Eczema or atopic dermatitis is an umbrella term used to signify a wide range of persistent skin conditions often characterized by dryness, itching, swelling, redness, cracking, oozing or bleeding. Eczema can affect any part of the body. When the affected region is restricted primarily to the hands (fingers and palm) and less commonly to the feet (toes and soles), it is called Pompholyx eczema (or vesicular eczema or dyshindrotic eczema). This skin condition is not contagious and usually accounts for about 5-20% of all hand eczema. It is most commonly seen 20-40 year olds.
Symptoms of pompholyx eczema are specific to the stage of infection. Appearance of small fluid filled, itchy blisters most commonly along the edges of fingers, toes, palms and soles are the initial symptoms of. Blisters are usually small (about 3mm), opaque and deep seated. Small blisters often aggregate and form larger pustules. Due to the thickness of the skin, the affected region often appears white in color. The condition often worsens upon contact with water, soap or other irritants. Scaly patches of skin that flake, crack and itch with a burning and tingling sensation usually accompany this during chronic stages of the disease. Not unlike other types of eczema, scratching leads to skin thickening (lichenification) followed by a vicious recurrent cycle of itching and blistering that prevents the affected person from performing daily functions. In severe conditions, secondary bacterial infection of pompholyx with Staphylococcus is not uncommon. Chronic pompholyx eczema around the nail can lead to nail dystrophy resulting in irregular ridges, pitting and swelling of the nail fold (paronychia).
Originally believed to be induced (and named ‘dyshindrotic’) by excessive sweating, research has now shown that this does not cause pompholyx eczema. Although, the exact cause the unknown, it is believed to be a combination of genetic and environmental factors. Some trigger factors include,
- Emotional stress, psychological trauma
- Sensitivity to certain metals like nickel, cobalt, chromate
- Other medical conditions including hay fever, asthma, pre-existing contact dermatitis
- Weather changes; hot and humid climate usually trigger flare-ups
- Inhalation of house dust mite allergens
- Females develop pompholyx eczema more frequently than males
- Certain medications like asprin
- Smoking, caffeine
- Oral contraceptives
The exact duration varies from individual to individual. While some patients have flare ups that clear within two to three weeks, others have recurrent monthly/yearly flare ups. Medication is usually suggested until a flare up is completely cured.
Diagnosis of pompholyx eczema is usually done by a visual examination of the skin by a trained dermatologist followed by a complete review of the affected individual’s medical history. A swab of the affected area is sometimes performed to identify any secondary infection. A standard eczema ‘patch test’ is usually performed for identifying the associated allergens. In certain cases, skin biopsies tests are also used.
Eczema in general has posed a challenge in terms of treatment because of the myriad allergens that could trigger a flare up and the inability to completely and fully control recurrence. Dermatologists usually employ an array of treatment options to control the condition depending on the extent of flare up. First and foremost, it is essential to follow a strict ‘prevention is better than cure’ approach. Patients are educated to rigorously use hand moisturizers and emollients (Moisturizing ointments are often more effective than creams) to prevent skin irritations and to avoid contact with any known allergens. They are advised to only use mild detergents on their laundry, mild hand and body soaps. Patients with pompholyx eczema are further instructed to use hand gloves while doing their daily chores to avoid contact with harsh detergents. Treatment options are usually aimed at alleviating the condition. The routine medical care options are listed below.
- Topical steroids and cold compress are often the first step of treatment. Topical steroids are used twice a day unto two weeks. Cold compress is suggested 4-5 times a day.
- Prescription antibiotics are used in case of secondary infections or in severe cases to prevent secondary infections.
- For severe conditions, systemic corticosteroids via injection or orally are often prescribed.
- Immunosuppressive medications and anti-histamines are sometimes used to help reduce the severe itching accompanying this condition.
- Potassium permanganate solution soak is often used to drain the blisters.
- PUVA therapy, a type of ultra violet light treatment has been successfully used in some cases.
- Lifestyle changes are often recommended targeting techniques like yoga to reduce stress triggering flare up.
- Diet and supplements like probiotics and vitamin D and A, Evening primrose oil, Borage oil etc have been found to reduce incidence of flare ups.
- Following an approved skin-care plan is often helpful in reducing flare ups.
- Avoiding excessive dry and sweating conditions.
- Behavioral approaches including training on scratch habit reversal has been found to be helpful in breaking the itch- flare up cycle.
Pompholyx eczema often prevents the affected individual from performing day to day activities. It affects the patient psychologically due to its unsightly appearance on the limbs. This is accompanied by uncontrollable urge to itch which is a social stigma. Recurrent and severe infections of the feet can lead to significant impairment in walking. Secondary infections often complicate the condition resulting in severe distress to the affected individual. Prolonged and excessive use of corticosteroids has been associated with skin thinning and fragility of the skin. So care must be taken to limit the use of these non-prescription medications. Due to their immunosuppressive nature, these medications sometimes lead to other skin infections. Due to these limitations, steroids should only be used sparingly over a certain time period. This is usually followed by a rest period, where the skin is allowed to recoup. If the condition persists, another round of medication may be needed. Patients suffering from eczema should not get smallpox vaccination due to a potential risk is developing a fatal condition called eczema vaccinatum.
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