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Pompholyx - a discussion on atopic eczema skin condition (Dishyrdrotic Eczema)

What is an Allergy?

"Allergy has been described as a 'process of inflammation now known to be a disorder of the immune system, which is made up of cells with the capacity for recognizing, evaluating and neutralizing or eliminating alien material.'"

"Allergic reactions, also called hypersensitivity reactions, are reactions of the immune system in which normal body tissues are injured."

I have suffered from eczema on my hands and feet from a very early age.  I have been through patch testing, coal tar treatments, etc., all with little success.   During my early 20's my disappointment with the medical profession lead me to alternative homeopathic remedies, which did have some positive effects.  Whilst I have gained a good understanding of the condition; alas there is no cure.  I have collated together this information from web resources and my own experience to assist other sufferers.

My current condition is Pompholyx (known in the US as Dishyrotic Eczema).  At an earlier age the condition was more similar to Psoriasis.  At other times I have had ringworm/tinea like many people - but this condition soon clears up, unlike Pompholyx/Psoriasis.  I spend some time in this paper defining the terms used to describe the skin condition, as many people use names like "eczema", "psoriasis", "dermatitis", etc., incorrectly.  I then go on to describe what aggravates the conditions, and what can be done to alleviate it. 

Please note that the pictures on this site are lifted from other places on the web, and are NOT of me!

Name and Description

Pompholyx 1 Pompholyx 2 Pompholyx 3 Pompholyx 4

Pompholyx (pronounced pom"fo liks) is also known as vesicular hand and/or foot eczema, or housewife eczema.  It is a common type of eczema affecting the hands (cheiro pompholyx), and sometimes the feet (pedo pompholyx).  The first (acute) stage shows tiny blisters (vesicles) deep in the skin, which look like sago grains or frog-spawn, associated with itching and a burning feeling.  The later and more chronic stage shows more peeling, cracking, or crusting, and often bleeding.  Secondary infection with Staphylococcal bacteria is not infrequent (impetigo).  The result is pain, redness, swelling and crusting or pustules.  Infection with herpes simplex (the cold sore virus) may cause a severe blistering rash.

Stages Characteristics
Acute Blisters, weeping, papules (pimply bumps), pustules (pus heads)
Subacute Redness, scaling, glistening serum and crusting.
Chronic Dryness, redness, scaling, lichenification (leathery thickening of the skin with accentuation of the skin markings) and fissuring (cracking)

The terms "dermatitis" and "eczema" are often used interchangeably.

Pompholyx is similar to atopic dermatitis, which is common in infants and small children (affecting about one in seven), but it usually clears before adulthood.  Atopic eczema rarely develops in babies before the age of four months (another type of eczema occurs before this).  The face is often affected first, then the hands and feet.  Sometimes dry red patches appear all over the body.  In older children the skin folds are most often affected, especially the elbow creases and behind the knees.  In adults the face and hands are more likely to be involved.

Atopic Eczema

Eczema may clear for years, only to reappear later at a different site.  The exact cause is unknown.  It is probably the result of an inborn defect of the skin that tends to run in families; other family members often have asthma or hay fever.   Atopic eczema is not contagious and does not affect one's general health.   Teenagers and adults with eczema should choose their occupation carefully, in particular avoiding careers that involve wet work (eg hairdressing) or handling detergents, chemicals and/or solvents.

Other names for Pompholyx:

 

Other skin conditions

Doctors define the following types of eczema:

Exogenous (external) eczema – contact dermatitis, eg allergy to cement, plaster, chemicals, soaps, detergents, etc.  Curable if the irritating substance can be detected and avoided.  Hives falls into this category.

Endogenous (internal) eczema – these are due to the constitution of the skin, and are not curable. The types include:

 

Psoriasis

Psoriasis is a disorder of the skin which typically consists of red patches covered by silvery-white scales.

Psoriasis 1  Psoriasis 2

These red scaly patches are usually found on the elbows, knees, lower back and scalp although not infrequently patches appear elsewhere including the nails. When psoriasis involves the groin, armpits, genital area and beneath the breasts it tends to be less scaly and have a glazed appearance.  Psoriasis infrequently affects the face.   It does not cause scarring and rarely results in hair loss.

Psoriasis is very common.  Approximately 2% of (USA) adults have psoriasis.   Its exact cause is unknown but the result is skin which grows about seven times more quickly and thickly than usual.  It is thought to be due, at least in part, to an abnormal immune reaction against some component of the skin.  Genetic factors play a part; only some families develop the condition, and about half those affected know of someone else in the family with it.

The rash often seems to start after some sort of trigger factor.  This may be emotional stress, skin injury (cuts and scratches for example), a streptococcal sore throat, hormones (it often first occurs at puberty), or rarely, certain medications.   These factors should be avoided whenever possible by people with psoriasis.  There are probably others that haven't been discovered yet.

It is not due to any particular food so special diets are not helpful, unless excessive weight is making psoriasis of the skin creases more troublesome.  Moderate alcohol intake doesn't affect it, although it may interfere with certain treatments.   Excessive alcohol aggravates psoriasis.  Psoriasis is not an allergy, nor is it infectious to others.  Psoriasis may improve or get worse during pregnancy.   It does not have any harmful effect on either mother or child.

Although the predisposition to psoriasis may pass on to the affected person's children, this does not necessarily mean they will develop the rash.  If the father has psoriasis, there is about a one-in-three chance of a child developing it as well; if the mother has it the chance is about one-in-five.  The extent of psoriasis varies, and fluctuates even without treatment.  It may even disappear completely.  However, the predisposition to develop psoriasis remains, so the rash may recur at a later date even when it has been absent for years.

Hives (Urticaria or Angioedema)

Hives 1  Hives 2

At some time in their lives, 20% of the population will experience urticaria, commonly known as hives.  Allergies to strawberries, shellfish, etc., are due to this type of skin reaction.

Hives, or urticaria, are common allergic reactions.  They are itchy, elevated, red blotches of varying size that appear suddenly and disappear mysteriously after hours to days.  Hives may be associated with dramatic swelling reactions; swelling of the lips, eyes, and ears can suddenly and grotesquely alter the appearance of an allergy victim.  Marked swelling especially of facial tissues is referred to as angioedema and is often associated with urticaria.  Swelling of the lips and tongue may occur immediately after eating a food and may be life-threatening because of airway obstruction.

Hives are usually the result of an allergic reaction that causes a release of histamine from cells in the skin.  The histamine then causes the blood vessels to dilate and leak fluid, causing the skin to swell.  This swelling irritates the nerve endings which results in the itching sensation.  A feeling of nausea, vomiting and dizziness may be present, in severe reactions.

The common food allergens that can cause hives are seafood, berries, nuts, wheat, cereals, milk, cheese, eggs, peas, oranges, fish, chicken, and chocolates.  Food preservatives, food additives such as yeast and MSG, and tartrazine (the colour additive FD&C Yellow No. 5) also fall in this group.  Fresh foods cause hives more often than cooked foods.

The environmental factors that may produce an onset of hives are exposure to pollen, house-dust, animal dander, fungi, plants, and extreme temperature changes.

The man made drugs that cause hives are antibiotics, aspirin, and medicines containing tartrazine, birth control pills, and cold medications.  Almost any prescription or over-the-counter medication can cause hives.

Tinea

Tinea

Tinea or ringworm is a superficial fungal infection of the skin.  The term "ringworm" is actually inappropriate because there is no worm involved and the ring-like expansion is due to the infection spreading.  Different terms are used according to the areas involved.

Fungi known as dermatophytes, are the main cause.  Infection may be contracted from other humans or from pets and farm animals.

Treatment of Pompholyx

The exact cause of Pompholyx (or Atopic Dermatitis) is unknown.  Some investigators consider it to be caused by abnormal sweating.  Often appears after a period of nervous tensions, worry or stress.  Does not appear to be directly linked to diet, though some foods (eg highly acidic) may aggrevate the condition.  It appears to be inherited, with a family history of dermatitis, asthma or hay fever.   It is a long-term problem, and may recur throughout life.

What to Avoid

 Allergic reactions (which can be detected by prick or patch tests) include the following, but note that Pompholyx is probably not due to an easily detectable contact allergen (none of these were effective for my condition):

Assisting recovery

Protect the skin for at least 4 months after the dermatitis has disappeared, to allow the skin to recover fully. Otherwise the dermatitis may reappear again quickly.

  

Standard Medical treatment for Pompholyx


Topical steroids

Potent topical steroids should be applied to the affected areas nightly.  They help reduce inflammation and itching.  The more potent products should not be used for more than two weeks unless your doctor advises otherwise.  Steroid creams are used when the skin is blistered or weeping.  Steroid ointments are used for the chronic dry stage.

The mildest topical steroid is hydrocortisone (available in New Zealand without prescription), which can be applied to facial skin or babies' bottoms.  It is quite safe used even for months, but should be used only intermittently on the face.  The stronger topical steroids should only be used for a few days or weeks, except when specifically advised by your medical practitioner.  Potent or ultrapotent topical steroid preparations should be avoided on the face, armpits, groins and bottom, because they may cause significant skin thinning and other problems.  A commonly used cream is Nerisone (available in New Zealand by prescription only).

 Antibiotics

Antibiotics are prescribed if secondary infections (usually bacterial) have set in.   Atopic eczema is frequently secondarily infected with bacteria, Staphylococcus aureus, which aggravates the eczema and results in oozing, crusting and the formation of pustules.  To treat:

 Antihistamines

Antihistamines are useful for reducing irritation, particularly at night.  The non-sedating type are sometimes helpful and with less side effects, but are often expensive, eg. terfenadine, loratidine, cetirizine.

The conventional type of antihistamine is cheaper, but may cause drowsiness.   These are often useful at night-time, eg. trimeprazine, hydroxyzine, mebhydrolin.

Antihistamines are drugs which block the action of histamine, the chemical that is released during an allergic reaction and which causes inflammation and itching. Examples of antihistamines include:

  • Chlorpheniramine maleate
  • Brohpheniramine maleate
  • Homochlorcyclizine hydrochloride
  • Buclizine hydrochloride
  • Dexchlorpheniramine maleate
  • Pheniramine
  • Promethazine hydrochloride
  • Azatadine maleate
  • Cyproheptadine hydrochloride
  • Promethazine hydrochloride
  • Mebhydrolin
  • Mequitazine
  • Trimeprazine tartrate
  • Hydroxyzine
  • Loratidine
  • Ebastine
  • Cetrizine

The last four antihistamines are newer and do not enter the brain and do not usually cause drowsiness.  Other possible side effects include dizziness, appetite loss, nausea, dry mouth, blurry vision and problems with urination.  You should not drive or operate heavy machinery if you are affected by drowsiness.

I have used Telfast 180 (Fexofenadine 180 mg) which are a non-sedating anti-histamine, with good results.

A side note on Histamines and antihistamine treatment

Histamines are a hormone/chemical transmitter (biogenic monoamine, similar to serotonine, epinephrine, norepinephrine) involved in local immune responses, regulating stomach acid production and in allergic reactions as a mediator of Immediate Hypersensitivity.  When released from mast cells, histamine causes vasodilation and an increase in permeability of blood vessel walls.  These effects in turn cause the familiar symptoms of allergy including a runny nose and watering eyes.  When released in the lungs, histamine causes the airways to swell shut in an attempt to close the door on offending allergens and keep them out.  Unfortunately, the ultimate result of this response is the wheezing and difficulty in breathing seen in people with asthma - an occasionally deadly allergic complication which kills an estimated 4000 Americans yearly.

Histamines cause blood vessels to widen, fluids to leak into tissues, and muscles to go into spasms.  Symptoms may be restricted to the skin as a rash or itching that may swell.

Antihistamines are chemicals which look enough like histamine to fool the cells of the body, but not enough like histamine to make the cells of the body do the nasty things which cause allergy symptoms (they 'block histamine receptors').  In other words, antihistamines stop histamine from working in the body.  But histamine is not just involved in allergies, it also plays a vital role in the brain.  What it does in the brain is to keep us attentive, alert, and awake.

So if we stopped all the histamine in the body from working, we would get rid of allergy troubles, but fall asleep, or at least become inattentive.  This would make us dangerous drivers, bad students, and generally bad at all daily tasks that need alertness.  That is exactly what happens if you take old antihistamines.   Fortunately newer antihistamines help allergies with little or no effect on your brain.

Cortisone

Sometimes cortisone preparations are prescribed by tablet or injection for severe cases.  The condition clears dramatically but may recur just as severely after the medication is stopped.  Long term treatment with these systemic steroids is rarely advisable because of undesirable side effects.

PUVA

PUVA therapy can be useful in selected cases.  This is a special kind of ultraviolet (UV) treatment.  Several times weekly the affected areas are soaked in a special solution (psoralen), before exposure to long wave UV light.  Treatment is usually continued for several months.  Usually the measures described result in satisfactory control.  Sooner or later the eruption subsides and disappears.  I have not tried PUVA, which is available in New Zealand hospitals on referral from a GP or skin specialist.

Essential oils - Evening Primrose Oil / Star Flower Oil

These oils contain gamma linolenic acid, a fatty acid apparently deficient in the skin of some Atopic subjects.  Three to six grams of evening primrose oil, or one capsule of star flower oil, may reduce itch, redness and the need for topical steroids.  They seem to be more effective in infants and have few side effects.

Coal tar or ichthammol

Ointments or paste bandages containing coal tar or ichthammol are useful for chronic lichenified patches of eczema.  Coal tar smells and stains the clothes so it is best applied at bedtime under cotton bandages or old pyjamas.  It can provoke a folliculitis (inflamed hair follicles).  I used coal tar for a while during late childhood, but did not find it very effective - in fact, I'm not sure that it helped at all.

 

Homeophathic treatment for Pompholxy

Eliminate allergenic foods from diet.  (Note: lower doses are recommended for children).

Bioflavanoids, a constituent found in dark berries and some plants, have anti-inflammatory properties, strengthen connective tissue, and help reduce hypersensitivity reactions.  The following are bioflavanoids that may be taken in dried extract form as noted.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems.  As with any therapy, it is important to ascertain a diagnosis before pursuing treatment.   Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts).  Unless otherwise indicated, teas should be made with 1 tsp. of herb per cup of hot water.  Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.  Drink 2 to 4 cups/day.   Tinctures may be used singly or in combination as noted.

Herbs that support dermal healing and lymphatic drainage are useful for relieving eczema.  Use the following herbs in combination as a tincture (15 to 30 drops tid) or tea (2 to 4 cups/day). Burdock root (Arctium lappa), yellow dock (Rumex crispus), red clover (Trifolium pratense), cleavers (Gallium aparine), yarrow (Achillea millefolium), peppermint (Mentha piperita), and nettles (Urtica dioica).  To prepare a tea, steep the root elements for 10 minutes, then add the rest of the herbs and steep an additional 5 to 10 minutes.

Topical applications of creams and salves containing one or more of the following herbs may help relieve itching, burning, and promote healing.  Chickweed (Stellaria media), marigold (Calendula officinalis), comfrey (Symphytum officinalis), and chamomile (Matricaria recutita). Marshmallow root tea (Althea officinalis) may soothe and promote healing of gastrointestinal inflammation that is often found with this condition.  Soak 1 heaping tbsp of marshmallow root in 1 quart of cold water overnight.  Strain and drink throughout the day.

Eczema can result in children from incompletely digested protein or to toxins in the blood due to the liver’s inability to break down certain foods properly. Conservative introduction of solid foods as child is weaning may help prevent hypersensitivity conditions.  If there is a strong family history of allergies or atopic conditions and/or if the child's immunity has been compromised in infancy, delay the introduction of highly allergenic foods (especially dairy and grains) until 1 year or older.  Infants exclusively breast fed, have a lower risk of atopic eczema development, and develop symptoms at a later age.  This may reflect later contact with cow's milk, a common sensitizer.

Steroid ointments certainly suppress the condition, but they do not cure it.  Some recommendations:

Homeopathy remedies:

Eczema requires professional treatment although the following remedies may be helpful to alleviate symptoms temporarily.  To be taken once to four times daily for 1 – 2 weeks:

A suppliment called ambrostose, which is a natural food source, has been cited as effective treating Pompholyx.

Hypersensitivity reactions may be associated with stress and anxiety.  Mind-body techniques such as meditation, Tai chi, yoga, and stress management may help reduce reactivity.

Starch, oatmeal, and other baths may temporarily relieve the symptoms.

Acupuncture may help restore normal immune function and reduce the hypersensitivity response.

Skin Creams with good results:

For general hydration of dry skin (not for reducing itching or inflammation of the skin):


A discussion from my own experience 

The above discussion was compiled from information on the web.  Now I will present my own observations as it pertains to my own condition - this does not mean it will be same for anyone else.  Skin conditions appear to be individual and specific.  Pompholyx does not appear to be dietary related, though over consumption of some foods (dairy products, oranges and other acidic forming foods) may aggrevate the condition.  It is not directly related to contact with substances.   It appears that some skin areas become weakened, eg hands, feet, face, and under some conditions contact with substances then sparks off the allergic reaction on the weakened areas.  Petrol, paint, soil, soap, on my arms, back, legs, etc. is no problem - but short exposure on the hands will trigger a reaction within 12 - 24 hours.   Reaction is not immediate - can take 24 hours before the reaction begins.   Once it has occurred, several weeks is required before the skin returns to normal, and during this time the skin is particularly sensitive to a recurrence of the reaction. 

With regard to remedies, when the skin is red, hot and itching, I was prescribed Crab-Apple Bach Flower remedy from Weleda (this is easily obtainable in many health shops) and this works very well.  Either a drop under the tongue, or a few drops in a glass or bottle of water drunk during the day, will take away the itching.  Useful if you want to be able to sleep at night.  Recently I have tried Sulpher 6c, and it also seems to be effective.  I have found very little else effective.  However, the Crab-Apple does not clear up the spots, it just relieves the itching. 

I recenlty tried Hidrosol (Aluminium Chloride 20% w/w) available from the chemist.  This has a dramatic affect on the Pompholyx spots.  It is prickly and a little itchy when applied, so suggest doing so an hour or so before going to bed at night.  But overnight it will dry up the spots and the skin will start to recover over the next few days.  Potassium Permanganate solution did not have the same effect, nor did Coal Tar. 

I know of no way to strengthen the skin, or effect a cure.  Often I work with two pairs of gloves - thin cotton gloves next to the skin, waterproof rubber gloves on the outside.  However, friction/vibration/work is also an irritant and will cause a reaction.  For example, mowing the lawn wearing gloves (no irritants, minimal sweating, etc.) will still result in a reaction.  I did have a steriod cream (Betnovate) during late childhood and recently also used hydrocortisone, and this is very effective on the areas of irritation, but I was warned about the long term effects of the cream. 

I recently was prescribed the anti-histamine Telfast 180 (Fexofenadine).  One tablet lasts a day, and this allows me to work during the day with standard hand protection (gloves) without any skin reactions.  It does have a slight dulling effect, and sometimes can cause a slight headache.  I suggest taking the anti-histamine last thing at night for protection for the following day.

I hope this information is useful to other sufferers and allows you to bring it under control.

© In the Light, 7 January, 2012 , Disclaimer, Son of Suckerfish drop-downs from HTML dog