurant food I believe... which set everything off again --- but once I was through the worst... my hands began this dreaded dyshidrosis! I looked up everything I could on this.. & again tried everything... My hands were so bad, swollen, useless, painful, ... & huge social disgrace trying to hide them.
I noticed that water or getting them wet at all increased the breakouts. Cotton gloves with plastic gloves over the cotton gloves was the only way I could wash my hair, etc.. During this time I kept reading how staph & strep bacteria were everywhere & always on our skin... some people being better carriers of it to slough it off on everything. I used alcohol &/or bleach wipes to keep the exposure less. I had read where cornstarch was an anti-bug natural remedy to put into the crevices of your house & floor boards ... as there were some ant problems in my house & I could obviously not use ANY bug spray or most cleaning products. Well.. Praise God! the cornstarch worked in keeping my home bug free.
During these past years, I had tried different powders .... medicated or anti-fungal, etc.... to relieve itching & breakouts.... but like Benadryl NOTHING really helped.... I bought a new Johnson's baby powder of "pure constarch" with aloe & vitamin E... & noticing it said it absorbs moisture... I determined that my hands were only better when they were overly dry... So, I put some in a plastic bag *so I wouldn't inhale any powder)- & "washed" my hands in this pure cornstarch. Wow! it really began relieving my hands! I kept this up... & like I would go out of my way to NEVER get my hands wet.. but just leave them totally covered all the time in cornstarch rubbed in constantly. Within about two months, my hands were really pretty good... by three months it was a regular routine & I was actually excited & amazed to have my hands back at all. It has now been over 7 months & no outbreaks! Thank you Jesus!
When I start to feel anything ... especially two fingers often start-up & sometimes my palms get the characteristic bumps... I immerse & rub in the cornstarch! It stops the new eruption / breakout cold!.. I have also found it stops most of my hives on my face, too - if they ever get in contact with whatever might trigger the angioedema /urticaria problem.
My theory on this is strictly an opinion, but I believe my body's immune system is re-acting to real threats of bacteria, virus, etc.. from contact on my skin to my internal intestines. Since I have a very strict diet - I am not exposing myself to huge amounts of industrial fermentation - bacteria, etc.. inside... and as far as outside contact.... I believe when I touch something on my skin or hands which no doubt contains the typical staph / strep bacteria everywhere. the cornstarch somehow surrounds the bacteria & prevents the site from getting further deep into my skin..... whereas washing my hands in water & any soap... kind of opens the skin pores more allowing the bacteria to go deeper into the skin. I also ALWAYS wash my hair, hands etc... in the coldest water I can stand as otherwise the heated up skin/ scalp will have a re-action.
As this remedy has worked for me (& my daughter, too - who has some skin problems) - I have been meaning to post it for others to find - since I gained a lot of insight during all these years from the support groups etc.. for severe skin & auto-immune disorders.
Best to all of you & much love! ... & may God bless all!
julie on October 13, 2014:
I have been suffering with this on the soles of my feet, sides & toes for the past 8months now, I am using clobetasol propionate (dermovate ointment) a very potent steroid preparation which I find sets the affected area out & helps reduce the itching, but as soon as one or 2 start 2 dissapear more are appearing. I find it hard on a daily basis with walking due 2 the discomfort it causes.
Park a on September 15, 2014:
Thank you! I hope more people find your page. This is the most comprehensive explanation of the available dyshydrosis treatments I've seen. I've been fighting the condition for the last 15 years (I'm 30 now), and my bouts with it would last anywhere from a month to a year.
I'm in my worst battle yet. It's on 5/10 fingers, and I can't bend my right index finger right now (and of course I'm a righty..). Doctors have been misdiagnosing me with dry skin forever and have just been renewing steroid prescriptions and frustratingly (condescendingly?) recommending I use hand cream.
I have a nickel allergy that's barely in check and is apparently part of the problem.
I'm so excited about potassium permanganate and burrow's solution! I can get burrow's solution at Walgreens (apparently it's "Domeboro" brand, but I really don't care), and the potassium crystals at Home Depot ("Pot Perm" brand, which is fun if you've ever smoked weed. ;-p )
Moon Daisy from London on December 26, 2013:
I've had this condition a few times on the backs of my hands. Each time it was caused by using a new soap or hand cream, which didn't agree with my skin. The doctor prescribed a paraffin-based cream, which only made the itching worse and drove me absolutely crazy.
What worked in the end was dripping red-wine vinegar on the backs of my hands at regular intervals and gently rubbing them together. It took a day or two, but then the relief was immense. And after that it got better very quickly. Now every time it happens I know what to do, and I don't worry about it so much.
Thanks for highlighting this condition, not many people know about it.