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Key Features

  • Pruritic "tapioca" vesicles of 1–2 mm on the palms, soles, and sides of fingers

  • Scaling and fissuring may follow drying of the blisters

  • Vesicles may coalesce to form multiloculated blisters

  • About half of patients often have an atopic background and many patients report flares with stress

  • Patients with widespread dermatitis due to any cause may develop pompholyx-like eruptions as a part of an autoeczematization response

  • Appearance in the third decade, with lifelong recurrences

Clinical Findings

  • Small clear vesicles on the sides of the fingers and on the palms or, less frequently on the soles, may be associated with intense itching

  • Later, the vesicles dry and the area becomes scaly and fissured

Diagnosis

  • KOH examination will reveal hyphae in cases of bullous tinea, which may be confused with pompholyx

  • Differential diagnosis

    • Bullous tinea

    • Tinea pedis with dermatophytid reaction of palms

    • Scabies

    • Drug eruption due to certain NSAIDs

Treatment

  • See Table 6–2

  • Systemic corticosteroids should be avoided in this chronic condition

  • A high-potency topical corticosteroid used early in the attack may help abort the flare and ameliorate pruritus

  • PUVA

  • Injection of botulinum toxin into the palms as for hyperhidrosis

  • Avoid anything that irritates the skin

    • Patients should wear cotton gloves inside vinyl gloves when doing dishes or other wet chores

    • Use a hand cream after washing the hands

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