Pompholyx in a Young Man

For as long as he could remember, a 27-year-old man had had a recurrent eruption on the palms and sides of the fingers. The rash was characterized by intense pruritus followed by the formation of small water blisters and increased perspiration that resolved with peeling of the skin. The dorsa of the hands were unaffected. Results of a potassium-hydroxide preparation and fungal culture of skin scrapings were negative for hyphae. The thyrotropin level was normal.

Robert P. Blereau, MD, of Morgan City, La, diagnosed pompholyx (dyshidrosis). The cause of this disorder is unknown but seems to be related to stress. Pustular psoriasis, which may be similar to pompholyx in appearance and course, is associated with pustules and pain rather than clear vesicles and pruritus. Pompholyx is not a contact dermatitis; however, contact allergens may aggravate the condition.

Treatment options include topical corticosteroids, cold wet compresses, antianxiety medication, and systemic antibiotics--if the patient shows signs of infection. Oral corticosteroids, low-dose methotrexate, and low-dose external-beam mega-voltage radiation therapy may be used in resistant cases.

This patient was treated with a potent topical corticosteroid with good results. *