Treatment

• exclusion of allergy
• potassium permanganate for acute blisters
• systemic antihistamines to control scratching
• antibiotics if secondary infection
• frequent application of lotions eg. 1% calamine to promote cooling
• topical steroids

Topical steroids or preparations containing steroids plus antimicrobials, with or without an occlusive dressing to aid penetration are considered the mainstay of treatment (1).

If treatment is unsuccessful, second line treatment options such as systemic corticosteroids, PUVA, or ciclosporin need to be considered (1).

Newer management options for pompholyx include (2):

• topical calcineurin inhibitors
• botulinum toxin A - the major disadvantage is the need for injections
• high-dose UVA1 phototherapy
• alitretinoin in chronic hand dermatitis including pompholyx

Reference:

• (1) Konstantopoulou M et al. Azathioprine-induced pancytopenia in a patient with pompholyx and deficiency of erythrocyte thiopurine methyltransferase. BMJ. 2005;330(7487): 350-351.
• (2) Wollina U. Pompholyx: a review of clinical features, differential diagnosis, and management. Am J Clin Dermatol. 2010;11(5):305-14. doi: 10.2165/11533250-000000000-00000. PMID: 20642293.