Pompholyx
- itchy
- chronic, recurrent
- often symmetric eruption on the palms of hands, fingers, and soles of the feet.
- It is characterised by small, deep-seated, 1–2 mm fluid-filled vesicles on these sites, which resolve after several weeks with scaling.
It is not related to occlusion of sweat glands as was first thought when the disease was recognised over 100 years ago, but there are some factors associated with the disorder, including:
- Atopy — the evidence is mixed with some reporting it as a risk and others not
- Contact dermatitis:
- Allergic contact dermatitis to a variety of antigens including nickel, chromium, and cobalt
- Irritant contact dermatitis may exacerbate the condition.
- Fungal infection — Tinea pedis can be associated with a dyshidrotic-like eruption
- Photoinduction — associated with ultraviolet A exposure
- Immunoglobulin therapy
- Hyperhidrosis — excessive sweating is an aggravating factor
- Other factors:
- Seasonal variation can also aggravate a recurrence
- Smoking
- Oral contraceptive pill
- Aspirin.
DDx
- bullous pemphigoid
- Palmoplantar pustular psoriasis
- Contact dermatitis (irritant or allergic)
Mx
- Avoid aggravating factors where possible.
- Potassium permanganate soaks may be useful in the acute phase.
- topical steroids (usually potent or ultrapotent)
- Pimecrolimus and tacrolimus
- Phototherapy: Topical psoralens and ultraviolet light A (tPUVA).
- Antihistamines