Definition. An acute, inflammatory, eruption consisting of deep-seated vesicles and blebs on the hands and feet, usually symmetrical in distribution.
Symptoms. The eruption always appears upon the hands, often between the fingers and upon the palmar surface, but rarely upon the dorsal. The feet may be affected but usually escape. The sensations consist of burning and itching before the small deep-seated vesicles, resembling sago grains, put in an appearance. These lesions show a tendency to group, often around the orifices of the sweat-ducts and, as they appear more distinctly, coalesce and form large bullae filled with a clear fluid. The contents of these lesions become opaque, purulent and dry up in the course of a week, leaving the epidermal covering to be exfoliated and showing beneath newly-formed, dry, red tender skin. While the itching and burning usually subside with the full distention of the lesions, these seldom spontaneously rupture but rather tend to be broken by scratching, or other traumatism. The disease is essentially recurrent but rarely it may persist indefinitely. Exceptionally severe cases may affect the whole palmar and other surfaces of the hand and corresponding parts of the feet, but in the average case the disturbance is so slight as to be hardly noticeable and quickly subsides. The constitutional symptoms are, as a rule, so trivial as not to be noticed.
Etiology and Pathology. The disease occurs most frequently in individuals who habitually perspire freely and hence was described by Tilbury For as a true dyshidrosis due to sweat retention. It may occur in either sex but is more common in young neurotic women who have been subject to some strain or worry. In susceptible persons, mental emotions, changes of temperature, especially heat (hence its common occurrence in warm months), or exposure of the hands to artificial heat, may precipitate an attack. Organic and functional cardiac disease have been urged as a cause.
Pompholyx is probably a vasomotor neurosis with a vesicular formation in the rate; the vesicle being at times directly connected with the sweat-glands while, at other times, no connection is apparent. Unna believe that a microorganism, similar to the tubercle bacillus; is the pathological agent while Hutchinson, Robinson and others believe the disease is an inflammatory dermatosis, related to herpes and pemphigus.
Diagnosis. The limitation of pompholyx vesicles to the hands and feet, without tendency to rupture or produce a continuous discharge but to dry up with or without first forming bullae and to recur repeatedly, are characteristic points of difference from other vesicular disease. The vesicles of a neurotic eczema may show like sago grains but they rupture spontaneously, leave a weeping surface behind and are more apt to appear on the back and sides of the fingers than on the palmar surfaces. The bullae of pemphigus are not formed by coalescence of small vesicles as is the case with pompholyx.
Prognosis and Treatment. while recurrences are not uncommon, even after a long period of freedom, the individual attack is usually over in from one to three weeks. Sources of nervous depression or other functional diseases should be investigated, nutrition improved and good hygiene insisted upon. there measures, together with the internal remedy, will cut short the attack and may tend to prevent a recurrence. On the affected parts, the blebs may be opened and simple ointments such as oleate of zinc or diachylon, or a saturated solution of picric acid may be applied. The X-ray has been reported as valuable in persistent cases. See indications for Bufo, Hepar sulph., Nat. sulph., Phosphorus acid, and Ranuac. bulb.