JOURNAL OF CHINESE MEDICINE NUMBER 66 JUNE 2001 TREATMENT BY CHINESE HERBAL MEDICINE


POMPHOLYX ECZEMA


by Mazin Al-Khafaji Definition and nomenclature


Pompholyx eczema is a very distinctive form of eczema, characterised initially by an eruption of very itchy vesicles on the sides of the fingers and palms of the hands and occasionally the soles of the feet and toes. The vesicles, which contain clear fluid, usually subside without ruptur- ing, although in some cases they may become tense, burst and discharge. In either case, the vesicular stage, which usually lasts for one to two weeks is followed by a dry desquamating phase, by which time the itching is usually markedly reduced. This condition has been recognised and described in medical texts in China since at least the Ming dynasty. In the True Lineage of External Medicine, Chen Shi-gong uses the name River snail vesicle (


), giving a fair description of


the disorder: “River snail vesicle mostly erupts on the hands and feet, suddenly it is as if the area was on fire; purple, white and yellow vesicles will appear next; this is wind damp attacking and pouring into the Spleen channel.” Less than a century later, Gu Shi-deng the author of Collection of Treatments for Sores uses the alternative and more com- monly used name of Ant nest (


) to define it: “Ant nest


…mostly erupts on the hands and feet, it’s appearance is like the nest of an ant, just like the pricks of a needle, the itching is extreme and enters the Heart. On rupturing there is a watery exudation … it may also erupt on the back of the hands and wrists”. The name pompholyx is derived from the Greek word for


the boss of a shield and by extension a bubble or blister, the characteristic lesion of this eczema. The alternative name dyshidrotic eczema refers to the common finding associ- ated with this eczema of excessive sweating from the palms and occasionally the soles.


Lesions


Vesicle is the characteristic lesion of pompholyx eczema. The smaller vesicles are commoner, although they may


coalesce to form larger vesicles or bullae. Typically the deep-set vesicles develop rapidly, and are accompanied by intense itching. Due to the thickness of the epidermis of the palms and soles, the fluid inside often appears pearly white, and instead of rupturing and discharging, as it would more often do if it were found elsewhere on the body, it is usually reabsorbed without a break in the skin. Bullae may form as a result of several vesicles coalescing, and are more often seen on the feet. Occasionally they may grow to a size of several centimetres. In such cases pain and incapacity may be significant features. Crusting is formed only if the vesicles or bullae rupture and discharge. There will typically be a mixture of yellow or white crusting tinged with dry bloody scabs. Erosion occurs as a consequence of breakdown of a vesicle or bulla. The superficial layer of skin, the epidermis, is worn away exposing the lower layer of skin, the dermis. This is almost always associated with crusting. Desquamation, scales and fissures are seen at the end stages of a cycle of eruption. They may develop following re-absorp- tion, or after break down, discharge and crusting of the vesicles and bullae. In some chronic cases, only the fissures are seen, with absence of any vesicles. Lichenification is most commonly seen in chronic cases, where typically the patient has suffered repeated attacks over many years, and vesicle formation is replaced by desquamation, fissuring and lichenification. Lichenifica- tion is often more readily observable when the eczema spreads to the dorsal aspect of the hands and fingers. Pustules are not infrequently seen when the area becomes infected.


Distribution


Pompholyx eczema affects the hands and feet, either to- gether or separately. By far the most common presentation, accounting for about 80% of cases is for the hands to be involved exclusively. The remaining 20% of cases will be


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