Pompholyx: what's new?
BACKGROUND
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
A MEDLINE and ClinicalTrials.gov research has been conducted and publications about new and emerging treatments for pompholyx have been analysed.


CONCLUSIONS
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.
Wollina
Uwe
U
Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital, Technical Unicersity of Dresden, Friedrichstrasse 41, 01067 Dresden, Germany. wollina-uw@khdf.de
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000077556:Alitretinoin; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002648:Child; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D009783:Dermatitis, Occupational / Q000188:drug therapy; D004311:Double-Blind Method; D015195:Drug Design; D011146:Eczema, Dyshidrotic / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011701:PUVA Therapy; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010778:Photochemotherapy; D012008:Recurrence; D014212:Tretinoin / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020024:Leukotriene Antagonists; D010726:Phosphodiesterase Inhibitors; D000077556:Alitretinoin; D014212:Tretinoin; D019274:Botulinum Toxins, Type A