Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 6-22: Pompholyx + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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