Pompholyx - Pictures, Symptoms, Treatment, Diagnosis, Causes, Cure
What is Pompholyx?
Pompholyx is an uncommon skin condition and a form of eczema. It is characterized by the onset of small blisters filled with fluid and an inflammation. The onset usually involves the palms and fingers of the hands and the soles and toes of the feet. Pompholyx is also termed as "Dyshidrosis" and "Dyshidrotic eczema".
Pompholyx causes an intense itching and the condition generally lasts for three weeks. The condition can either be acute or chronic with recurrence just before the previous blisters have fully recovered. It is not a contagious condition and is rather self-limiting although the onset can be painful once the blisters have dried and formed cracks in the skin. The condition is discomforting and can affect the quality of life and the condition is often an unsightly appearance that can affect the social interaction of an affected individual. Pompholyx equally affects both men and women with peak onset 38 years old while it may also occur in children age 4 years and above. Pompholyx usually occur during the summer months or during spring season.
Pompholyx ranked third among the most common type of eczema in the hands according to some studies. The term dyshidrosis refers to the sweat duct although Pompholyx has no clear evidence of the link or any association with it although Pompholyx can also be aggravated by excessive sweating and heat.
This skin condition that involves the hands and the feet is a form of eczema. Eczema is the general term for a many types of a chronic inflammation of the skin. It is most common in infants with onset before the child has reached the age of years. It may permanently resolve by the time the child reaches the age of 3 years in most cases while it may also recur throughout life for some patients. Eczema is not a contagious disease and is being implicated in family history of eczema and other allergic conditions. The exact cause remains unclear but important factors are being considered such as the deficiency in the function of the skin barriers associated with the aberration in the function of the immune system.
The onset of Pompholyx starts with the development of blisters in the center of the palm of the hand and the sides of the fingers. The blisters may also develop initially at the center of the soles of the feet and the sides of the toes.
The small blisters that appear are usually itchy and later develop into a blister with the following characteristics:
- Blister size is about 3mm or less similar in diameter to the width of a standard pencil lead.
- The blisters may be flushed within the skin or may have an elevation slightly above the skin.
- Small blisters will eventually form a large blister after they cluster together.
- The blisters contain serum that collects in between the irritated skin cells.
The blisters will begin to itch and may have pain. The palms of the hands or the soles of the feet whichever is affected will have a reddish discoloration and may have wetness similar to a perspiration. Later in the course, the blisters will erupt with bases that are inflamed and may possibly be associated with skin peeling or lichenification. The blisters will persist for about 3 to 4 weeks until it disappears spontaneously.
The blister outbreak may be associated with swelling of the lymph nodes. The swelling of lymph nodes may also be associated with a tingling sensation in the forearm and may also have bumps in the armpit. The nails of the fingers or the nails of the toes that are affected will in turn have a pitted appearance.
The blisters will eventually dry in a period of 3 to 4 weeks and the primary skin will have redness and tenderness. The onset of Pompholyx will then resolve but may recur rather on a regular basis such as once every 6 months or once every year depending on the exposure to triggers or may range from once every month to once every year.
The etiology of Pompholyx remains unknown while the occurrence is believed to be associated with a skin condition called atopic dermatitis. The eruptions of Pompholyx may also be associated with seasonal allergic reactions.
The episode of Pompholyx is also implicated on various factors that can trigger the eruption and such may include:
- The mental state of the affected individual who may be experiencing emotional stress, anxiety and depression that can trigger excessive sweating during these periods of mental state.
- Fungal infection like Athlete’s foot, which is believed to be the most common cause, is implicated in the vesicular eruptions.
- Exposure to contact allergens such as nickel, balsams, chromium and others can flare up the condition of Pompholyx.
- Exposure to contact irritants is also implicated on the trigger of Pompholyx.
- Various kinds of allergic reactions can also trigger the episode of vesicular eruption.
- The dehydrating effect of alcohol from too much consumption of it can aggravate the fissures and dryness of the skin affected by blisters.
- Exposure to costume and fashionable jewelries that may have a material that can irritate and aggravate the condition.
- Previous medical treatment of intravenous immunoglobulin therapy
- Infection with Human immunodeficiency virus
- Prolonged exposure under the sun especially during the summer months or during spring season.
- There have been reported cases of Pompholyx triggered by chlorinated water of the pool and treated tap water.
Certain risk factors also account for the onset of Pompholyx and this may include the following:
- Female gender as there have been reports of cases with higher incidence in women than in men.
- Regular exposure of skin to wet and water
- Emotional stress
- Summer months and spring season
- Metal salt exposure such as nickel, cobalt and chromium
- Occupational exposure for long period under the sun such as farmers and gardeners.
- Individuals with sensitive skin that are prone to rash development after exposure to contact irritants.
- Individuals suffering from atopic eczema are at risk for developing Dyshidrosis.
No laboratory test can specifically confirm the condition of Pompholyx. Blood tests may be done to isolate the other underlying condition. Culture and sensitivity test may also be done to isolate bacterial infection especially to those who remain unresponsive to previous treatments. Skin scraping is done to identify the fungus that caused the episode or triggered the onset of Pompholyx. The patch test is also considered to confirm contact dermatitis that is being implicated in the onset of Dyshidrosis.
There treatment options for Pompholyx depend on the severity of signs and symptoms. Various kinds of treatment are made available but only a few have been developed to clinically treat the condition. The treatment is directed towards the relief of symptoms manifested during the course of the condition and this may include the following:
Corticosteroid cream and ointment can hasten the desertion of blisters. This treatment facilitates the drying of crack although this can cause itchiness after the lesions has dried.
Burrow’s solution is 10% aluminum acetate in 1:40 dilution. It is a drying soak that is especially useful for oozing blisters and lesions.
Potassium permanganate in 1:10.00 dilute solutions is a popular soak for drying out the blisters or the vesicles.
Sterile syringe is used for draining the large blisters that can leave the roof intact to avoid secretion of blood and serum contained in the blister.
PUVA therapy or psoralen combined with ultraviolet A is a special kind of ultraviolet treatment that is helpful for individuals with severe Dyshidrosis. The affected part is exposed to long wave ultraviolet light but is soaked first in a special solution called psoralen prior to exposure. The blister eruptions will later subside after continued treatment for several months with improvement in the skin appearance.
Diamino-diphenyl sulfone or Dapsone is an antibacterial sulfonamide recommended for chronic cases of Pompholyx.
Cool compress with the use of Condy’s crystals, aluminum acetate or vinegar diluted in water and applied for 15 minutes will help dry out the blisters and relieve the itchiness.
Emollients applied liberally on the affected skin will help keep the skin soft and moist to prevent it from drying and avoid cracks and fissures that will cause pain.
Botulinum toxin injection is rather a new treatment option that has not been generally accepted. It is recommended by some doctors to treat severe cases of Pompholyx by injecting the experimental treatment in the affected hands or feet.
The exact etiology of Pompholyx remains unknown. This is the very same reason that no exact cure has been developed either to permanently relieve or cure the condition. Most patients are given treatment for the relief of symptoms but not for the exact cure of the condition. Some treatments however have the capacity to delay the onset and recurrence of Pompholyx.