Pompholyx (Dyshidrotic Eczema)

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Last Medical Review: March 27, 2020
Medically Reviewed by Dr. David Costa Navarro
Pompholyx (dyshidrotic eczema) (March 27, 2020)
Dyshidrotic Eczema (March 27, 2020)

Most frequent signs and symptoms

Dyshidrosis is characterized by small, opaque, deep, in some cases slightly raised, epidermal vesicles that do not break easily, with a bilateral and symmetrical localization typically in the palms of the hands, in the soles of the feet and in the lateral and dersal areas of the fingers of the feet and hands. These vesicles, by confluence, can form more voluminous bubbles or increase in volume in the presence of hyperhidrosis, which in the past has led to believe that it was a pathology mainly caused by sweat (hence the term dyshidrosis, i.e. excessive sweating) . The vesicles, during their migration to the surface due to the pressure due to the liquid contained in them, are responsible for a particularly itchy symptomatology, sometimes painful, difficult to bear. Symptoms persist for 3/4 weeks, the time it takes for the blisters to spontaneously reach the surface. This is followed by the breakup and the desquamative phase which can last weeks or months. In severe cases, areas of excoriation are formed, with cracks and thickenings of the skin so disabling as to make daily work difficult. Symptoms worsen after contact with soap, water or irritants.

Dyshidrosis can also occur in different clinical forms (e.g. pustular, dry) that require careful differential diagnosis (e.g. from pustular psoriasis, from exfoliative keratolysis). Only in the less severe forms or when it is possible to identify and eliminate the agent that caused the pathology, is it possible to recover. Mostly the problem has a recurring seasonal pattern, sometimes with long periods free from disease.

Non-pharmacological measures

Certain hygiene-behavioral measures can help alleviate symptoms

  • Protect areas affected by moisture and heat whenever possible.
  • Wear cotton socks and shoes with leather soles avoiding footwear made with synthetic materials.
  • Remove often socks and shoes in order to allow easy perspiration of sweat.
  • To carry out normal daily tasks, wear cotton-lined vinyl gloves.
  • The gloves should be dried internally after use and thrown away whenever they are torn.
  • Avoid contact with irritants such as dust and other chemicals and wear leather gloves for heavier jobs.
  • For the bath and shower use lukewarm water and minimal quantities of soap.
  • The use of antiperspirants to be used on the hands and feet, avoiding excessive sweating, can help.
  • There is no special diet for this pathology except in the case in which a food allergy is recognized among the causes or aggravating factors.

Treatment

No treatment allows for rapid healing. Topical corticosteroids are the drugs of choice because they reduce inflammation and itching and are generally applied twice a day. Their symptomatic efficacy can improve with the frequent application of emollient creams. If topical therapy fails, the doctor may opt for short-term oral or injection treatment. In severe forms, unresponsive to common treatments, especially if associated with hyperhidrosis or which worsen during the summer, with increased sweating, completely preliminary data indicate a possible efficacy of botulinum toxin, due to its sweating reduction effect . Sometimes the use of anxiolytics and antidepressants can improve symptoms, in cases where the stress condition plays a predominant role. Variable results have been reported with PUVA therapy (association of a psoralen with exposure to ultraviolet A, i.e. with a wavelength between 320 and 400 nM). In particularly difficult cases, topical (e.g. tacrolimus) and systemic (e.g. cyclosporine) immunosuppressive treatments have also been used.

Possible complications

Secondary bacterial infections can sometimes develop on lesions and grazes caused by dyshidrosis. In this case, the doctor will prescribe the appropriate treatment. To prevent these complications it is therefore important to adopt adequate hygiene rules.  

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