Wednesday, March 11, 2015

Pompholyx (dyshidrotic eczema)

Introduction 

Pompholyx is a type of eczema that causes tiny blisters to erupt across the palms of the hands and sometimes the soles of the feet.
It's also known as dyshidrotic eczema.
It can be confused with similar-looking infections and diseases (see box, left), but if you have any sort of blistering skin condition you should see your GP.

What are the symptoms?

Pompholyx usually starts as intense itching and burning of the skin on the palms of the hands. The palms (and sometimes fingers and soles of the feet) then erupt into tiny itchy blisters about 1-2 mm in diameter.
In severe cases, blisters may be larger and may spread to the backs of the hands and feet and to the limbs. The blisters can become infected.
Some people may also develop ridges in their nails or inflammation of the skin surrounding the nails (paronychia), and may also havehyperhidrosis (excessive sweating).
Stressful situations and heat can bring on the condition and make it worse.
The blisters will usually heal within one to two weeks, although in severe cases it may go on longer. The skin tends to go dry and crack or peel as it is healing up.

What causes it?

It's not known what causes pompholyx, but it may be triggered or aggravated by:
  • a fungal skin infection – this may be on the hands or at a distant site from the blisters (such as the toe spaces) and will need treating
  • contact allergy to a chemical such as nickel, plants or chemicals in creams (you may have a nickel allergy and already have contact dermatitis)
  • emotional stress
  • sweating (it's more common in spring and summer, and in warmer climates)

Who is affected?

Pompholyx is usually seen in people aged in their early 20s, but it can affect you at any age, including childhood and older age.

How is it treated?

Pompholyx usually lasts two or three weeks before eventually clearing up on its own.
During this time, avoid contact with soap and wear gloves to protect the hands from strong chemicals or irritants such as acidic foods.
Don't burst the blisters – allow them to heal on their own.
Symptoms can be relieved with various treatments outlined below. For more detailed information on these treatments, read the section on treating atopic eczema (both types of eczema are treated in a similar way).
The main treatments to try are:
  • emollients (moisturising treatments) – use these all the time and instead of soap 
  • steroid cream – reduces the inflammation and irritation and helps the skin to heal.
Your GP will probably prescribe you a high-potency steroid cream to use for a short period of time, to mimimise risk of steroid side effects.
You may be advised to wear cotton gloves at night, to help the cream sink into the skin.
Also, you can try:
  • soaking your hands in a dilute solution of potassium permanganate (1/10,000) up to twice a day for 10-15 minutes (available from pharmacies without prescription; your pharmacist will instruct you on how to use it)
  • antihistamines to help control scratching (speak to your pharmacist about these)
  • applying calamine lotion to help soothe the skin
Antibiotics will only be prescribed if the skin has become infected.

Referral

If your pompholyx keeps returning or is severe and doesn't get better with the above treatments, your GP may refer you to a specialist in treating skin conditions (dermatologist). A dermatologist may offer one of the following treatments:
  • phototherapy – exposure to ultraviolet (UV) light
  • steroid tablets or very strong steroid cream
  • an immunosuppressant medication such as ciclosporin or azathioprine, which will suppress your immune system



Other blistering conditions

  • pustular psoriasis, an uncommon type of psoriasis that causes pus-filled blisters to appear on your skin 
  • fungal skin infection
  • bullous impetigo, a contagious skin infection that mainly affects children and causes sores and blisters
  • bullous pemphigoid, a blistering skin disease that tends to affect the elderly 
  • contact dermatitis, a type of eczema caused by skin contact with a substance that causes irritation or allergy 
  • pemphigus vulgaris, a rare and serious condition that causes painful blisters to develop on the skin as well as inside the mouth, nose, throat, anus and genitals
  • epidermolysis bullosa, a group of rare inherited skin disorders that cause the skin to become very fragile and prone to blistering
  • a herpes simplex infection (genital herpes)

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