Case of Pompholyx Eczema in Young Mother

Pompholyx Eczema (aka Dishidrotic Eczema) most commonly affects new mothers taking care of their newborns. Their post-partum immune system is often compromised and they may be doing too much washing of the hands, which compromises.

This lady is a mother of 2 kids (2 and 4 yo) coming to see me because she had been suffering from pompholyx since October last year, Started applying topical steroids 4 months later in February this year, and ended up needing to go on oral steroids 40mg qd as she tapered downward. When she came for the first consultation, she was still tapering off at about 10mg of perdnisolone while still using topical steroids and moisturizers. She presented during the last week of June this year, and I diagnosed her as ‘damp’ from a Chinese Medicine perspective (especially as evidence by the tongue and stool presentation), and the fingers and hands were slightly swollen.

We treated with the intention to manage any possible rebound flare, and I gave herbs that cleared damp-heat with a component that managed the blood heat — this is in the prescriptional tradition of Zhu Lao in Beijing. I paid less attention to the her Spleen deficient presentation during the first two weeks of treatment as we wanted to focus more on reducing inflammation, and mitigating any negative effects of ‘rebound’ steroid withdrawal.

Below, her hands during her first consultation, still tapering off at 10mg Predni qd.

Notice the slight swell in the fingers (proximal phalanges) as well as the pinkish bis in the palm. Forearms presenting with grainy papules. She responded positively to the acupunture treatment, however…

Within 4 days, as the the dose of Xepason (which is a ‘better’ steroid with anti-inflammatory action 4x that of hydrocortisone, but mineralocorticoid activity is 0.6x smaller) fell to 5mg qd, the patient started experiencing the rebound effect.

Apart from hand pomphlyx, the flare had spread up to her forearms and also the sides of the neck.

She also started feeling ‘drier,’ which is actually the effect of the herbs. In a way, for such a situation where pompholyx presents as pus and blisters, and a TCM diagnosis detects an excess of damp, then dryness is what we want from the herbs, but may be experienced as a side effect. The only consolation is that a dry presentation is ‘better’ than a weepy presentation from a therapeutic perspective.

Against what felt right for her, I also suggested she consider ceasing use of physiogel lotion, and instead to consider using potassium permanganate or ACV, both of which provide some extent of astringent or antimicrobial effect.

I also suggested coming twice a week during this rebound period. This is not the usual frequency people come unless they are experiencing an acute flare. She was an excellent responder to acupuncture treatment, which reduced the intensity of erythema, exudation and itch. Within 25 days after her last 5mg dose of Xepasone, with twice weekly acupuncture treatment together with herbs, the patient arrived at a place where, despite having some doubts about the sustainability of the treatment, she could happily bathe her two children and also resume cooking for the house.

I asked her to come back for one last acupuncture treatment 2 weeks later if she felt it would be helpful, or not to come back at all if she felt confident enough in the progress.

The patient is a good responder to acupuncture, and that actually helps me alot as a practitioner. Why? Because when a patient responds well to acupuncture’s anti-inflammatory and immuno-modulatory effects, it mitigates the intensity of any acute flare, and allows the herbs to continue its positive effects.

Herbs also worked well for her because her presentation from a TCM point of view primarily that of damp accumulation as a results of Spleen deficiency. In the terms of herbal treatment, as soon as the acute flare was out of the way, we slowly shifted the prescription to one that tonified her Spleen (TCM Spleen) and helped with gut recovery.

There are some patients who present with an intense pompholyx flare, but do not respond as well to acupuncture treatment.  There are others who have more complicated presentation e.g. someone with a very deficient Spleen (TCM Spleen), who cannot handle strong herbal anti-microbials and anti-inflammatories during the acute phase of the rebound flare.