July 12, 2025 • 15 mins
✅ MSRA Deep Dive: Pompholyx – Vesicles, Triggers, and Management
In this focused MSRA revision episode, we explore Pompholyx (also called dyshidrotic eczema), a distinct form of eczema that causes intensely itchy vesicles on the hands and feet. If you're revising dermatology, this one is high-yield. We break down everything from presentation and differentials to treatment and prognosis, following UK NICE-aligned content.
🧠 Key Learning Points
📌 Definition
• Pompholyx is a vesicular eczema primarily affecting palms, fingers, and soles
• Also known as dyshidrotic eczema, but not due to sweat gland blockage
• Name comes from Greek “pompholix” meaning “bubble”
📌 Pathophysiology
• Caused by inflammatory skin changes, not sweat retention
• Thought to involve skin barrier dysfunction, immune dysregulation, and environmental triggers
📌 Triggers
• Stress, heat, humidity, excessive handwashing, contact allergens, and irritants
• More common in people with atopic background (eczema, asthma, hay fever)
🔍 Clinical Features
• Sudden onset of small fluid-filled blisters (1–2mm vesicles) on sides of fingers, palms, or soles
• Severe itching or burning
• Lesions may burst, peel, or crust, leaving behind dry, cracked skin
• Flares typically last 3–4 weeks
• Nail changes (transverse ridges or pits) if inflammation involves nail matrix
🧠 Differential Diagnoses
• Pustular psoriasis (palmar/plantar)
• Tinea infections
• Contact dermatitis (allergic or irritant)
• Bullous impetigo, bullous pemphigoid, linear IgA disease
• Juvenile plantar dermatosis, erythema multiforme, herpes simplex, and fixed drug eruptions
📌 Key point: Always consider testing or referral if the clinical picture is unclear or resistant to treatment
🧪 Diagnosis
• Clinical diagnosis in most cases
• Investigations if atypical or recurrent:
• Bacterial swabs (if secondary infection suspected)
• Fungal scrapings or biopsy (to rule out tinea)
• Patch testing (for contact allergens)
• Bloods/HTLV1 only if suspecting rare T-cell lymphoma variant
💊 Management
🎯 First-line
• Emollients – restore skin barrier
• Topical corticosteroids – reduce inflammation
• Cold compresses, antihistamines (for itching)
• Avoidance of triggers (soaps, irritants, allergens)
🎯 Second-line
• Oral steroids (e.g. prednisolone) for short-term flare control
• Topical calcineurin inhibitors (tacrolimus/pimecrolimus)
• Phototherapy (UV light) for resistant cases
🎯 Severe/Refractory Cases
• Immunosuppressants: methotrexate, azathioprine, mycophenolate, cyclosporin
• Botulinum toxin (may help reduce sweat triggers)
•
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the deep Dive. We're doing something a bit
different today, really zeroing in on a topic.
For those of you prepping for the MSRA exam, we've got the
source material you sent over and we're going to pull out the
absolute key high yield facts. And today's topic is Pomfolix.
That's it. Yeah, the idea is to slice right
through to the core information in those notes.
(00:20):
We'll build up a really clear picture of Pomfolix.
You know what it is, what might cause it, how you'd spot it,
crucially, what else it might be, and how you'd go about
managing it. All geared towards helping you
revise effectively. Right, like unpacking those
notes into something really usable.
Exactly memorable for the exam. OK, let's start unpacking then.
First things first, what exactlyare we talking about with Palm
(00:42):
follics? OK, so palm follics formally
it's it's a type of dermatitis. You might also hear it called
dishidrotic eczema or maybe vesicular hand eczema.
The absolute key feature, the thing that defines it really, is
this eruption of small blisters.They're usually fluid filled and
often, really often incredibly itchy, and they pop up in very
(01:03):
specific places, mainly the hands and feet.
It's flagged up as a condition that tends to be chronic and
recurrent. It comes back.
And the next mention those specific names to
chiropumpholics for hands, pedopumpholics for feet makes
sense. I also saw that little detail
about the name pump folics coming from the Greek for bubble
kind of paints a picture, doesn't?
(01:24):
It it really does. Yeah.
Yeah. So fundamentally it's an eczema
type affecting palms and souls. Yeah, an inflammatory skin
thing. The exact trigger isn't totally
nailed down, but it presents with this very characteristic
itchy, bubbly rash. Could be a one off acute flair
or might keep coming back or even become, you know, chronic.
So if the exact cause is unclear, what do the sources
(01:45):
suggest might be going on? Any clues?
It's not like there's one singlesmoking gun.
The thinking outlined in the materials that it's probably a
mix, you know, some genetic factors making someone
susceptible, plus environmental influences.
There's mention of a possible link to abnormal sweating
patterns and maybe some issues with the skin's natural barrier
(02:06):
function. But, and this is really
important, the kind of thing they love asking about.
Despite that old name, Dishidrotic, suggesting sweat
duct problems, when you actuallylook the skin Histology under
the microscope, there's no evidence the sweat glands are
involved. So that name, it's actually a
bit of a misnomer. Now we know better.
OK, that's a vital point then. So abnormal sweating might be
(02:28):
linked, maybe as a risk factor, but the condition itself isn't
caused by block sweat glands. Precisely.
That's the key takeaway. The inflammation in those
vesicles, they're not forming because sweat is trapped.
It's tied to the inflammation, the skin barrier, problems
perhaps triggered by something. Else, right.
So what are those triggers? What sort of things can set off
a flare up? Well, the material lists a few
usual suspects. Contact with certain allergens
(02:51):
or irritants. Think detergent, solvents, that
kind of thing. Emotional stress comes up quite
strongly as a trigger too, and very commonly you see it linked
with warm, humid weather. High temperatures and humidity
definitely seem to play a role in bringing it on for some
people. That fits with it being more
common sometimes maybe certain seasons or climates, which leads
to who's actually more likely toget this?
(03:13):
What are the risk factors? OK.
Looking at the risk factors pulled from the sources,
definitely having a personal or family history of atopic
conditions like eczema, asthma, hay fever, that's a big one.
Also people whose jobs involve frequent exposure to those
urgents we mentioned, or just lots of hand washing, lots of
water contact. Excessive sweating or
(03:35):
hyperhidrosis is listed as a risk factor which links back to
that sweating association, even if it's not the direct 'cause.
I see. Psychological stress again
fitting with it being a trigger and living in or travelling to
warm humid places. It all ties together.
OK, got it. Now let's go a bit deeper.
Under the skin itself, the pathophysiology.
(03:56):
My notes talk about these small deep blisters.
What's actually happening there?Right.
So on a sort of cellular level, the sources describe a process
that involves the immune system not quite behaving itself,
problems with the skin barrier, that protective outer layer and
resulting inflammation. The little blisters, the
(04:16):
vesicles, they form within the layers of the skin, the
epidermis and dermis. But, and I'll say it again
because it's crucial, the Histology shows no involvement
of sweat glands or ducts. The disodronic misnomer again.
Exactly that old theory about trapped sweat?
Incorrect. It's key to remember it's
inflammatory, linked to barrier and immune issues.
Got it. Inflammatory barrier issues,
(04:36):
Immune involvement, not sweat glands.
Super important distinction. OK, now for exam revision.
Differential diagnosis are absolutely massive.
What else could look like this? What mimics are listed in the
source material? Yeah, this is a really, really
critical section. You see blisters on hands and
feet. You have to think broader.
What else could it be? And the sources give quite a
long list. OK, let's hear it.
Right. So you need to have in mind
pustular psoriasis, especially the pomoplaner type fungal
(05:00):
infections, Tinia can sometimes cause blisters, bacterial
infections maybe like bullets and pedigo, something called
recurrent focal palmar peeling or keratolysis exfoliative.
Then there are rarer blistering conditions like dysidrosis form
bolus pemphigoid or just standard bolus pemphigoid for
kids, acropostolosis of infancy or juvenile plantar dermatosis
(05:22):
affecting the feet. Linear IGA diseases on the list,
sometimes with hemorrhagic sort of blood filled blisters and a
really key one, contact dermatitis, both allergic and
irritant types, which is tricky because as we said, irritants
can also trigger pomphilics itself.
Right. So it can be hard to distinguish
sometimes, yeah. Exactly.
The list goes on. Pemphigoid gestationis that's
(05:43):
specific to pregnancy. Pemicus vulgaris, a very rare
one, the dysidrosis like variantof adult T cell leukaemia,
lymphoma, pityriasis, rubra Polaris, epidermolysis blosa.
That's a whole group of genetic blistering disorders.
Sub coneal pustular dermatosis erythema multiform, even things
(06:04):
like contact urticaria syndrome,fixed drug eruptions, simple
friction blisters, and perpes simplex infections.
Wow OK that is comprehensive. Definitely highlights why you
might need investigations if it's not textbook or not getting
better. That list is definitely worth
reviewing a few times. Absolutely.
Knowing those differentials is key for safe practise and for
(06:24):
exams. OK, moving on.
Who actually gets Pomfolix? How common is it?
What about the epidemiology? According to the material, the
exact numbers for the UK aren't really known, but it's generally
considered pretty common. It mainly effects adults,
typically hitting people betweenthe ages of 20 and 40 most
often. There's also a slight tendency
for it to be a bit more common in women and then men, but while
(06:45):
that 2040 bracket is the peak, it can happen at any age really.
You can see it in children too. And reinforcing what you said
about triggers, it's definitely more common in warmer months and
warmer climates. OK, so let's imagine a patient
walks in. What are the classic signs you'd
be looking for on examination? What does palm folics actually
look like clinically based on these descriptions?
(07:06):
The absolute hallmark is those small fluid filled blisters or
vesicles. You'll find them typically on
the fingers, often starting on the sides, the palms, the soles
of the feet or maybe the toes. And the symptom that almost
always comes with them is the itch.
It's often described as really intense, severe itching.
Sometimes people also report a burning feeling in those areas.
(07:28):
Sounds pretty miserable. It really does.
What happens to those blisters over time?
Do they just stay there? No, they tend to evolve.
They can burst or maybe just dryup and when they resolve the
skin underneath often becomes quite dry and it can crack or
peel. As we mentioned, the condition
might be a one off acute thing or can keep coming back in
flares, or sometimes it just sticks around chronically.
(07:50):
Looking closer at the vesicles themselves, they're typically
quite small, maybe one or two millimetres across.
And yeah, often starting along the sides of the fingers before
spreading onto the palms or soles is a pretty characteristic
pattern. Anything else to look for?
You might see the surrounding skin looking a bit red, maybe
sweaty, especially during a flare up.
And as the glisters resolve, youoften see this sort of peeling
(08:12):
or rings of scale where the vesicles work.
They kind of unroof themselves, yeah.
I remember seeing something in the notes about nails as well if
the flare is near the nails. Yes, that's right.
If you get eruptions near the nail matrix where the nail grows
from, it can sometimes cause changes in the nail itself, like
transverse ridges or furrows across the nail plate.
(08:32):
It's a sign of the inflammation affecting nail growth.
Interesting. And how long does a typical
flare last? The source material suggests the
vesicles themselves usually stick around for about 3 to 4
weeks, and then they tend to disappear spontaneously, even if
you don't treat the blisters directly.
OK, so you've seen these features.
You suspect palm folics. How do you confirm it?
(08:53):
Do you always need tests? Usually not actually.
The emphasis in the material is that the diagnosis is typically
clinical. You make it based on recognising
the characteristic appearance, the type of blisters, where they
are. In straightforward cases,
specific tests often aren't needed.
But when would you investigate further?
What makes you think maybe I need some tests here, right?
(09:16):
You'd start thinking about investigations if the picture
isn't quite classic, or if the person isn't getting better with
the usual first line treatments,and crucially, if you need to
rule out one of those other conditions.
On that big differential list wewent.
Through makes sense. So the specific tests mentioned
are If you're worried about a secondary bacterial infection,
maybe the skin looks weepy or crusted, then a swab for culture
(09:38):
and sensitivity is a good idea. If you think a fungal infection
could be playing a role, especially if it's not
responding, a skin scraping or maybe even a punch biopsy might
be used to look for fungus. Patch testing comes up too,
particularly if you suspect contact dermatitis is the real
culprit, or at least a contributing factor.
Right, given the overlap. Exactly.
And then there's that very specific point about ruling out
(10:01):
the dysidrosis like T cell leukaemia, lymphoma variant that
would involve blood tests, serology for HTLV one, but only
in very specific clinical situations where that's a
genuine suspicion. So mostly clinical, but tests
have their place for tricky cases or ruling things out.
Precisely. OK, so we've got the diagnosis
or we're treating it presumptively.
(10:23):
What's the management strategy? How do you actually help someone
with pomphilics according to thesources?
Right, the main aims are pretty clear.
You want to relieve those symptoms, especially the itch,
which can be debilitating. You want to try and prevent
future flare ups and you want tohelp the skin heal.
Symptom control is a huge part of it.
The sources describe a kind of stepped approach.
First line, the basics. Emollients, lots of them, to
(10:46):
moisturise and repair that skin barrier.
Topical steroids, creams or ointments applied directly to
the rash to calm the inflammation and reduce the
itch, and simple things like cold compresses can feel really
soothing for that burning and itching.
OK, standard eczema type approaches to start.
Pretty much. Other topical options mentioned
are calcineurin inhibitors like tacrolimus or pulmicrolimus.
(11:09):
Oral antihistamines might help with the itch, especially at
night. And a really key part of
management alongside the creams is identifying and avoiding any
known triggers. That's fundamental.
Right. What if that's not enough for
more severe cases? If.
Topical treatments aren't cutting it.
Then you move up. Oral steroids like Prednisolone
are listed as a second line option for getting bad flare ups
(11:30):
under control quickly, but usually just short courses.
For really severe, persistent orwidespread cases, more potent
options might be needed. Systemic immunosuppressants are
mentioned drugs like methotrexate, azathioprine,
mycophenolate mofidol or cyclosporin.
These require careful monitoring, obviously.
Yeah, these are big guns. They are.
(11:52):
Other things mentioned include phototherapy using controlled UV
light treatment which can be effective sometimes.
If you have really large tense blisters causing a lot of pain,
draining them carefully under sterile conditions can give
relief. And of course, if it gets
secondarily infected with bacteria, you'll need
antibiotics. Any other treatments mentioned?
Yeah. The material also briefly
(12:12):
touches on botulinum toxin injections, which have shown
some promise, possibly related to reducing sweating in the
area. And it notes ongoing research
into other things like systemic allotretinoin, a retinoid,
topical bixeratine, newer biologic drugs like monoclonal
antibodies, and even radiotherapy in very specific,
difficult situations. So quite a tool kit available,
(12:35):
ranging from simple moisturisersall the way up to specialised
treatments. Definitely.
It's about matching the treatment intensity to the
severity of the condition and the individual patient.
OK. Last section then.
What's the long term outlook, the prognosis?
Is this something people just get over, or is it more
persistent and are there complications to worry about?
The general picture painted by the sources is that palm phylics
(12:57):
tends to be a chronic and relapsing condition, so it often
sticks around long term and flares are quite common even if
people have periods where their skin is clear.
The positive side is that for most people the symptoms can be
controlled pretty well with consistent management using the
treatments, avoiding the triggers.
This often leads to remission, You know, periods without
(13:19):
symptoms, but the potential for it to flare up again is usually
there. The notes did emphasise that
while the overall health outlookis good, it can really impact
quality of life because of the symptoms.
And while individual flares often resolve in three to four
weeks, as you said, some people do experience a much more
chronic, persistent course that's harder to manage.
(13:40):
That's true. It can be quite relentless for
some individuals. Complications.
What should we be aware of? They're described as relatively
rare, thankfully. Yeah, but secondary bacterial
infection is probably the most common one.
The broken skin from blisters orscratching let's bacteria in
that eats antibiotics. As we've touched on the sheer
discomfort, the intense itching,sometimes pain can significantly
(14:00):
interfere with daily life, work,sleep, impacting overall
well-being and quality of life. That's a major complication in
itself, yeah. Absolutely.
With chronic repeated episodes, the skin can sometimes become a
thickened and leathery that's called lichenification.
You might also see changes in pigmentation, usually darkening,
called post inflammatory hyperpigmentation and finally
(14:21):
that link with stress. The condition can cause stress,
and stress can worsen the condition, potentially creating
a difficult cycle for the patient.
OK. That gives us a really
comprehensive overview of Palm Full X, pulling everything from
that MSRA revision material. We've covered the definition,
the potential causes, the risk factors, the actual
pathophysiology, clearing up that dishydrotic confusion, a
(14:42):
huge list of differentials, who tends to get it, what it looks
like, when to investigate, the whole range of management
options, and finally the prognosis and potential
complications. Yeah.
So just to quickly recap the absolute essentials type of
eczema, itchy blisters, hands and feet.
Remember the dishidrotic name isa misnomer, not sweat glands.
Triggers like stress, heat, irritants are key.
(15:05):
Diagnosis usually clinical but keep differentials in mind.
Manage with emollients, topical steroids first line plus trigger
avoidance. It's often relapsing.
Flares usually resolve in weeks but can be chronic and really
impact quality of life. Perfect summary, so here's a
final thought to leave you with.We heard how stress is both a
risk factor and a trigger, and how much the issuing impacts
(15:26):
quality of life. Thinking about that, how crucial
might a more holistic approach be looking beyond just the skin
creams and considering psychological support or stress
management for really helping patients cope with this
condition effectively in the long run?
Something to consider, right? That wraps up this deep dive
focused on pomfolics for your MSRA revision.
For more free MSRA revision resources, you can visit
(15:46):
freem-sra.com. And if you're looking for the
full Premium Revision Toolkit, head over to pass them sra.com.
Welcome to the deep Dive. We're doing something a bit
different today, really zeroing in on a topic.
For those of you prepping for the MSRA exam, we've got the
source material you sent over and we're going to pull out the
absolute key high yield facts. And today's topic is Pomfolix.
That's it. Yeah, the idea is to slice right
through to the core information in those notes.
(00:20):
We'll build up a really clear picture of Pomfolix.
You know what it is, what might cause it, how you'd spot it,
crucially, what else it might be, and how you'd go about
managing it. All geared towards helping you
revise effectively. Right, like unpacking those
notes into something really usable.
Exactly memorable for the exam. OK, let's start unpacking then.
First things first, what exactlyare we talking about with Palm
(00:42):
follics? OK, so palm follics formally
it's it's a type of dermatitis. You might also hear it called
dishidrotic eczema or maybe vesicular hand eczema.
The absolute key feature, the thing that defines it really, is
this eruption of small blisters.They're usually fluid filled and
often, really often incredibly itchy, and they pop up in very
(01:03):
specific places, mainly the hands and feet.
It's flagged up as a condition that tends to be chronic and
recurrent. It comes back.
And the next mention those specific names to
chiropumpholics for hands, pedopumpholics for feet makes
sense. I also saw that little detail
about the name pump folics coming from the Greek for bubble
kind of paints a picture, doesn't?
(01:24):
It it really does. Yeah.
Yeah. So fundamentally it's an eczema
type affecting palms and souls. Yeah, an inflammatory skin
thing. The exact trigger isn't totally
nailed down, but it presents with this very characteristic
itchy, bubbly rash. Could be a one off acute flair
or might keep coming back or even become, you know, chronic.
So if the exact cause is unclear, what do the sources
(01:45):
suggest might be going on? Any clues?
It's not like there's one singlesmoking gun.
The thinking outlined in the materials that it's probably a
mix, you know, some genetic factors making someone
susceptible, plus environmental influences.
There's mention of a possible link to abnormal sweating
patterns and maybe some issues with the skin's natural barrier
(02:06):
function. But, and this is really
important, the kind of thing they love asking about.
Despite that old name, Dishidrotic, suggesting sweat
duct problems, when you actuallylook the skin Histology under
the microscope, there's no evidence the sweat glands are
involved. So that name, it's actually a
bit of a misnomer. Now we know better.
OK, that's a vital point then. So abnormal sweating might be
(02:28):
linked, maybe as a risk factor, but the condition itself isn't
caused by block sweat glands. Precisely.
That's the key takeaway. The inflammation in those
vesicles, they're not forming because sweat is trapped.
It's tied to the inflammation, the skin barrier, problems
perhaps triggered by something. Else, right.
So what are those triggers? What sort of things can set off
a flare up? Well, the material lists a few
usual suspects. Contact with certain allergens
(02:51):
or irritants. Think detergent, solvents, that
kind of thing. Emotional stress comes up quite
strongly as a trigger too, and very commonly you see it linked
with warm, humid weather. High temperatures and humidity
definitely seem to play a role in bringing it on for some
people. That fits with it being more
common sometimes maybe certain seasons or climates, which leads
to who's actually more likely toget this?
(03:13):
What are the risk factors? OK.
Looking at the risk factors pulled from the sources,
definitely having a personal or family history of atopic
conditions like eczema, asthma, hay fever, that's a big one.
Also people whose jobs involve frequent exposure to those
urgents we mentioned, or just lots of hand washing, lots of
water contact. Excessive sweating or
(03:35):
hyperhidrosis is listed as a risk factor which links back to
that sweating association, even if it's not the direct 'cause.
I see. Psychological stress again
fitting with it being a trigger and living in or travelling to
warm humid places. It all ties together.
OK, got it. Now let's go a bit deeper.
Under the skin itself, the pathophysiology.
(03:56):
My notes talk about these small deep blisters.
What's actually happening there?Right.
So on a sort of cellular level, the sources describe a process
that involves the immune system not quite behaving itself,
problems with the skin barrier, that protective outer layer and
resulting inflammation. The little blisters, the
(04:16):
vesicles, they form within the layers of the skin, the
epidermis and dermis. But, and I'll say it again
because it's crucial, the Histology shows no involvement
of sweat glands or ducts. The disodronic misnomer again.
Exactly that old theory about trapped sweat?
Incorrect. It's key to remember it's
inflammatory, linked to barrier and immune issues.
Got it. Inflammatory barrier issues,
(04:36):
Immune involvement, not sweat glands.
Super important distinction. OK, now for exam revision.
Differential diagnosis are absolutely massive.
What else could look like this? What mimics are listed in the
source material? Yeah, this is a really, really
critical section. You see blisters on hands and
feet. You have to think broader.
What else could it be? And the sources give quite a
long list. OK, let's hear it.
Right. So you need to have in mind
pustular psoriasis, especially the pomoplaner type fungal
(05:00):
infections, Tinia can sometimes cause blisters, bacterial
infections maybe like bullets and pedigo, something called
recurrent focal palmar peeling or keratolysis exfoliative.
Then there are rarer blistering conditions like dysidrosis form
bolus pemphigoid or just standard bolus pemphigoid for
kids, acropostolosis of infancy or juvenile plantar dermatosis
(05:22):
affecting the feet. Linear IGA diseases on the list,
sometimes with hemorrhagic sort of blood filled blisters and a
really key one, contact dermatitis, both allergic and
irritant types, which is tricky because as we said, irritants
can also trigger pomphilics itself.
Right. So it can be hard to distinguish
sometimes, yeah. Exactly.
The list goes on. Pemphigoid gestationis that's
(05:43):
specific to pregnancy. Pemicus vulgaris, a very rare
one, the dysidrosis like variantof adult T cell leukaemia,
lymphoma, pityriasis, rubra Polaris, epidermolysis blosa.
That's a whole group of genetic blistering disorders.
Sub coneal pustular dermatosis erythema multiform, even things
(06:04):
like contact urticaria syndrome,fixed drug eruptions, simple
friction blisters, and perpes simplex infections.
Wow OK that is comprehensive. Definitely highlights why you
might need investigations if it's not textbook or not getting
better. That list is definitely worth
reviewing a few times. Absolutely.
Knowing those differentials is key for safe practise and for
(06:24):
exams. OK, moving on.
Who actually gets Pomfolix? How common is it?
What about the epidemiology? According to the material, the
exact numbers for the UK aren't really known, but it's generally
considered pretty common. It mainly effects adults,
typically hitting people betweenthe ages of 20 and 40 most
often. There's also a slight tendency
for it to be a bit more common in women and then men, but while
(06:45):
that 2040 bracket is the peak, it can happen at any age really.
You can see it in children too. And reinforcing what you said
about triggers, it's definitely more common in warmer months and
warmer climates. OK, so let's imagine a patient
walks in. What are the classic signs you'd
be looking for on examination? What does palm folics actually
look like clinically based on these descriptions?
(07:06):
The absolute hallmark is those small fluid filled blisters or
vesicles. You'll find them typically on
the fingers, often starting on the sides, the palms, the soles
of the feet or maybe the toes. And the symptom that almost
always comes with them is the itch.
It's often described as really intense, severe itching.
Sometimes people also report a burning feeling in those areas.
(07:28):
Sounds pretty miserable. It really does.
What happens to those blisters over time?
Do they just stay there? No, they tend to evolve.
They can burst or maybe just dryup and when they resolve the
skin underneath often becomes quite dry and it can crack or
peel. As we mentioned, the condition
might be a one off acute thing or can keep coming back in
flares, or sometimes it just sticks around chronically.
(07:50):
Looking closer at the vesicles themselves, they're typically
quite small, maybe one or two millimetres across.
And yeah, often starting along the sides of the fingers before
spreading onto the palms or soles is a pretty characteristic
pattern. Anything else to look for?
You might see the surrounding skin looking a bit red, maybe
sweaty, especially during a flare up.
And as the glisters resolve, youoften see this sort of peeling
(08:12):
or rings of scale where the vesicles work.
They kind of unroof themselves, yeah.
I remember seeing something in the notes about nails as well if
the flare is near the nails. Yes, that's right.
If you get eruptions near the nail matrix where the nail grows
from, it can sometimes cause changes in the nail itself, like
transverse ridges or furrows across the nail plate.
(08:32):
It's a sign of the inflammation affecting nail growth.
Interesting. And how long does a typical
flare last? The source material suggests the
vesicles themselves usually stick around for about 3 to 4
weeks, and then they tend to disappear spontaneously, even if
you don't treat the blisters directly.
OK, so you've seen these features.
You suspect palm folics. How do you confirm it?
(08:53):
Do you always need tests? Usually not actually.
The emphasis in the material is that the diagnosis is typically
clinical. You make it based on recognising
the characteristic appearance, the type of blisters, where they
are. In straightforward cases,
specific tests often aren't needed.
But when would you investigate further?
What makes you think maybe I need some tests here, right?
(09:16):
You'd start thinking about investigations if the picture
isn't quite classic, or if the person isn't getting better with
the usual first line treatments,and crucially, if you need to
rule out one of those other conditions.
On that big differential list wewent.
Through makes sense. So the specific tests mentioned
are If you're worried about a secondary bacterial infection,
maybe the skin looks weepy or crusted, then a swab for culture
(09:38):
and sensitivity is a good idea. If you think a fungal infection
could be playing a role, especially if it's not
responding, a skin scraping or maybe even a punch biopsy might
be used to look for fungus. Patch testing comes up too,
particularly if you suspect contact dermatitis is the real
culprit, or at least a contributing factor.
Right, given the overlap. Exactly.
And then there's that very specific point about ruling out
(10:01):
the dysidrosis like T cell leukaemia, lymphoma variant that
would involve blood tests, serology for HTLV one, but only
in very specific clinical situations where that's a
genuine suspicion. So mostly clinical, but tests
have their place for tricky cases or ruling things out.
Precisely. OK, so we've got the diagnosis
or we're treating it presumptively.
(10:23):
What's the management strategy? How do you actually help someone
with pomphilics according to thesources?
Right, the main aims are pretty clear.
You want to relieve those symptoms, especially the itch,
which can be debilitating. You want to try and prevent
future flare ups and you want tohelp the skin heal.
Symptom control is a huge part of it.
The sources describe a kind of stepped approach.
First line, the basics. Emollients, lots of them, to
(10:46):
moisturise and repair that skin barrier.
Topical steroids, creams or ointments applied directly to
the rash to calm the inflammation and reduce the
itch, and simple things like cold compresses can feel really
soothing for that burning and itching.
OK, standard eczema type approaches to start.
Pretty much. Other topical options mentioned
are calcineurin inhibitors like tacrolimus or pulmicrolimus.
(11:09):
Oral antihistamines might help with the itch, especially at
night. And a really key part of
management alongside the creams is identifying and avoiding any
known triggers. That's fundamental.
Right. What if that's not enough for
more severe cases? If.
Topical treatments aren't cutting it.
Then you move up. Oral steroids like Prednisolone
are listed as a second line option for getting bad flare ups
(11:30):
under control quickly, but usually just short courses.
For really severe, persistent orwidespread cases, more potent
options might be needed. Systemic immunosuppressants are
mentioned drugs like methotrexate, azathioprine,
mycophenolate mofidol or cyclosporin.
These require careful monitoring, obviously.
Yeah, these are big guns. They are.
(11:52):
Other things mentioned include phototherapy using controlled UV
light treatment which can be effective sometimes.
If you have really large tense blisters causing a lot of pain,
draining them carefully under sterile conditions can give
relief. And of course, if it gets
secondarily infected with bacteria, you'll need
antibiotics. Any other treatments mentioned?
Yeah. The material also briefly
(12:12):
touches on botulinum toxin injections, which have shown
some promise, possibly related to reducing sweating in the
area. And it notes ongoing research
into other things like systemic allotretinoin, a retinoid,
topical bixeratine, newer biologic drugs like monoclonal
antibodies, and even radiotherapy in very specific,
difficult situations. So quite a tool kit available,
(12:35):
ranging from simple moisturisersall the way up to specialised
treatments. Definitely.
It's about matching the treatment intensity to the
severity of the condition and the individual patient.
OK. Last section then.
What's the long term outlook, the prognosis?
Is this something people just get over, or is it more
persistent and are there complications to worry about?
The general picture painted by the sources is that palm phylics
(12:57):
tends to be a chronic and relapsing condition, so it often
sticks around long term and flares are quite common even if
people have periods where their skin is clear.
The positive side is that for most people the symptoms can be
controlled pretty well with consistent management using the
treatments, avoiding the triggers.
This often leads to remission, You know, periods without
(13:19):
symptoms, but the potential for it to flare up again is usually
there. The notes did emphasise that
while the overall health outlookis good, it can really impact
quality of life because of the symptoms.
And while individual flares often resolve in three to four
weeks, as you said, some people do experience a much more
chronic, persistent course that's harder to manage.
(13:40):
That's true. It can be quite relentless for
some individuals. Complications.
What should we be aware of? They're described as relatively
rare, thankfully. Yeah, but secondary bacterial
infection is probably the most common one.
The broken skin from blisters orscratching let's bacteria in
that eats antibiotics. As we've touched on the sheer
discomfort, the intense itching,sometimes pain can significantly
(14:00):
interfere with daily life, work,sleep, impacting overall
well-being and quality of life. That's a major complication in
itself, yeah. Absolutely.
With chronic repeated episodes, the skin can sometimes become a
thickened and leathery that's called lichenification.
You might also see changes in pigmentation, usually darkening,
called post inflammatory hyperpigmentation and finally
(14:21):
that link with stress. The condition can cause stress,
and stress can worsen the condition, potentially creating
a difficult cycle for the patient.
OK. That gives us a really
comprehensive overview of Palm Full X, pulling everything from
that MSRA revision material. We've covered the definition,
the potential causes, the risk factors, the actual
pathophysiology, clearing up that dishydrotic confusion, a
(14:42):
huge list of differentials, who tends to get it, what it looks
like, when to investigate, the whole range of management
options, and finally the prognosis and potential
complications. Yeah.
So just to quickly recap the absolute essentials type of
eczema, itchy blisters, hands and feet.
Remember the dishidrotic name isa misnomer, not sweat glands.
Triggers like stress, heat, irritants are key.
(15:05):
Diagnosis usually clinical but keep differentials in mind.
Manage with emollients, topical steroids first line plus trigger
avoidance. It's often relapsing.
Flares usually resolve in weeks but can be chronic and really
impact quality of life. Perfect summary, so here's a
final thought to leave you with.We heard how stress is both a
risk factor and a trigger, and how much the issuing impacts
(15:26):
quality of life. Thinking about that, how crucial
might a more holistic approach be looking beyond just the skin
creams and considering psychological support or stress
management for really helping patients cope with this
condition effectively in the long run?
Something to consider, right? That wraps up this deep dive
focused on pomfolics for your MSRA revision.
For more free MSRA revision resources, you can visit
(15:46):
freem-sra.com. And if you're looking for the
full Premium Revision Toolkit, head over to pass them sra.com.
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