Pompholyx is characterised by intensely itching, watery blisters occurring on the sides of fingers and palms and the soles of the feet. Around the nail bed it causes swelling, becoming paronychia when infected, typically with S. aureus but Streptococcus and Pseudomonas species are also common.21,22

In more severe cases the blistering can start to spread up the limb. It can occur at any age but usually starts in adults before they reach the age of 40.21

An itching/burning sensation will precede the outbreak of small vesicles. These then increase in size and weep, with inflamed and painful skin. As the wound dries, peeling skin and subsequent cracks continue to be painful.

Trigger factors include stress, heat and sweating (there is an association with hyperhidrosis), and exposure to metals such as nickel, cobalt or chromate compounds. Pompholyx can also occur alongside fungal infections which may complicate a diagnosis.

Half of people with pompholyx have atopic eczema, or there is a history of atopy in the family. As pompholyx occurs on areas of the skin most prone to contact dermatitis, the patient should consider whether flare ups occur in patterns which may warrant testing for contact allergies.21

A form of psoriasis, palmoplantar pustulosis, has similar features of blisters on the palms and soles.23