Pompholyx of the nail organ and the true onychomycosis

Pompholyx is one clinical form of the endoparasitic-hematogenous skin eruptions. It is characterized by sago-grain-like, deeply embedded blisters or pustules within the normal, primarily non-inflamed skin, localized to the palms, soles, fingers, toes and interdigital webs, and in the nail organ. The blisters may be located in the nail wall causing paronychia, and/or beneath the nail plate causing onychia. The discussion of the etiology and pathogenesis of the pompholyx of the nail organ is inseparable from pompholyx at other sites (e.g. palms and soles), since they are identical. Hence, the term pompholyx should replace such misleading terms as infectious eczematoid dermatitis, id eruption, of the hand and/or feet, dermato- or epidermophytosis, dyshidrosis, and the vernacular athlete's foot. Even though hyphomycetes (true pathogens and common molds) of many sorts may be detected in the roof of the blisters, particularly on the feet, and scrapings of detritus from the nails, they have no role in the etiology or pathogenesis of this condition. Due to an universal infection immunity pompholyx is not infectious or transmissible. True onychomycosis is clinically and pathogenetically an entirely different condition. The purpose of this paper is to clarify the fundamental differences in etiology and pathogenesis between the two conditions.