Pompholyx

Also called Dyshidrotic eczema, Vesicular hand eczema

Intensely itchy deep blisters on the palms, sides of fingers and soles. A form of eczema, and a common reason people cannot do their job.

What it is

A type of eczema causing crops of small, deep, intensely itchy blisters on the palms, the sides of the fingers and the soles.

The blisters sit deep in the thick skin and look like tapioca. They dry out over one to three weeks, and the skin then peels, cracks and becomes sore.

Triggers include heat and sweating, stress, contact with irritants and allergens including nickel and cobalt, wet work, and fungal infection elsewhere on the body.

It matters practically because it affects the hands. Carers, cleaners, hairdressers, caterers, health staff and mechanics all find it difficult or impossible to work with cracked, blistered, painful hands, and it is a recognised occupational skin disease with employer duties attached. See contact dermatitis.

Treatment is potent topical steroid, used properly and in adequate quantity, plus relentless emollients and avoidance of irritants. Severe cases need specialist treatment including light therapy and immunosuppressive drugs.

Secondary bacterial infection is common in cracked skin and needs recognising.

Under-treatment is the usual reason it persists: people are given a weak steroid, use it sparingly for a few days, and stop.

Signs you might notice

Sudden crops of small, deep, fluid-filled blisters on the palms, sides of the fingers or soles.

Intense itching or burning, often before the blisters appear.

Blisters drying, then peeling, cracking and fissuring.

Painful splits, particularly at the fingertips and finger creases.

Nail changes: ridging and pitting.

Signs of infection needing treatment: increasing pain, redness spreading, yellow crusting, pus, or fever. See cellulitis.

See a GP for: hands that are cracked and painful; failure to respond to treatment; suspected infection; or any effect on work.

Consider fungal infection of the feet as a trigger; treating that sometimes settles the hands.

How it can affect day-to-day life

Hand skin needs far more emollient than people use, and far more often. Carrying a tube and using it after every hand wash, ten or more times a day, is the standard that actually works.

Soap substitutes rather than soap, lukewarm water, and thorough drying between the fingers all matter.

Gloves protect against wet work and irritants, and worn for long periods they trap sweat and worsen it; cotton liners underneath are the answer.

Steroid ointments in adequate strength and quantity are needed. Fingertip units and how much to use should be explained; most people under-apply by a large margin.

At work, this is a health and safety matter with employer duties: risk assessment, suitable gloves, emollients provided, and health surveillance. It is also reportable as an occupational disease.

Nickel avoidance helps some people and can be tested for with patch testing.

Cracks are extremely painful and heal poorly; liquid dressings and taping help function.

Supporting someone well

Use emollient constantly, after every wash, many times a day. Carry it.

Use a soap substitute, lukewarm water, and dry carefully between the fingers.

Use the prescribed steroid ointment in adequate strength and quantity, and for long enough.

Wear gloves for wet work, with cotton liners, and for as short a time as possible.

Treat any fungal foot infection, which can trigger hand eczema.

Ask for patch testing if an allergy is suspected.

Raise it at work; there are employer duties and it is reportable.

Get suspected infection treated promptly.

Ask for dermatology referral if it is not controlled; light therapy and other treatments exist.

Where to get help

A pharmacist for emollients; a GP practice for prescription treatment and referral.

Occupational health where work is involved.

Dermatology for severe or resistant disease, and for patch testing.

British Association of Dermatologists and National Eczema Society publish hand eczema guidance.