Pompholyx eczema – The complete guide

Pompholyx eczema is also known as dyshidrotic eczema. It is a type of eczema that affects the hands and feet. In most cases, it can develop into itchy, watery blisters, mostly affecting the sides of the fingers, palms of the hands, and the soles of the feet. Some people also have a combination of pompholyx eczema and other types of eczema on their hands and feet.

It is more common in women.

The exact causes of pompholyx eczema are not known, but it is thought that factors such as sensitivity to metal (compounds such as nickel, cobalt, or chromate), stress, heating, and sweating can aggravate this condition. For these reasons, pompholyx eczema can be difficult to manage and it can also cause problems with work.

Pompholyx eczema can also come with fungal infections, so the hands and feet should be checked for any infections.

The hands and feet are the areas where pompholyx commonly occurs, these areas are also prone to dermatitis (this can be in two forms – irritant contact dermatitis or allergic contact dermatitis).

It could also be caused by contact with detergents such as soap, detergents, solvents, acids, chemicals, and soil resulting in irritant contact dermatitis. Or, there could be an allergic reaction to a substance that is not commonly an irritant (such as nickel, cobalt, and chromium), resulting in allergic contact dermatitis.

• Universal triggers for everyone:
  • Exposure to water (like hot water, frequent hand washing, jobs like dishwasher and lifeguard)
  • Stress
  • Heat and sweat (living in high-humidity places)
  • Harsh products (like soaps, shampoos, sanitizers with drying alcohols, detergents, and dishwashing soap). You can replace these products with hypoallergenic, unscented products.

• Common Allergies:
  • Nickel is a common metal that people with eczema are allergic to (found in jewelry like rings, keys, and many foods like oatmeal and nuts). Other metals include cobalt and chromium.
  • Food-related allergies or sensitivities (alcohol, sugar, dairy, spicy, gluten, meat, nuts) D
  • Dust, mold, house dust mites, latex, and rubber (found in gloves) are some other triggers. 30-50% of people who have a latex allergy are allergic to certain foods like chestnuts, kiwis, bananas, avocados, passion fruits, and tomatoes.

• Uncommon triggers:
  • Hard water (soft water is better for eczema, get a hard water filter or a water softener)
  • Bodily changes (pregnancy, surgery, hormonal pills, etc)
  • Parasites (ticks, mites, and especially intestinal parasites like worms are linked to eczema)
  • Exposure to sunlight
  • Other possible causes could be heat or a UV-related allergy but are very rare.
  • Vitamin/mineral deficiencies (take a blood test to find out).

• Environment:
  • Weather (hot summers or season shifts)
  • Seasonal allergies (pet hair/dander)
  • Dust, mold, or house dust mites (clean your house often and check for dust and mold in corners. Air purifiers can help with the mold in the air.)

• Dirty money, coins, fragrances, allergies to methylisothiazolinone/methylchloroisothiazolinone (MCI /MI), other chemicals in the isothiazolinones class, propylene glycol, and gel polish (Other options include a regular polish, press-on nails with adhesive stickers, or Hema-free monomer (Glitter bells) are some other triggers.

• If you think it’s diet/food related:
  • Keep a food diary to keep track of what you eat, ingredients, time, etc.
  • You can take a skin prick test to see if you are allergic to certain foods
  • Go on an elimination diet and watch for patterns
  • Common food intolerances: sugar, histamine foods, alcohol/caffeine, dairy
  • Vitamins are another way. Use a digital app like Cronometer to track vitamin intake.
  • You can take a blood test to see if you are lacking vitamins

• If you think it’s a contact allergy:
  • Think back to when it appeared and list all the things you touched with that area of skin today and yesterday.
  • Take pictures of the ingredients in all of the products you use such as detergents, cosmetics, soap, shampoos, and household chemicals. See if there are common ingredients, buy products without those ingredients, and see if your skin gets better.
  • Use a journal to keep track of what you touch
  • You can also ask your doctor for allergy testing

• If you think it’s related to the weather:
  • High humidity increases sweating. Keep your place cool with air conditioning or a fan. You can also get a dehumidifier to reduce the moisture in the air.
  • ‍Extremely low humidity can dry out your skin and make it harder to heal. Get a humidifier and put it in your room while you sleep. During cold days, wear mittens or put your hands in your pockets to keep the moisture in.
  • Keep track of the places you travel to and the weather there.

• If you think it’s related to the dust/mold:
  • Clean and vacuum your place frequently. Wear a mask when you clean.
  • Remove carpets and curtains. Go for wood floors.
  • Get a dehumidifier if you live in a hot climate. Use a hygrometer to make sure the humidity in your home is below 55%. mold and dust mites cannot thrive in low humidity.
  • If you have a dust allergy, place a HEPA air purifier in your bedroom. Keep pets outside of the house. For dust mites, get 100% cotton bedsheets and pillowcases and wash them in hot water once a week. Get a humidifier if you live in a dry place as they will help to add moisture to the air and soothe the nose and throat.
  • If you have a mold allergy, dry damp areas of the house such as under the kitchen sink, washing machine, etc. Dry water-damaged items within 24 hours. Clean out air conditioners often. Clean out the fridge once a week. Throw away expired food and leftovers.

• If you think you’re sensitive to hard water:
  • Go to a hotel or a vacation spot that uses soft water for one to two weeks. See if your skin gets better while you’re there.
  • If it does get better, you can install a water softener or a hard water filter in your home, move to a new area that uses soft water, or limit your contact with hard water such as taking short showers.
  • Note: A water filter is different from a water softener. While water filters will not turn hard water into soft water, it filters out impurities from hard water like metals and chemicals. It costs around $30-$50 every few months and has helped people reduce their eczema flare-ups.

• Learn what your triggers are: firstly, any triggers for a pompholyx flare should be avoided.

• Emollients and potassium permanganate soak: emollients (medical moisturizers) can help with dryness. A wet soak can also be used if your skin is weeping, oozing, and crusting. Usually, a potassium permanganate soak is used under supervision (prescribed as permitabs, which are dissolved in water to the strength of the colour of rose wine) once or twice a week. Soak your hands/feet in this solution (you can use an old bucket or bowl because the solution can stain your skin.) for 15 mins and then rinse it in water with emollients and pat dry. After using the soak, make sure to moisturize your hands/feet. When the acute flare of pompholyx subsidies, the soaks should be stopped after 3-7 days. A leave-on emollient or an emollient soap substitute should be used for washing, and try avoiding detergent hand washes. Bleach baths and Epson baths are some other ways.

• Topical steroids: Topical steroids should be used to treat active eczema and reduce inflammation. It will help to reduce sore, red, and cracked skin. Hands require stronger steroids. so potent topical steroids are prescribed (moderate steroids for children). The treatment is generally for 2 weeks. Topical steroids can make the skin drier, so make sure to apply emollients. Some topical steroids are:
  • Clobetasol propionate
  • Mometasone
  • Clotrimazole
  • Triamcinolone
  • Betamethasone dipropionate
  • Terbinafine
  • Elidel and tacrolimus are some non-steroid creams you can try out

• You can google “steroid potency chart” and check which steroid suits you depending on the severity of your skin (after consulting a doctor).

• Oral treatment: for severe pompholyx eczema, a dermatologist is required and he/she will conduct a patch test to check the severity of pompholyx eczema you may have. Treatment may include a course of oral immunosuppressant drugs. Alitretinoin (also known as Toctino) is an oral treatment used for treating severe hand eczema (including pompholyx) that has not responded to potent topical steroids. It helps to reduce inflammation by damping down the response of the immune system. It is a capsule that is taken orally (once a day) for 12-24 weeks.

• Alitretinoin: is a retinoid that is prescribed by a dermatologist who has experience in both severe hand eczema and retinoids. Retinoids could cause birth defects if taken during pregnancy. So you should avoid getting pregnant during treatment and for one month after stopping treatment. You should also avoid breastfeeding while taking alitretinoin and for a month after completing treatment.

• Phototherapy: using either UVB or UVA rays administered by a special hand/foot lightbox, may be recommended if this treatment is available locally. Before the treatment, your hands or feet will be coated in a light-sensitizing solution called psoralen. This treatment will be done 2-3 times a week. It can take a few months until the pompholyx eczema has resolved.

• Duxipent, Eucrisa, and Opzelura: are biologic drugs that can be expensive but can get the job done. You will have to use this for your whole life.

• Wash with lukewarm to cool water: Gently pat them dry immediately with a paper towel or a soft towel and then put on moisturizer within 3 minutes to keep the moisture from leaving your skin. Avoid washing your hands as much as possible as It would strip your natural oils and make your skin drier.

• Moisturizers: when you have a flareup, use a thick, greasy moisturizer several times a day. If your hands are sweaty, do not put moisturizer on them as it could make your hands sweat more. Use moisturizer after you wash your hands and on dry areas. When your blisters heal, you can use a lighter, cream moisturizer if you want.

• Gloves:
  • White cotton gloves: you can use these for everyday wear and daily chores. This helps the moisturizer sink into the hands/feet and prevents scratching. Make sure to get a few pairs of cotton gloves and change your gloves during the day when you feel them getting wet inside.
  • Nitrile gloves: you can use these for washing dishes and gardening. You can wear cotton gloves inside of your rubber gloves or buy gloves with an inner soft lining.
  • Disposable gloves: you can wear nitrile gloves with a hair tie on each of your wrists when taking showers. If the water irritates your hands a lot, consider wearing these when you need to use the restroom and throwing them away afterward.
  • Alternative gloves: running gloves (may be useful for sleep scratching), tubular support bandages (made of cotton), and white cotton socks

• Antihistamines for sleep: if itchiness is interfering with sleep, you can use sedating antihistamines (they help with sleep rather than actively treat eczema). Some examples are Claritin, Allegra, and Benadryl. Do not take antihistamines in the morning as they can cause drowsiness.

• Treating blisters: large blisters can be drained by using a large sterile needle. Very gently make a jagged tear in the blister (a pin-prick hole won’t be effective as it will seal up very quickly and won’t release any fluid). Make sure to not remove the roof of the blister as it can delay the healing process and might cause infection.

• Use cotton: make sure that your tights, stockings, socks, and gloves are 100% cotton (or silk) as synthetic fibers like nylon are less absorbent than cotton and won’t allow the skin to breathe.

• Bandages: Bandaging (or wrapping) can help to protect the skin. You can also use cotton or silk gloves or socks can be worn. If paste bandages or wet wraps are used, make sure to discuss them with a doctor regarding their suitability, application technique, and how to use them with creams and ointments. Any weeping blisters should be covered with a non-stick dressing (to prevent tearing the blister roof).

• Steroid-impregnated tape: since it is difficult to keep topical steroids on the hands, you can use steroid-impregnated tape which would need to be prescribed by your doctor.

• Hydrocolloid Bandages: if you have painful cracks and fissures post-blister stage, you can try using Extra Thin Duoderm. It is a hydrocolloid dressing that you can cut to shape and put on cracks and fissures. You should speak to your doctor before using duoderm on the areas you treat with topical steroids because when you cover the skin that is being treated with a topical steroid, it will make the steroid more potent.

• Using the right footwear: footwear should be kept dry and must be permeable to the air. Try to avoid plastic or rubber shoes, and any trainers that can cause sweating. Leather linings are more than synthetic.

• Wet wrap therapy: involves applying medication and moisturizer to a flare-up and then wrapping the area with a second layer of dry cloth such as cotton pajamas. The wraps allow the medicine and moisturizer to sink into the skin effectively. This can be before going to sleep and the next day, you will see that the flare-up has reduced.

• Aloe Vera, manuka honey, oatmeal, and witch hazel can soothe the skin.

• ‍Oils like rosehip seed oil, hemp seed oil, calendula oil, coconut oil, and tea tree oil can help.

• Keratolytic agents‍ like lactic acid, urea, salicylic acid, and sulfur can help.

• AHAs like glycolic acid, lactic acid, citric acid, hydroxycaprylic acid, and hydroxycapric acids can help.

• Diets like low-carb diets, low histamine diets, anti-inflammatory diets, caveman diets, keto diets, carnivore diets, etc can help if you have food allergies. Stick with it for at least two months to see any changes. Consult with your doctor before you decide to take on a diet.

• Supplements like omega-3 supplements, milk thistle, and fish oil might work.

• Fasting is also one way.

• Diluted vinegar soaks (apply white vinegar or cider vinegar soaks for 5-15 minutes. One tablespoon of vinegar in one pint of water. They are mainly used for fungal infections, not dyshidrosis. Vinegar soaks will make your skin very dry and may cause more inflammation. Use this method with caution. If you have open cuts/raw skin, it will burn badly.

• Mouthwash soaks (Listerine) can cause irritation and dry out the skin due to the presence of alcohol. It also contains eucalyptol that can bring temporary relief to the skin but there are more effective and safer alternatives out there like ice packs and coconut oil

• Probiotics can be a great way to boost your immune system and aid the digestive system.

• Popping blisters be a way to relieve the itchiness and prevent the infection if done correctly.

• Using oxybutynin for the treatment of dyshidrotic eczema.

This particular treatment involves targeting a fungus called candida in the gut.

• Nystatin: Nystatin orally, preferably as a bitter powder (about one-eighth of a teaspoon with a teaspoon of water), 4 million units or 1 million units 4 times a day for 28 days. A second course may be required to kill any spores that have ‘hatched’ to save themselves from the first course of Nystatin. In many countries, Itraconazole is an over-the-counter medication and 200mg daily can be used concurrently with Nystatin.

• Diet: A wheat, sugar, and alcohol-free diet are essential for the best results.

• Alitretinoin: we already talked about it above.

• Vitamin A: it should be taken with a fatty meal.

• Probiotics: Probiotics can also be taken along with this treatment.

The Herxheimer Reaction is a reaction that happens when following the above treatment. If your dyshidrosis  gets worse, then the dermatophyte is dtying. This means that the treatment is working and can last for a few days.

If you want to know more about this treatment, visit this link: http://www.dyshidrosis.co.uk/ (you can contact the doctor and has completely free information)

• Skin prick test: For inhaled allergens (mold, pollen, pets, etc.) and food allergies. Tests up to 40 different allergies.

• Patch test: To find vitamin deficiencies and nutrition levels; detects minerals, iron, gluten, calcium, and other deficiencies.

• Blood test: To find vitamin deficiencies and nutrition levels; detects minerals, iron, gluten, calcium, and other deficiencies.

• Skin biopsy: To check if you have an infection or other skin disorders.

• Skin and wound cultures: A test to find germs such as bacteria or fungus that cause infections.

• What if you’re allergic to everything: go to an allergist. See if you can get allergy shots and immunotherapy such as hyposensitization.

Scratching can tear the skin’s surface and prevents moisturizers from working. Continuous scratching and rubbing can cause lichenification, a condition where the skin becomes uneven, thick, and leathery and will clear up when the scratching stops.

The itch-scratch cycle starts when you start to feel itchy and scratch that part of your skin.

People can form unconscious habits to scratch in certain situations. Many eczema sufferers scratch their hands and feet unconsciously.

This is a simple and free habit reversal therapy you can do at home and is usually used for people with uncontrollable tics, but it can also be applied to people who have itchy eczema.
‍
Objective: To replace damaging habits with new responses

Duration: Do this for at least 6 weeks

Here are the steps:
‍
1) Building awareness: Use a tally counter or a paper tally list to note down every time you scratch.

2) Behavior modification: Replace the scratching habit with a competing response such as shaking your hands for 30 seconds or clenching your fist for 40 seconds. It can be a combination of responses such as clenching your fist for another 60 seconds, deep breathing for 60 seconds, then placing your hands at the sides of your body firmly at waist level.

The new response has to be long enough for the scratching urge to go away. This will break the itch-scratch cycle. If you’re going to be around other people every day, choose a response that people won’t notice.

3) Awareness + behavior modification: Write down all the situations that make you itch and then create individual methods for each situation to avoid scratching yourself.

Ex: If you scratch yourself unconsciously when you drive then the method for this situation is to keep both of your hands on the steering wheel so you can’t use your hands for scratching.

4) Relaxation training: Learn relaxation skills such as deep breathing, mental imaging, and muscle relaxation for stressful situations.

5) Example responses you could use: pumping hands up in the air, doodling/writing in the air, tapping or patting the arm/leg, or deep breathing.

There are many different types of meditation, but for this case, let’s focus on mindfulness. Habit reversal training is more effective than this method, but some eczema sufferers have found success with meditation.

This mindfulness is about recognizing your itch, resisting the urge to scratch, and letting it slowly fade away. You will learn that if there is an itching sensation, you do not have to immediately react to it.

Other techniques are body scan guided meditation.

• Environment:
  • Keep your room cool with a fan
  • Measure humidity levels (if too dry, buy a humidifier)
  • 100% cotton or silk bedsheets and pajamas

• Soothe:
  • Buy a diffuser with essential oils (lavender, rose, chamomile)
  • Before bed, you can drink chamomile tea or take a short and cold shower

• Scratch prevention:
  • Soften your nail cuticle
  • Cotton gloves for winter and cotton finger guards for summer
  • For fashionable people: fake nails make it harder to scratch because of their round edges
  • If the above does not work and you still scratch, try taping your cotton gloves or buy hand control mitts

• Sleep Medications
  • Benadryl
  • Nyquil

• Daytime:
  • Dry body brushes for the day (no damage, satisfies itchy feeling, may worsen eczema)
  • Rubbing/scrubbing/dragging 100% cotton towels for severe itchiness (least damage)

• Other tips:
  • There are cooling pads you can buy for your mattresses
  • Thine silk gloves
  • There are cotton gloves with built-in ice packs

1) Find ways to relieve your stress: such as massages, baths, or activities (yoga, sleeping, etc.)

2) CBT Techniques: This is for negative thoughts that are stressing out your mental health. When you notice yourself having negative thoughts, write them down and reflect to see if the thought is reasonable. If it is not logical, correct it with positive thoughts.

• Basic tips
  • Take off your socks/shoes whenever possible. Switch socks throughout the day if needed.
  • Moisturize your feet several times a day.
  • You can use bandages or hydrocolloid patches.
  • Try to keep your feet dry by sprinkling a thin layer of antifungal powder inside the sock, which will help to keep your feet stay dry and prevent athlete’s foot.
  • If you have built-up of skin, use a foot file in the shower to remove the dead skin on your heels

• Methods that have worked for others:
  • Put on Amlactin to break down dead skin. Then put on a thick layer of Vanicream to lock in moisture. Afterward, put on socks.

Socks can be 100% wool socks, cotton socks, or natural fibers like bamboo.

Note: Avoid synthetic fabrics like polyester and spandex.

For shoes, you can wear natural fiber shoes such as Allbirds or cotton shoes such as Converse or Vans. Sandals may irritate a person’s feet more than closed-toed shoes. If you want to wear sandals, keep in mind that brands like Crocs use antibacterial materials that could irritate some people’s skin.

Talk to your manager about your skin condition and see if they can assign you to work away from water.

Ex: If you work in a fast food chain, ask them to not assign you prep food and dish work.

Hand routine:
1) Moisturize your hands
2) Put on cotton gloves
3) Put on nitrile gloves over the cotton gloves.
4) Switch out cotton gloves regularly when they get wet/sweaty.
5) Repeat the process

‍What if I work in the medical field:
1) Avoid sanitizers, especially alcohol-based ones. They will dry out your skin.
2) Use the tips above such as putting on cotton gloves before putting on other gloves.

If your condition becomes very severe, take a leave to recover or consider switching to a profession that will be less irritating on your hands such as working in an office, in retail, or remote work.

Bring these items to school:
1) Travel-size moisturizer
2) Band aids
3) Mini soap dispenser with liquid soap inside
4) Steroid cream (if needed)
5) Towel to dry your hands (if needed)

If you do not want your classmates to see these items, wear a large jacket with zippered pockets and put all of these items in your pocket or sew a large pocket inside of your jacket so it won’t be as noticeable.

Ask your doctor. It is usually applied 1-4 times a day for 1-2 weeks. Remember to apply all over the affected area.

Some people buy a keratolytic lotion and use it with a topical steroid.

1) Take a wound-cleaning solution and wipe your hand with it.
2) Put an antibiotic ointment on such as Neosporin.
3) Wrap bandages/gauze wrap over it or non-stick gauge pads + self-adhesive medical tape.
4) Wear cotton gloves if you want.

Tip: Do not wet your open wound or put lotion/moisturizer on it until it heals.

• Dr. Bronner’s Unscented Pure-Castile Liquid Soap (tip: you can buy a sanitizer dispenser watch from Amazon and take it anywhere you want).

• Raw Sugar Simply Hand Wash for Sensitive Skin

• Dr. Bronners Bar Baby Mild Unscented Soap

• The Unscented Company Hand Soap

• Facial cleansers that have the word “hydrating” and “gentle” on them can be used as soaps (Cerave, Cetaphil, vanicream, and Aveeno are some good brands.

• Dove Sensitive Skin Beauty Bar

• LiveClean soft soap

• Seventh Generation Free & Clear Unscented Hand Soap

• Eucerin Baby Wash & Shampoo

• Seventh Generation Free & Clear shampoo

• Live Clean Fresh Water Hydrating Shampoo

• The Unscented Company Daily Shampoo

• Regular Tide

• Seventh Generation Free and Clear

• The Ordinary’s Glycolic Acid 7% Toning Solution

Pycnogenol 5% from The Ordinary (a holy grail product for many people)

• Dermasilk gloves (if cotton irritates your skin, try these expensive silk gloves).

• CARA Moisturizing Eczema Cotton Gloves

• NatraCure Gel Moisturizing Socks

• Farm to Feet (around $17/pair, expensive but comfortable)

• Smartwool

• The Ordinary Rosehip Seed Oil

• Allbirds: it is made with natural materials, very breathable. For everyday wear; does not do very well in rain or long hikes.

• Gloves in a bottle (a lotion that doesn’t wash off with water and protects your skin).

• Creams or moisturizers.

• Band-Aid Brand Hydro Seal All Purpose Adhesive Bandages.

• Cetaphil Flare-up Relief Body Wash