Pompholyx

• Pruritic vesicular eruptions usually on palms and soles
• In some cases, the vesicles can be found on the dorsum of hands and feet and in between fingers.
• It is a chronic disease (with flares and remissions)
• Excessive scratching can lead to secondary bacterial infection
• If the rashes are exclusively on the dorsum and hands and feet, one needs to rule out tinea corporis/dermatophyte infection and contact dermatitis

Management

• First-line: lifestyle measures
  • Avoid triggers or exacerbating factors (e.g. skin products with fragrances/dyes, stronger cleansers)
  • Advised against wet work and suggest wearing protective gloves
• Add topical steroids
  • E.g. topical triamcinolone 0.025-0.1% apply sparingly to affected areas twice daily until resolution of symptoms
• If unresponsive to lifestyle measures and topical steroids, consider oral steroids
  • Prednisolone 60 mg po od for 3-4 days
• If pruritus the main symptoms
  • Consider chlorpheniramine as required
• In some patients, offer referral to treat hyperhidrosis
  • E.g. botulinum toxin type A or iontophoresis

Reference: Survival for All vol 1, BMJ Best Practice.