Pompholyx



Pompholyx


Anne E. Burdick and Ivan D. Camacho


Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports


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Pompholyx, also known as dyshidrosis or dyshidrotic eczema, is a recurrent, pruritic vesicular eruption of the palms, soles, and lateral aspects of the fingers. It is of unknown etiology and is considered a reaction pattern to various endogenous and exogenous factors, including atopy, hyperhidrosis, dermatophytosis, contact allergic dermatitis (to nickel, chromium, balsams and cobalt), irritant dermatitis, and possibly emotional stress and seasonal changes. Pompholyx has also been reported to be induced by intravenous immuneglobulin (IVIG) therapy and during the immune reconstitution inflammatory syndrome.



Management strategy


Although pompholyx may resolve spontaneously, treatment is aimed at controlling pruritus and the formation of vesicular lesions. Evaluation is required to exclude dermatophytosis, irritant or allergic contact dermatitis, impetigo, herpes simplex, and vesiculobullous disorders.


Topical corticosteroids are the mainstay of treatment. For mild localized disease, mid- to-high-potency corticosteroid creams or ointments are recommended. Oral antihistamines are useful for control of symptoms. Emollients are also beneficial. A course of oral antibiotics (cephalosporins or doxycycline) is recommended for secondary impetiginization.


Topical tacrolimus or pimecrolimus is useful, alone or in combination with a corticosteroid, which may be delivered under occlusion for increased penetration. For severe disease, systemic corticosteroids are indicated: daily prednisone 0.5–1.0 mg/kg/day tapered over 2 weeks, or intramuscular triamcinolone acetonide (40–60 mg). Hand and foot narrowband phototherapy and UVA, alone or with oral or topical psoralen, are also effective.


Refractory pompholyx may respond to systemic retinoids such as alitretinoin and immunosuppressive agents including azathioprine, methotrexate, cyclosporine, mycophenolate mofetil or etanercept. Radiotherapy may be an option in recalcitrant cases.


Intradermal botulinum toxin A may be helpful as adjuvant therapy. Low nickel and cobalt diets are recommended in nickel-sensitive patients who demonstrate a positive provocation test.



Specific investigations














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Aug 7, 2016 | Posted by in Dermatology | Comments Off on Pompholyx

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