Pompholyx (Dyshidrotic Eczema)

Definition

• A vesicular hand and foot dermatitis presenting with deep-seated vesicles or bullae on the palms and soles. Also called vesicular endogenous eczema.

Key Features

• More common in young adults and females

• Often linked to hyperhidrosis (excessive sweating)

• ~50% have a history of atopic eczema

• Triggered by stress, humidity, sweating

Aetiology & Risk Factors

• Genetics

• Irritants: Prolonged contact with water, detergents, friction

• Nickel/Allergen Exposure: Common allergic trigger for hand dermatitis

• Tinea (dermatophyte infections): May incite an id reaction

• Drug Reactions (e.g., immunoglobulin therapy in rare cases)

Clinical Features

• Recurrent crops of deep-seated blisters on palms/soles → intense itching/burning

• Blisters rupture → red, dry, cracked skin prone to secondary infection

• May involve:

  • Paronychia (nail fold swelling)

  • Nail dystrophy (pitting, ridges)

• Duration: Weeks, often with frequent recurrences

Differential Diagnosis

Management

General Measures

• Avoid Triggers: Limit exposure to water, detergents, allergens, friction

• Protective Gloves for wet/dirty tasks

• Regular Emollients to prevent dryness, cracking

• Potent Antiperspirants (e.g. aluminium chloride) applied at night for hyperhidrosis

Pharmacological Treatment

• Drying Agents: Potassium permanganate soaks, saltwater soaks for acute vesicular eruptions

• Topical Corticosteroids:

  • e.g. Betamethasone dipropionate 0.05% cream

  • Use under occlusive dressing for severe or recalcitrant lesions

• Systemic Steroids (severe cases):

  • Oral prednisolone 25 mg daily for 3–4 days, then taper over 2–3 weeks

Notes

• Recurrent vesicular rash on hands/feet → suspect dyshidrotic eczema.

• Strong link with hyperhidrosis, stress, and high humidity.

• Avoid irritants, maintain emollients, use protective gloves.

• Topical steroids are first-line, oral steroids for severe flares.