A rare presentation of pompholyx in a child mimicking bullous pemphigoid

Abstract

Pompholyx, or dyshidrotic eczema, an eczematous condition predominantly seen in adults, occasionally presents in children, where it can be mistaken for other bullous diseases, such as bullous pemphigoid (BP). This case report describes a rare and atypical presentation of pompholyx in a 7-year-old male who exhibited vesicular and bullous lesions on the palms, soles, and dorsae of the feet, mimicking BP. Histopathological examination showed spongiotic reaction and intraepidermal vesicle formation, and direct immunofluorescence was negative for immunoglobulin (Ig)G, IgA, IgM, and C3 deposits, ruling out BP and confirming a diagnosis of pompholyx. Treatment with systemic and topical corticosteroids and emollients led to rapid improvement, with complete resolution in 1 month. A 3-month follow-up showed no recurrence. This case emphasizes the diagnostic challenge of differentiating pompholyx from BP in pediatric patients due to clinical overlap. Accurate identification is essential, as management strategies differ significantly; misdiagnosis can lead to unnecessary immunosuppressive therapy. This report also highlights the need for increased awareness of atypical presentations of pompholyx in children to optimize patient outcomes and reduce treatment-related complications.