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.
- Use frequent emollient and soap substitution, reduce wet work, and select protective gloves for the actual chemical with cotton liners for prolonged wear.
- Palmar skin often needs a potent topical corticosteroid for a defined course; very-potent treatment or occlusion should be supervised and short.
- Unilateral scale, grouped painful digit vesicles or loss of movement should trigger tinea, herpes or deep infection assessment.
- For Pompholyx and hand eczema, document body sites, severity, sleep and function, recent treatment, infection features and what the patient can realistically apply each day.
- In Pompholyx and hand eczema, reassess the diagnosis when a well-used, correctly potent regimen fails rather than repeatedly intensifying treatment without examining adherence, exposure and mimics.
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.
- Reduce wet work and sweat occlusion and review within two to four weeks for new vesicles, fissure closure and function.
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.Avoid untreated infection and unplanned occlusion; review atrophy, total quantity and response, and investigate tinea or allergy when disease persists.
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.Do not use on face, untreated infection or widespread skin; avoid prolonged occlusion, monitor local and systemic toxicity, and step down promptly with response.