Pompholyx

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

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

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

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

Oral alitretinoin may be effective

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