Synopsis
Recognise vesicular pompholyx within the broader hand-eczema phenotype, identify fungal, contact and occupational contributors, and restore function with protection and site-appropriate treatment.
- Pompholyx causes intensely itchy deep-seated vesicles on palms and finger sides, followed by peeling, fissures and sometimes secondary infection.
- Hand-eczema shape does not reveal cause; atopy, wet work, allergic contact and dermatophyte infection frequently overlap.
- Ask about every task, hand-wash, sanitiser, glove material, hobby and product, plus improvement away from work and foot or nail fungus.
Key red flags
Severe pain, reduced movement, fever, spreading cellulitis, clustered painful erosions, extensive bullae, occupational incapacity or persistent unilateral disease requires urgent or specialist review.
Progressive pain, swelling, limited movement, lymphangitis or fever requires urgent assessment beyond superficial eczema care.
Investigation priorities
Quantify wet work, chemical contact, occlusion and periods of improvement.
Management branches
Symmetrical itchy palm or finger-side vesicles occur without fever, focal herpes or deep infection.
- Use cool wet compresses briefly for weeping, then a frequent bland emollient and soap substitute while protecting fissures.
- Apply a potent palmar topical corticosteroid once or twice daily for a defined licensed course, using very-potent escalation only under supervision.
Key medicines
Betamethasone valerate 0.1% creamApply a thin film to active hand skin once or twice daily for up to four weeks, reducing or stopping when inflammation is controlled.
Clobetasol propionate 0.05% ointmentAdults apply thinly once or twice daily only to resistant thick palmar plaques for a short specialist-directed course not exceeding four weeks or 50 g weekly.