Pompholyx - Causes, Symptoms, Diagnosis, and Treatment.

Introduction:

Pompholyx is a commonly occurring vesiculobullous condition affecting the palms and soles, sometimes both. The cause of the pompholyx is unknown. Pompholyx is a cutaneous condition characterized by small blisters in the fingers, palms, and soles. Pompholyx may range from mild to severe disease. Pompholyx mostly occurs in summer.

What Is Pompholyx?

Pompholyx is also known as “Dyshidrotic eczema” or an “acute palmoplantar eczema.” The term dyshidrosis was used to describe the blisters on the palms and soles in 1873. Eczema occurs due to spongiosis in the intraepidermal layer of the thick epidermis. Accumulation of edema leads to the formation of fluid-filled vesicles. Vesicles are clear, tense, and distributed to the lateral aspects of the fingers. Pompholyx is present with vesicles and bullae, along with the recurrent rash.

What Does Pompholyx Look Like?

Pompholyx is an acute vesiculobullous condition characterized by the presence of clear fluid-filled vesicles distributed in the hands and soles. Pompholyx features often spread to the palmar surface of the hands. Vesicles coalesce to form bullae. Pruritic deep-seated vesicles will be present, like the appearance of a "tapioca pudding." Following vesicles and bullae, Pompholyx sometimes presents with scaling, fissures, and skin lichenification. Secondary infections can also occur in the lesion. Pompholyx is more susceptible in women than men.

Who Is Susceptible to Developing Pompholyx?

The exact prevalence of pompholyx is unclear, but it likely affects around 20 % of individuals with hand eczema. This condition appears to impact people of all ages and genders.

What Are the Symptoms of Pompholyx?

Pompholyx has the unique symptom of “sago-like” vesicles in the palms and soles. Patients also have symptoms of severe burning, itching, and pain. The skin of the palms and soles is thick with a compact stratum corneum.

Symptoms of pompholyx include,

• Presence of vesicles and blisters.

• Severe burning sensation.

• Itching.

• Pain.

• Scaling.

• Fissures.

• Thick skin.

What Is the Cause of Pompholyx?

The precise cause of pompholyx remains unidentified. Pompholyx is a leading cause of hand dermatitis. Pompholyx has been associated with several causative factors, including atopic dermatitis, irritant exposure, allergens, hyperhidrosis, ultraviolet rays, smoking, and the use of intravenous immunoglobulins. Its occurrence is particularly common in warm weather, with a higher incidence rate observed during the summer. The development of pompholyx eczema is associated with several factors, including:

• Psychological stress.

• Allergies, such as hay fever.

• The presence of other types of dermatitis.

• Atopy and contact allergies.

• Adverse effects of any drug.

• Exposure to irritants such as chromium, cement, cobalt, and nickel.

How to Diagnose Pompholyx?

Diagnosis of pompholyx is made with the combined clinical, histological, and immunological response of the individual. Clinical examination is observed for the presence of sago-like vesicles in palms and soles. Laboratory findings are done for any abnormal levels of enzymes. A slight elevation of aspartate aminotransferase (AST) is observed in a report. Histological findings include diffuse involvement of intraepidermal vesicles, spongiosis in the intraepidermal layer, presence of epidermal Langerhans cells and microabscesses. Lymphocytic infiltration in the perivascular layer and histiocytes, and sometimes in allergic conditions, eosinophilic infiltration is seen. Immunological studies reveal the involvement of immunoglobulins E antibodies in the lesion.

Diagnosis of pompholyx includes,

• Clinical examination.

• A patch test is done in an allergic condition.

• Skin biopsy.

• Histological examination.

• Immunological study.

• Immunohistochemistry(IHC).

• Multicolor Direct ImmunoFluorescence(MDIF).

What Is the Differential Diagnosis of Pompholyx?

The differential diagnosis for pompholyx includes the following skin conditions:

• Bullous pemphigoid (autoimmune disease causing large, fluid-filled blisters).

• Palmoplantar pustular psoriasis (psoriasis causing pustules on palms and soles).

• Scabies (skin infestation by mites causing intense itching rash).

• Contact dermatitis (both irritant and allergic).

• Tinea (manuum and pedis).

What Are the Food Tips for Pompholyx?

Certain foods contain anti-inflammatory properties and probiotics. Probiotics build a strong immune response to reduce the recurrence and flare-ups of a certain type of eczema. Sometimes inflammatory foods will increase the symptoms, especially foods containing nickel, which should be avoided during eczema. The food sensitivity test is done in food-responsive eczema. If one finds something positive about certain foods, consumption of particular foods is avoided. Diet is made healthy to avoid the symptoms and flare-ups of the eczematous condition.

Foods to Include for Eczema Include:

• Fatty fish.

• Tuna, salmon, and sardines are rich in omega-3 fatty acids.

• Fermented pickles.

• Sourdough bread.

• Yogurt.

• Kimchi.

• Quercetin-rich foods such as apples, blueberries, and broccoli.

• Cherries.

• Kale and onion.

Foods to Avoid for Eczema Include:

• Nickel-containing foods such as,

• Whole wheat.

• Grains.

• Rye.

• Oats.

• Cocoa powder.

• Baking powder.

• Soy products.

• Canned foods.

• Dried fruits.

Food Allergens:

• Dairy.

• Eggs.

• Soy.

• Nuts.

What Is the Treatment for Pompholyx?

Pompholyx is a mild to moderate case with few vesicles that will resolve on their own. Topical corticosteroids and calcineurin inhibitors are prescribed in a mild case of pompholyx. In a severe form of pompholyx, systemic infusion of corticosteroids is used for the treatment. Topical psoralen ultraviolet A therapy (PUVA) is used for the refractory case of pompholyx. Advanced topical calcineurin inhibitors (TCI) and botulinum toxin A (BTXA) are also effective against pompholyx.

Various Treatment Measures of Pompholyx

• Topical Corticosteroids.

• Corticosteroid pills.

• Corticosteroid shots.

• Systemic immunomodulators.

• Topical calcineurin inhibitors.

• Phototherapy psoralen ultraviolet A (PUVA).

• Coal tar preparations.

• Botulinum toxin A.

• Bexarotene gel.

What Complications Can Arise From Pompholyx?

Dyshidrotic eczema (pompholyx) can result in several complications:

• Secondary infections, such as bacterial infections with Staphylococcus aureus or Streptococcus pyogenes, lead to lymphangitis and cellulitis.

• Physical and psychological disability, as well as potential economic costs due to loss of work opportunities.

• Paronychia and nail dystrophy are when the condition affects areas near or adjacent to the nail fold.

What Is the Prognosis for Pompholyx?

The duration of pompholyx differs from person to person. For some, it resolves within two to three weeks and does not recur. However, it typically reappears, with some individuals experiencing repeated episodes, each lasting a few weeks, causing the condition to seem intermittent.

Preventive Measures of Pompholyx

• Always wash the hands with warm water.

• Use emollients.

• Use protective gloves made of cotton while using chemicals like shampoos, cleansers, and detergents.

• Avoid using nylon, plastic, or rubber material shoes.

• Avoid bursting the blisters.

Conclusion

Pompholyx, also known as dyshidrotic eczema, is a type of eczema characterized by the presence of ‘sago-like ‘ vesicles distributed on the surface of the skin extremities. The patient will get itchy. Burning pain in the affected area. The symptoms last for two to three weeks. If one finds any signs of infection or any other changes, visit the general physician. The doctor advised that treatment would help control the condition.