About pompholyx eczema

Pompholyx eczema (also known as dyshidrotic eczema) is a type of eczema that affects the hands and feet. In most cases, pompholyx eczema involves the development of intensely itchy, watery blisters, mostly affecting the sides of the fingers, the palms of the hands and soles of the feet. Some people have pompholyx eczema on their hands and/or feet with other types of eczema elsewhere on the body. This condition can occur at any age but is usually seen in adults under 40, and is more common in women.

What causes pompholyx eczema?

The exact causes of pompholyx eczema are not known, although it is thought that factors such as stress, sensitivity to metal compounds (such as nickel, cobalt or chromate), heat and sweating can aggravate it. Fifty percent of people with pompholyx have atopic eczema as well, or a family history of atopic eczema. Pompholyx eczema can coexist with fungal infections, so assessment should include checking for the presence of any fungal infection on the hands and feet.

The hands and feet are areas of the body that are also prone to contact dermatitis. Contact dermatitis involves a skin reaction that usually occurs within a few hours or days of exposure to an irritant or allergen. It is possible to have been in contact with a substance for years without any problems and then suddenly develop a sensitivity to it. If you identify a pattern in your pompholyx eczema, tell your healthcare professional, as allergy patch testing may be appropriate.

What does it look like?

The skin is initially very itchy with a burning sensation of heat and prickling in the palms and/or soles. Then comes a sudden crop of small blisters (vesicles), which turn into bigger weepy blisters, which can become infected, causing redness, pain, swelling, and pustules. There is often subsequent peeling as the skin dries out, and then the skin can become red and dry with painful cracks (skin fissures). Pompholyx eczema can also affect the nail folds and skin around the nails, causing swelling (paronychia).

How is it treated?

Emollients (medical moisturisers) are the first-line treatment and should be used for washing and moisturising. If your skin is weeping, oozing and crusting, a wet soak may be advised – usually, a potassium permanganate soak under supervision (prescribed as Permitabs, which are dissolved in water to the strength of the colour of rosé wine) once or twice a week.

Topical steroids are likely to be needed to reduce inflammation.

If your hands and feet are 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.

Treatments for severe pompholyx include phototherapy, oral immunosuppressant drugs, and the drug treatment Alitretinoin.

For more information on pompholyx eczema, please see our Pompholyx eczema factsheet