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Pompholyx eczema

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Abstract

VOL: 99, ISSUE: 41, PAGE NO: 22

Download a print-friendly PDF file of this article here

WHAT IS IT?

- Pompholyx eczema is a distinctive form of eczema that affects the fingers, the palms of the hands, and the toes and soles of the feet.

- It is also known as dyshidrotic or vesicular eczema.

EPIDEMIOLOGY

- It is most often seen in 20 to 40-year-olds and occurs slightly more often in women than men.

- It accounts for approximately six per cent of hand dermatitis cases (Pillinger, 2003).

CAUSES

- The first attack is often triggered by hot weather in late spring or summer, or by intense emotions such as grief or stress.

- It is aggravated by irritants such as detergents and solvents and some patients with pompholyx eczema are allergic to nickel.

- Sometimes excessive washing or the use of detergents or chemicals without proper protection can irritate the hands and trigger an attack.

SYMPTOMS

- The first stage is characterised by tiny vesicles or blisters that are deep in the skin of the hands or feet.

- The deep-set vesicles develop rapidly, and are accompanied by intense itching.

- The vesicles are most commonly seen along the edges of the fingers, toes, palms and soles.

- Very small vesicles are the most common, although they may coalesce to form larger vesicles or bullae.

- Due to the thickness of the epidermis of the palms and soles, these vesicles often appear pearly white in colour.

- The vesicles contain clear fluid and usually subside without rupturing, although occasionally they can burst and discharge fluid.

- The vesicular stage usually lasts for 1-2 weeks and it is then followed by a dry, desquamating phase in which the skin can peel, crack or crust. At this point the itching sensation has significantly reduced.

TREATMENT

- Various treatment options are available - their selection depends on the stage of the disease.

- Cool compresses using weak solutions of potassium permanganate, aluminium acetate or vinegar in water applied for 15 minutes four times a day will dry up blisters.

- Emollients, such as dimethicone barrier cream, should be applied frequently.

- Topical steroids can be applied to the affected areas each night to help reduce inflammation and itching. They should be used when the skin is blistered or weeping.

- Antibiotics, such as flucloxacillin, are used in the treatment of any secondary infections.

- Severe cases can be treated with systemic steroids.

DIFFERENTIAL DIAGNOSIS

Pompholyx eczema is a straightforward condition to diagnose, but care should be taken not to confuse it with the following common conditions:

- Fungal infection;

- Contact dermatitis;

- Pustular psoriasis.

NURSING IMPLICATIONS

- The intense itching associated with pompholyx eczema causes significant distress.

- Denudation of the fingers and palms, from regular eruptions on the hands, can make simple daily activities such as cutting vegetables, peeling fruit or handling paper a major problem.

- Pronounced eruptions on the feet can lead to problems in walking or an inability to walk.

WEBSITES

Information and support service for eczema sufferers and their families: www.talkeczema.com

Information on treatment: www.ubht.nhs.uk/ederm/guidelines/eczema.htm

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