The cause is usually unknown, but pompholyx is sometimes provoked by heat or emotional upsets. In subjects allergic to nickel, small amounts of nickel in food may trigger pompholyx. The vesicles are not plugged sweat ducts, and the term ‘dyshidrotic eczema’ should now be dropped.
In this tiresome and sometimes very unpleasant form of eczema, recurrent bouts of vesicles or larger blisters appear on the palms, fingers (Fig. 7.25) and/or the soles of adults. Bouts lasting a few weeks recur at irregular intervals. Secondary infection and lymph-angitis are a recurrent problem for some patients.
None are usually needed: sometimes a pompholyx-like eruption of the hands can follow acute tinea pedis (an ide reaction). If this is suspected, scrapings or blister roofs, not from the hand lesions but from those on the feet, should be sent for mycological examination. Swabs from infected vesicles should be cultured for bacterial pathogens.
As for acute eczema of the hands and feet. Appropriate antibiotics should be given for bacterial infections. Aluminium acetate or potassium perman-ganate soaks, followed by applications of a very potent corticosteroid cream, are often helpful.