From the Research
Dyshidrotic eczema, also known as pompholyx, is a chronic relapsing inflammatory vesicobullous skin disease of the hands and feet belonging to the spectrum of eczema, characterized by small, intensely itchy blisters on the palms, sides of fingers, and soles of feet. The condition is hard to treat because of the peculiarities of the affected skin, namely the thick horny layer and richness of sweat glands 1.
Key Characteristics
- The cornerstones of topical therapy are corticosteroids, although calcineurin inhibitors also seem to be effective 1, 2.
- Systemic therapy is often necessary in bullous pompholyx, with corticosteroids commonly used, although no controlled study has been published to date 1, 3.
- For recalcitrant cases, corticosteroids are combined with immunosuppressants, and alitretinoin has efficacy in chronic hand dermatitis including pompholyx 1, 2.
Treatment Options
- Topical photochemotherapy with methoxsalen (8-methoxypsoralen) is as effective as systemic photochemotherapy or high-dose UVA-1 irradiation 1, 2.
- Intradermal injection of botulinum toxin is another evolving treatment option 1, 2.
- Radiotherapy might be an option for selected patients not responding to conventional treatment 1.
Prevention and Management
- Daily moisturizing with fragrance-free emollients is essential, and avoiding irritants like soaps, detergents, and frequent water exposure helps prevent flares.
- Cold compresses can provide temporary itch relief.
- For chronic cases, maintenance therapy with tacrolimus 0.1% ointment or pimecrolimus 1% cream twice weekly may prevent recurrences.
- Severe or resistant cases might require phototherapy or systemic immunosuppressants like methotrexate or cyclosporine under specialist care 4, 5.