Pompholyx is a chronic relapsing inflammatory vesicobullous
skin disease of the hands and feet belonging to the spectrum of
eczema. Established treatments, both topical and systemic, are limited in efficacy, risk:benefit ratio and prevention of further relapses. New treatment options are needed.
OBJECTIVE: The article will discuss new treatment options, in particular for cheiropompholyx.
METHODS: Among the recent developments, topical
calcineurin inhibitors (TCI) and
botulinum toxin A (BTXA) seem to be effective against
pompholyx. The major disadvantage of BTXA is the need for
injections, but efforts are being made to develop a topical form of application. Bexaroten gel has been used for chronic hand
dermatitis, with good efficacy in the hyperkeratotic type. Further studies on
pompholyx are needed. There is currently widespread interest in plant-based
pharmaceuticals. Studies involving such topical drugs are on the way. In systemic treatment,
retinoid alitretinoin has been most extensively studied in hand
dermatitis. However, experiences relating to
pompholyx are more limited. New types of anti-inflammatory oral drugs such as
leukotriene inhibitors and
phosphodiesterase-4 (
PDE4) inhibitors have become available. These seem to have potential in the adjuvant treatment of
pompholyx.
Monoclonal antibodies of various types have been investigated in small series, but have failed to demonstrate consistent efficacy. Further investigations with new monoclonals are needed.
Phototherapy of
pompholyx is a cornerstone in treatment. High-dose UVA1 has been established as an effective modality in centres where the rather expensive equipment is available. Recently, UV-free
phototherapy has been introduced, but more data are needed before final conclusions can be drawn.