First, any obvious trigger for the pompholyx eruption should be avoided as far as possible, especially in the case of a contact allergy. But pompholyx will also need to be treated. The treatment options are set out below along with some practical tips.
As with any type of eczema regular use of emollients as leave-on moisturiers and to wash with (so avoiding soap and detergents) is the first step in managing pompholyx eczema. For more information about emollients, click here.
Potassium Permanganate Soaks
Emollients will be very soothing, but if your skin is weepy, oozing and crusty, a wet soak may be advised – usually a potassium permanganate soak (prescribed as Permitabs, which are dissolved in water to the strength of the colour of rosé wine), used under supervision, once or twice a week. Soak the hands and/or feet in this solution for approximately 15 minutes (preferably in an old bucket or washing-up bowl as it stains everything it comes into contact with) and then rinse in water with emollients and pat dry.
When the acute eruption of pompholyx subsides, the soaks should be stopped and topical steroids can be applied. These will need to be prescribed by your doctor or other healthcare professional. Topical steroids switch off the inflammatory response but as they reduce the inflammatory process the skin can become drier, so you will need to apply leave-on emollients frequently.To find out more about topical steroids, click here.
If your hands and feet are extremely sore and weepy, and yellow crusting is present, you may have a bacterial infection. This will require a course of oral antibiotics, prescribed by your doctor or other healthcare professional.
Additional treatments for severe pompholyx
Alitretinoin (known as Toctino®), a retinoid drug derived from vitamin A, is used for adults with chronic hand eczema – hand eczema (including pompholyx) that lasts a long time and is not helped with steroid creams or keeps coming back. Alitretinoin works by reducing the inflammation associated with eczema as well as damping down the response of the immune system. It is a capsule that is taken once a day with a meal for 12–24 weeks, depending on how the condition responds to the treatment.
Alitretinoin can only be prescribed by dermatologists or doctors with experience both in managing severe hand eczema and in the use of retinoids. You will also need to be carefully monitored. It is known that retinoids are very likely to cause severe birth defects if taken during pregnancy. This means that any woman with child-bearing potential must avoid becoming pregnant during treatment and for one month after stopping treatment – for example, by using two effective methods of contraception.
Phototherapy (UVB or PUVA), using either UVB or UVA rays administered by a special foot/hand light box, may be recommended if this treatment option is available locally to you. Assessment and treatment (2–3 times a week) would usually take place in a dermatology department. Prior to treatment, your feet or hands might be coated in a light-sensitising solution called psoralen (the P in PUVA). Treatment usually continues for a few months until the pompholyx eczema has resolved.
Occasionally, for very severe outbreaks of pompholyx eczema, a short course of oral steroids tablets is prescribed.
Practical Management Tips
- Use lukewarm water for washing as very hot or cold water may irritate.
- Try to avoid direct contact with any detergents or cleansing agents, using cotton-lined gloves rather than rubber or plastic gloves alone.
- If itching is interfering with sleep, sedating antihistamines may be helpful at night (but will cause unwelcome drowsiness if taken during the day).
- Large blisters may be gently drained by using a large sterile needle. Very gently make a small jagged tear in the blister (a pin-prick hole will not be effective as it will not release fluid and will seal up very quickly). Make sure that you do not remove the ‘roof’ of the blister though.
- Tights, stockings, socks and gloves should be 100% cotton or silk if possible, to allow the skin to breathe.
- Footwear should be kept dry and permeable to the air. Avoid plastic or rubber shoes, trainers and any other type of footwear likely to cause sweating. Alternating shoes from one day to the next can also help to avoid the build-up of moisture.
- If you have pompholyx on your feet, it may be worth considering the possibility of sensitivity to chromate, which is used in shoe leather production, or to rubber or chemicals used in shoe adhesives. If you think this could be the case, ask your doctor about patch testing.
For more information about pompholyx eczema, its management and treatment, you can download our pompholyx eczema fact sheet that you will find as a related document to the right of this page.