My Life as a Canary: Pompholyx in Photos

The occurrence that finally tipped the scales for me and convinced me to start this blog was a recent outbreak of pompholyx. As I type this, I am in the middle of an outbreak. I finally received a diagnosis for what exactly is happening to me only yesterday, just over 24 hours ago. This is not my first flare up of pompholyx. I had my first experience with it in 2006, with sporadic flare ups since that time.

I am currently on day 5 of the current flare up. I will continue to take photos and update this post as the flare up continues. I will document what treatment I follow each day, and try to describe both the good and the bad.

Day 1 - July 30, 2011
I fear that my own stupidity may have brought this current flare up into action. Many years ago, I underwent some allergy patch tests that indicated that I am allergic to some compounds in fabric sizing. As such, I am always sure to wash newly purchased clothing a couple of times before wearing them. However, on July 30th I purchased a very cute pair of shorts, and at the risk of sounding girly and ridiculous, I just couldn't wait to wear them! That afternoon, I had plans to make a public appearance at a therapy dog demonstration, so decided to wear my new shorts before washing them, as I would only have them on for an hour or two at most. I wore the shorts for a total of 1.5 hours, and by the time I got home after the demonstration, the flare up had begun.

It started with the palms of my hands feeling tingly and numb. It's a difficult sensation to describe, but imagine that you are wearing a very tight pair of leather gloves. You can still feel when you are touching things, but are unable to discern the little nuances of texture. At the same time, hard contact feels painful, and temperature changes register as more extreme.

The first visible signs of the flare up are patchy red blotches on the palms of my hands. These tend to be worse around the heel and thumb base pad, the "meaty" parts of my hand. The red blotches are delimited to the keratinized skin of my palm, and stop abruptly when the skin transitions to the thinner, less keratinized skin of the back of my hand and wrist.

Day 1 - Left palm showing red patches

Day 1 - Right palm showing red patches

Day 1 - Right wrist showing border between affected and unaffected skin

Day 2 - July 31, 2011
Upon waking the next morning, the condition of my hands has worsened. The entire palm is red and slightly swollen. Small, very deep seated, fluid filled vacuoles are present on the "meaty" portions of the heel of my palm and the thumb base. These vacuoles are tiny, and the surface of the skin is smooth. It does not appear raised over these vacuoles. Sensation in my hands is more extreme than normal, painful to the touch and temperature fluctuations are likewise painful. Small raised bumps are present on my finger tips and around my fingernails. A few small bumps are also present at the border of the keratinized palm skin and the thin skin on the back of my hand. There is a sporadic dull ache in the joints of my hands and wrists. This ache does not persist, though is very noticeable when it does occur. In addition to the hand eczema, the skin on my torso, specifically the skin that is normally covered by undergarments, is red and slightly swollen, though not overtly itchy. Small red bumps are visible on the inside surface of my forearm. These bumps are not itchy, and disappear later in the day.

Day 2 - Right hand and wrist

Since it is Sunday morning of a long weekend, my regular doctor is unavailable. I make a trip to a nearby walk-in clinic and consult with the doctor on duty. He appears stumped by my symptoms, and I wonder what his treatment approach would have been if I had not mentioned my suspicions of an allergic reaction. He prescribes two oral antihistimines (Ranitidine and Cetirizine) to be taken twice daily and a strong topical steroid (Clobetasol) to be applied twice daily.

Day 3 - August 1, 2011
Visible and sensory symptoms are very similar to Day 2. Vacuoles increase in number and spread across my entire palm. I continue with the oral antihistimines and topical steroids. The antihistimines do not appear to have any affect, apart from making me very dopey and irritable. The prescribing doctor indicated that these antihistimines are non-drowsy, but I frequently have adverse reactions to medications, even when touted as being "non-drowsy". I frequently feel dopey, groggy, unable to focus, and irritable when I take medications such as those for cold and flu, muscle aches, etc. I wonder if my propensity for allergic reactions, chemical sensitivities, and skin inflammation is somehow related to my over-sensitivity to medications. If my body is unable to tolerate environmental toxins, might it also be inappropriately tolerating oral medications?

Day 4 - August 2, 2011
At the end of February, 2011, I had an appointment with a dermatological specialist regarding allergy testing. On a whim, I decided to call his office with the news that I am in midst of an allergy/eczema outbreak, as my appointment with him earlier in the year coincided with a time when I was not having any sort of reaction. The receptionist said that if I could rush over to the office immediately, he would see me this morning. I explained the flare up to date, and he confirmed my suspicions and gave a diagnosis of pompholyx (also known as dyshidrotic eczema, dyshidrosis, and acute vesiculobullous hand eczema). He also indicated that flare ups could be brought on by contact with an allergen, contact with an irritant, or as result of an autoimmune reaction to an endogenous trigger. Essentially, it is possible that I could confine myself to a bubble and still have eczema flare ups. Not necessarily the news I want, but at least it gives me a direction to head in!

I spent some time on the internet looking for information regarding pompholyx, and came up with disappointingly little to go on. What few sites I could easily find appeared to all have the same information word-for-word copy-and-pasted from a single source. However, I did find a couple of suggestions to get me started. A few sites recommended a salt-water soak to dry out the vacuoles and potentially prevent the mass peeling that I experienced in previous flare ups. I decided to conduct a little experiment, whereby I soaked my left hand only in a bowl of room temperature salt water for 40 minutes. I then applied my steroid cream to both hands, and covered them with vinyl gloves for about half an hour to enhance the absorption of the cream. I will review tomorrow whether there appears to be a difference between the salt-soaked and unsoaked hands.

I took both of the oral antihistimines in the morning, as prescribed, but discussion with the dermatologist indicated that the oral antihistimines would do no good for the pompholyx. Since the antihistimines were causing me to be groggy and sleepy, I decided to discontinue the Ranitidine. I continue to take the Cetirizine twice daily, as the rash on my torso persists and becomes moderately itchy at times.

Regarding symptoms, visually my hands appear unchanged from Day 3. Small vacuoles persist, with a few becoming raised at the surface. My hands are becoming quite itchy, though scratching is painful. Rubbing them together or on my pants provides the most relief.

Day 5 - August 3, 2011
The fluid filled vacuoles that were previously small and deep-seated, have now expanded in size and are becoming somewhat raised at the surface. My palms are noticeably swollen and it feels as though they are filled with fluid, similar to a water balloon. The swelling, pain, and redness is still limited to my palms. The backs of my hands appear completely normal, apart from a slight redness around my fingertips and fingernails. Both hands are "fluid filled", though the left hand (which was soaked in salt-water the previous evening) appears less affected than the right unsoaked hand. There are small darkened patches on my left hand that appear to be dried out vacuoles. These darkened patches are not present on my right hand.

The fluid-filled portions on both hands are quite painful, and feel as if they are pressurized or "blown up" like a balloon. Rolling the thumb of one hand along the heel of my palm of the other hand produces a very strange sensation. It is as if there are multiple small bubbles under my skin, and applying a rolling pressure "pops" these bubbles, merging them into larger blisters. The sensation is similar to that of tiny bubble wrap. When one of these larger bubbles bursts, it releases a surprisingly large amount of clear, odorless fluid. I don't know if I should be popping these blisters or not, but it is surprisingly satisfying and helps to relieve the pressure in my palms. As confirmation of earlier findings, the blisters on my left (salt-soaked) hand are much smaller and cover less overall area than on my right (unsoaked) hand.

Day 5 - Right hand showing fluid filled heel

Day 5 - Close up of the large fluid filled blisters on my right palm

Day 5 - Multiple small raised blisters/vacuoles on right palm

Day 5 - Small raised bumps and redness around the fingernails of my right hand

Day 5 - Close-up of the many small fluid filled vacuoles on my right palm

I applied the topical steroid in the morning, and wore a pair of vinyl gloves for half an hour after application. During the day, I repeatedly applied Glaxal Base lotion.

This evening, I soaked both hands in room temperature water with dissolved epsom salts for 40 minutes each. After soaking, my hands feel much less "pressurized" and the skin feels much softer and more pliable. I drained all of the blisters. While my palms are still painful to the touch, they are much less sore than prior to soaking and draining.

In previous flare ups, I have not soaked my hands and have tried to refrain from popping the blisters. I applied Glaxal Base lotion frequently. The result is that my hands peeled excessively, and revealed very raw and tender skin beneath. I have since looked into the ingredients in Glaxal Base, and have found that one of the compounds to which I tested positive for allergic reactions to earlier this year is found among them. As such, I picked up a new emollient cream on the way home from work today, and will give it a shot tonight. I hope that the steps I have taken this time will prevent the extreme peeling of previous episodes.

There are a few other symptoms that I have noticed over the past couple of days. I have been monitoring my weight for the past year in efforts to drop some extra pounds. Prior to this flare up, I was steadily losing weight at a rate of about 1-2lb per week. Over the past 5 days, since the visible signs of the flare up, I have gained 2.5lb. All despite maintaining a healthy eating plan, drinking upwards of 12 cups of water daily, and running 5km every other day. Additionally, this morning I noticed what appears to be a vaginal yeast infection. I am not prone to yeast infections, having only had a couple, the last one many years ago. These symptoms, combined with the pompholyx flare up and the disperse rash on my torso, hints at a possible system-wide disruption. My suspicion is that there was exposure to an allergen, causing the rash on my torso and triggering the pompholyx flare up on my hands. Combined, these have resulted in water retention, leading to the weight gain, and have lowered my immune defenses allowing a yeast infection to form. Makes sense in my head, but is all speculation at this point.

Day 6 - August 4, 2011
My hands feel so much better today! They still look horrible, but I can tell that things are starting to heal up. The soaking and draining of the blisters yesterday seems to have made a big difference. The heels of my hands that were previously filled with fluid are mostly dried up. There is a small patch on my right hand that appears to still have some fluid, but the rest of the vacuoles have dried up and the swelling has gone down. The skin on my palms has become hardened and thick, slightly raised above where the vacuoles were. The hardened patches are very dark red in color, with some appearing almost brown-ish in color.

Day 6 - Left palm. Dark red patches are dried vacuoles

Day 6 - Close-up of dried patches on left palm

Day 6 - Right palm. Dark patches are dried vacuoles

Day 6 - Close-up of dried patches on right palm.

My finger tips are still fluid filled and quite tender. Those vacuoles do not seem to be drying out at the same rate as those on my palms. However, the skin on my finger tips feels as if it is thickening as well, so perhaps they will skip the large blister stage.

Day 6 - Raise fluid-filled blisters on the side of my finger tip.

Day 6 - Small, deep-seated fluid-filled vacuoles on the tip of my finger

The pain is much less today than yesterday, primarily, I believe, because of the lessened pressure from the drained blisters. My hands are still very tender, however, and repetitive use is very uncomfortable. The thickened dry skin feels as though it would crack easily at this point, so I have been moisturizing frequently with Uremol cream. I have also avoided getting my hands wet, when possible, by wearing powder-free vinyl gloves.

I am continuing to take the Cetirizine twice daily and applying the Clobetasol morning and evening. This is the first day using Uremol as an emollient. My hands feel slightly tacky after applying the lotion, but I don't know if this is due to the lotion itself or the strange texture of my skin at the moment. I will update on this as healing progresses.

Day 7 - August 5, 2011
This is getting really old, but at least I am seeing changes daily. The vacuoles have all essentially dried up. The vacuoles that were closer to the surface or under thinner skin (such as those on the sides of my fingers and around my finger nails) are darkened to a reddish-brown color, though the individual vacuoles (or what remains of them) are still distinguishable. The skin on my palms where the majority of the raised fluid-filled blisters (bullae) were located is likewise darkened to a reddish-brown color. The skin over my entire palms and the palmar surface of my fingers is also quite hardened. It's difficult to describe how the hardened skin feels, especially as my finger tips are also covered with it, so determining texture is hard to do. The hardened skin feels smooth and not overly dry. It appears to be thick, as when I lightly tap my hand on a hard surface, it makes a knocking/tapping sound. The thickened, hardened skin has not yet begun to peel, though I can see that on the near horizon. It is not yet cracked, but moving my fingers or hand too much results in sharp pain that I believe heralds cracking and peeling soon. I've been moisturizing frequently with Uremol, but it doesn't appear to be absorbing very well. In addition to the thickened skin, my finger nails have thickened as well, with the pink attached portion regressing to reveal more whiteness.


Day 7 - Right palm

Day 7 - Close up of hardened skin on the heel of my right palm

Day 7 - Left palm

Day 7 - Close up of hardened skin of left palm

As a follow-up to the salt-soak, I really do think that it is a good tool to use, though there appears to be a limited window of time when it is effective. I started by soaking my left hand on Day 4, when there were multiple small deep-seated vacuoles that had not yet become completely raised or bullous. By Day 5, the vacuoles had all become raised bullae and I had worked to pop them after soaking both hands in epsom salts. By Day 7 (today) my left hand is dry and hardened, but not as severely as my right hand. The hardened skin on my right hand seems thickest and most painful directly over where the large bullae had burst a couple days earlier. The skin on my left hand (the one that was soaked) is slightly less thick and doesn't feel as if it is going to crack when I move it. I would wager that the salt soak is most effective for the couple of days when the vacuoles are present but not raised or bullous. This appears to have dried out the small vacuoles and prevented the large bullae from forming, which eventually leads to the thick, hard skin.

Day 8 - August 6, 2011

WARNING: Some people may find the following pictures gross and disturbing. If you have pompholyx, you might as well scroll down and look because this could very well be your hands or feet. But if you have a queasy stomach when it comes to things like peeling skin flakes, you might want to skip this day's update.

The thick leathery skin from yesterday has begun to peel. It starts with an area appearing to be lighter in color than the rest of my palm. In truth, this lighter color is caused by the leathery surface skin becoming detached from the deeper layer. A small crack or hole will develop in the top layer and this will easily peel off in very large sheets. The peeling layer is not dry and flaky, but holds its shape quite well. The peeling started where the skin was the thickest, around the base of my thumb and the heel of my palm. My palm feels slightly itchy, though not unreasonably so. Once the top layer peels, the revealed skin is quite sensitive and raw. It dries out very easily and appears excessively wrinkled. When the skin peels, it comes off of my palm very easily, but stops peeling abruptly at the borderline where the keratinized skin of my palm meets the thin skin of my wrist or the back of my hand.

Day 8 - Left palm showing partially peeled region. The edges are lighter in color indicating that the top layer of thick skin is separating from the layer beneath.

Day 8 - Large flap of peeling skin still partially attached to my left palm.

Day 8 - After the thick skin is removed, the skin beneath is very red, prone to driness, and appears wrinkled. Small drops of blood near my wrist shows that, while the skin peels easily from my palm, it stops peeling abruptly when the skin type changes at my wrist.

Day 8 - My right palm, mostly peeled. You can see the border of the peeled region, with brighter red skin in the peeled region and duller/darker skin that is yet to peel.

Day 8 - My left (moisturized) hand next to some large peeled sections of skin. This is to show that the peeling skin is not flaky, dry, or thin. Rather the skin is quite thick, allowing large sheets to peel off and hold together.

I've continued to moisturize with Glaxal Base every 15-20 minutes. The skin dries out that quickly. Note that some lotions will sting and burn the sensitive skin! I find that Glaxal Base does not sting, where something like Uremol is very painful to use.

Day 13 to 19 - August 11 to 17, 2011

For the past 6 days, my hands have continued to peel. The large, thick sheets were mostly gone on the first day of peeling. For the past 6 days, the peeling has mostly been on my fingers, finger tips, webbing between my fingers, and around the edges of my palms. My hands continue to be quite dry, though I can get away with moisturizing only every hour or two, instead of multiple times per hour. When stretched tight, the skin on my palms appears very shiny. Though when my hands are relaxed, the skin is very very wrinkled. If left to dry out too much, the skin is prone to cracking and bleeding along the "wrinkle" lines. My palms still appear more red than normal, and they are somewhat sensitive, though no where near what it was like a week or two ago. I have noticed that my cuticles look really clean and nice. The cuticle skin around my nails has completely peeled off.