Pompholyx - Causes, Symptoms, Diagnosis, and Treatment.

Introduction

Pompholyx is a commonly occurring vesiculobullous condition affecting the palms and soles or sometimes both. The cause of the pompholyx is unknown. Pompholyx is a cutaneous condition characterized by the presence of 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 present on the palms and in the 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 an 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.

What Are the Symptoms of Pompholyx?

Pompholyx has the unique symptom of “sago-like” vesicles in the palms and soles. Patients also have a symptom 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 exact etiology of pompholyx is unknown. Pompholyx is one of the major causes of hand dermatitis. And pompholyx is found to have certain causative factors. Causative factors for pompholyx are atopic dermatitis, allergens, exposure to an irritant, hyperhidrosis, smoking, ultraviolet rays exposure, and any use of intravenous immunoglobulins. The occurrence of pompholyx is quite usual in warm weather conditions. The incidence rate of pompholyx is higher in summer. Certain factors to develop pompholyx eczema are followed,

• Psychological stress in an individual.

• Presence of any allergies like hay fever.

• Presence of any other dermatitis.

• Atopy and contact allergy.

• Adverse effects of any drug.

• Exposing hands to any irritants that include cement, chromium, 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. It is observed with a slight elevation of aspartate aminotransferase (AST) 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, 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?

• Systemic lupus erythematosus(SLE).

• Rheumatoid arthritis.

• Bullous pemphigoid.

• Pemphigoid.

• Dyshidrosiform pemphigoid.

• Contact dermatitis.

• Linear immunoglobulin A disease.

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 should be avoided during eczema. The food sensitivity test is done in food-responsive eczema. If you find something positive about certain foods, consumption of particular food 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.

• Salmon, tuna, 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.

How to Manage Pompholyx Spread at Home?

Pompholyx spread can be controlled by keeping the skin moist with skin moisturizers and with the help of skin lubricants. Ointments such as petroleum jelly, creams, and lotions are used to maintain the moisture of the skin. Moisturizers should be free of alcohol. Avoid using scents, dyes, fragrances, or other chemicals. Antihistamines are effective against itching.

Skincare for pompholyx at home includes,

• Use of moisturizers.

• Application of prescribed topical anti-itch cream before sleep.

• Application of antihistamines which includes Fexofenadine, Cetirizine, and Loratadine.

• Topical corticosteroid cream.

What Is the Treatment for Pompholyx?

Pompholyx is a mild to the moderate case with few vesicles that will get resolved on its 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.

Preventive Measures of Pompholyx

• Always wash your 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 2-3 weeks. If you find any signs of infection or any other changes, visit the general physician. The doctor advised treatment will help to control the condition.