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 dyshidrotic 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. The appearance of small fluid-filled, itchy blisters most commonly along the edges of fingers, toes, palms, and soles are the initial symptoms.
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. The condition usually 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, a 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 ‘dyshidrotic’) by excessive sweating, research has shown that this does not cause pompholyx eczema. Although the exact cause of 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 aspirin
- 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 outbreaks. Medication is usually suggested until an outbreak is completely cured.
Diagnosis of pompholyx eczema is usually made 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. Common eczema ‘patch test’ is usually performed for determining the associated allergens. In some instances, skin biopsies tests are also used.
Eczema, in general, has posed a challenge in terms of treatment because of the various 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 manage the condition depending on the extent of the outbreak. 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 avoid contact with any known allergens. They are advised to only use mild detergents on their laundry, gentle 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. Routine medical care options are listed below.
- Topical steroids and cold compresses are often the first steps of treatment. Topical steroids are used twice a day for two weeks.
- A 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 antihistamines 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 ultraviolet light treatment, has been successfully used in some cases.
- Lifestyle changes are often recommended targeting techniques like yoga to reduce stress triggering a flare-up.
- Diet and supplements like probiotics and vitamin D and A, Evening primrose oil, Borage oil, etc. have been found to
- reduce the 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, have been found to help break the itch- flare upcycle.
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. That is accompanied by an 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 specific period. That 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 the potential risk is developing a fatal condition called eczema vaccinatum.