What Does Dermatitis Look Like On Hands – Pompholyx (also known as ‘dyshidrotic’) is a type that affects the hands and feet. It involves developing very itchy, watery blisters, affecting the sides of the fingers, palms of the hands and soles of the feet. Some people have pompholyx on their hands and/or feet with other types of other places on the body. This condition can occur at any age but is most commonly seen in adults under the age of 40, and is more common in women.
The skin is initially very itchy with a burning or tingling sensation. Then comes a sudden crop of small blisters (vesicles), which turn into large, bleeding, potentially infected blisters. When the skin is infected, there is inflammation, irritation/pain, swelling and pustules. Peeling is often followed as the skin dries out, and people of any skin color can experience skin that is red or darker than the surrounding skin and dry, with painful cracks (skin cracks) . Pompholyx can also affect the nails and the skin around the nails, causing swelling (paronychia).
What Does Dermatitis Look Like On Hands
The causes of pompholyx are not known. It is thought that stress, sensitivity to metal compounds (such as nickel, cobalt or chromate), heat and sweating can make this condition worse. Fifty percent (50%) of people with pompholyx are also atopic, or have a family history of atopic. Pompholyx can be accompanied by fungal infections, so evaluation should include checking for any fungal infections on the hands and/or feet.
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Pompholyx occurs on the palms of the hands, fingers and feet. The skin in these areas is particularly prone to being exposed to sources of irritation and irritation. For this reason, pompholyx can be debilitating and difficult to manage. It can also cause problems with employment.
The hands and feet are also prone to contact dermatitis. This can take one of two forms: irritant contact dermatitis or allergic contact dermatitis.
An irritant reaction may result from contact with potential irritants such as soaps, detergents, solvents, acids/alkalis, chemicals and soil. Or there could be an allergic reaction to a substance that is not considered an irritant, such as rubber, nickel, or dyes in leather shoes. It is possible to have been in contact with a substance for years without any problems and then suddenly develop a sensitivity to it. If you notice a pattern, tell your doctor, as patch tests may be appropriate. Patch testing is done in suspected cases of allergic contact dermatitis, not irritant contact dermatitis.
Pompholyx can occur as a single episode, but for most people, it is a chronic type that comes and goes with a flare that lasts 2-3 weeks.
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Any obvious stimulus for the pompholyx flare should be avoided as much as possible, especially if there is a contact allergy.
Emollients (medical moisturisers) are a first-line treatment and should be used for moisturizing and washing. If your skin is itchy, oozing and peeling, you may be advised potassium permanganate juice. Potassium permanganate is a chemical that is available as a ‘tablet’, solution or crystals. It is for external use only, which means it should never be put in the mouth or swallowed. It is usually available on prescription (usually as Permitabs) but can be bought over the counter from a pharmacy. We recommend consulting a healthcare professional before use. Potassium permanganate soaks can be used once or twice a week.
Wearing disposable protective gloves, use a clean container (such as a large saucepan, bucket or wash bowl) lined with a clean white bin liner bag. A white net bag allows you to see the color of the water when potassium permanganate is diluted with it. Fill the lined container with 4 l of warm tap water and add one tablet – let the tablet dissolve completely in the water. The color of the water should be light pink, or the color of rose wine. Soak the hands and/or feet in this solution for 10-15 minutes. Then wash them in water with moisture, and dry them with a clean towel.
Potassium permanganate will stain the skin and the container, which is why it is advisable to wear gloves when handling it, and use a saucepan, bucket or wash bowl lined with a bin liner bag as a container . It is also a good idea to apply petroleum jelly (for example, Vaseline) to the nails beforehand to prevent staining. After using the soaks, continue to moisturize your hands and/or feet with a soothing sensation. When the amount of pompholyx decreases, the tools should be stopped (usually after 3-7 days).
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A cleanser should be left on or a soap cleanser should be used for washing, as soap softens the skin and can also be irritating. During the Covid-19 pandemic, people were advised to wash their hands first with soap and then with emollients, as emollients were not thought to be effective in removing particles Covid-19. It’s a good idea to carry around a small dispenser or pot of emollients for hand washing throughout the day. For more information and practical disposal tips, see the National Society of Emollients fact sheet.
Pompholyx must be treated with topical steroids to reduce inflammation and heal cracks. Hands usually require stronger steroids (the skin of the palms is thick), and strong topical steroids are usually prescribed for adults (medium strength for children). They should be used for a short treatment burst – usually 2 weeks. For more information, see the National Society’s fact sheet on topical steroids. Topical steroids must be prescribed by your doctor or other health care professional. Topical steroids remove the inflammatory response, but as they reduce the inflammatory process, the skin can be drier, so you have to reapply frequently.
If your hands and/or feet are sore and itchy, and a yellow rash is present, you may have a bacterial infection. A course of oral antibiotics, prescribed by a healthcare professional, will be required.
For severe pompholyx, dermatology referral may be necessary for treatment and/or diagnosis of contact allergy through patch testing. Treatment may include a short course of an immunosuppressant drug. Alitretinoin (known as Toctino) is an oral treatment approved for use in adults with severe hand ulcers (including pompholyx) that have not responded to treatment with strong topical steroids. Alitretinoin works by reducing the inflammation associated with it as well as reducing the response of the immune system. It is a capsule that is taken by mouth once a day with food for 12-24 weeks, depending on how the condition responds to the treatment.
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Alitretinoin can only be prescribed by dermatologists or doctors who have experience in both the treatment of dry skin and the use of retinoids. The specialist will determine if your hand is stiff by examining your hands and asking a series of questions about how it affects your life. You have to study it carefully. Retinoids appear to cause serious birth defects if taken during pregnancy. This means that anyone of childbearing potential must avoid becoming pregnant during treatment and for one month after stopping treatment – for example, by using two methods effective on contraception. The drug can only be given if a pregnancy test is negative. Pregnancy tests will be done regularly during treatment.
The most common side effects are headache, dry lips and skin, and flushing. Other effects include elevated blood fats such as cholesterol, and decreased levels of thyroid hormones. Because of possible side effects, a lower dose will be prescribed if you have diabetes.
Phototherapy (UVB or PUVA), using either UVB or UVA rays administered with a special foot/hand light box, may be recommended if this treatment option is available locally to you. Assessment and treatment (2-3 times a week) usually take place in the dermatology department. In some areas of the UK, you may be able to borrow a light box so you can give your treatment at home, although you will be monitored by the dermatology department. Phototherapy treatment is usually done for 12-16 weeks.
• Use warm water for washing as very hot or cold water can damage the skin. Remember to use an emollient as a soap substitute.
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• Try to avoid direct contact with detergents and cleaning agents. Wear 100% cotton gloves under rubber or plastic gloves when doing housework. When shampooing your hair, wear cotton gloves under waterproof gloves, as above. If possible, when the pompholyx is active, have someone else do the shampoo for you – and the housework too!
• If itchiness interferes with sleep, taking antihistamines at night may help (but will add unwelcome sleepiness if taken during the day). Remember, antihistamines help sleep rather than actively treat itching.
• Large blisters can be gently drained using a large sterile needle. Gently make a small sharp tear in the blister (a pin hole will not be effective as it will not release fluid and seal
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