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Pompholyx

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Also known as … Dyshidrotic Eczema or Vesicular Eczema of Palms and Soles

What is Pompholyx?

Pompholyx is an often recurrent and frequently extremely itchy disorder characterised by tiny blisters and bumps on the sides of fingers, toes, palms and soles.

The cause of pompholyx is unknown. Pompholyx is considered a localised reaction pattern seen in other forms of dermatitis such as atopic dermatitis and allergic and irritant contact dermatitis.

Pompholyx is characterised by the sudden onset of crops of symmetric, firm, deep-seated tiny blisters on the palms, sides of fingers and less often on the soles and toes. These may aggregate and form larger blisters.

Intense itch and/or burning sensation usually precede the eruption. The attack can subside spontaneously over weeks to months. It is often recurrent.

© 2021 Elsevier Inc. All rights reserved. Habif’s Clinical Dermatology
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SEVENTH EDITION James G.H. Dinulos, MD

The most significant association is cutaneous T-cell lymphoma (mycosis fungoides).

A skin biopsy is needed to confirm the diagnosis. Even with a skin biopsy, it can be difficult to distinguish between benign cases and lymphoma-associated cases.

Once follicular mucinosis is diagnosed, further assessments are needed to exclude the possibility of an underlying lymphoma. This may include a physical examination, blood tests and imaging studies. Ongoing follow-up is also recommended.

Benign follicular mucinosis is usually treated using potent topical corticosteroids or intralesional corticosteroid injections. A range of oral medications may be used including tetracyclines, retinoids and dapsone, antimalarials and corticosteroids.  In resistant cases, superficial x-ray therapy may be used.

If an underlying lymphoma is diagnosed, treatment is directed towards the lymphoma.

Many cases of benign follicular mucinosis burn out and resolve over a few months to years, particularly if the skin lesions are few in number and localised. Other cases can be more persistent, particularly if the skin lesions are more widespread. There can be permanent bald patches if scarring has occurred. If there is an underlying lymphoma, the prognosis is less favourable.

This information has been written by  Dr Davin Lim and Dr Heba Jibreal

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