Pompholyx

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

• 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