The medical term for this condition is pompholyx, a type of hand eczema. This condition starts with tiny bumps/blisters deep in the skin of the palm and fingers. The bumps are often extremely itchy or come with a burning sensation. Pompholyx may become severe with big blisters and cracks which prevent the hands from performing any task. In the more chronic stage the hands show more peeling, cracking and crusting. At this stage, the hands appear rough, dry and wrinkled with deeply pigmented patches. Then the skin heals up. The blistering process may start all over again where one site may be blistering while another is dry and cracked, if the hands are repeatedly exposed to irritants. Severe pompholyx around the nail folds may cause deformed nails, resulting in irregular ridges and chronic nail fold swelling (paronychia) and nail infection (onychomycosis). Often patients try to burst the blisters with pins to get relieve from the itching and burning. This may lead to secondary bacterial infection with intense pain, redness, swelling, pustules and crusting.

There is a genetic component in patients with pompholyx. They often have a personal or family history of atopic dermatitis, asthma or hay fever. As with other forms of hand eczema, pompholyx is aggravated by contact with irritants such as water and detergents as in the case above. Pompholyx often runs a chronic course. Emotional stress plays a major role in this condition and pompholyx often reappears after a period of nervous tension or worry. Some people with pompholyx are found to have nickel allergy as well, which can be detected and confirmed using patch testing at the dermatologist office. The most common occupational factor leading to pompholyx is frequent immersion in water and

strong solvents.

Patients with this condition should avoid professions which require them to come into frequent contact with water

and solvents (eg nurses,

hairdressers, chefs, mechanics, helpers). This is because the water/ solvents eventually strip the skin of its natural protective layer, resulting in frequent relapse of this condition. A moment of indiscretion can result in flare-up that can last for several months.

Dr Patricia Yap is a dermatologist at Apex

Skin Care and Laser

Center. E-mail: apexskinclub@gmail.com