Fasd (Venesection) in Refractory Post-COVID-19 Pompholyx: Two Case Reports

Pompholyx (dyshidrotic eczema) is a relapsing vesicular dermatitis of the hands and feet associated with intense pruritus, pain, and impaired hand function. Management of refractory disease remains challenging. Faṣd (therapeutic venesection), a classical Ilāj-bit-Tadbīr intervention in Unani medicine, has been proposed as an adjunct therapy, though contemporary clinical evidence remains limited. Two adults with chronic, refractory palmar pompholyx unresponsive to standard topical therapy underwent a standardised Faṣd protocol comprising four sessions over 60 days. Venesection from the dorsal third of the metacarpal vein was performed under strict antisepsis, with withdrawal titrated to a visible lightening of venous efflux and patient tolerance. Topical emollients were permitted, while systemic immunosuppressants were avoided. Outcomes were assessed on days 0, 15, 30, 45, and 60, including itch intensity (0–10), Investigator’s Global Assessment (0–4), and a HECSI-informed severity score. Absolute eosinophil counts and erythrocyte sedimentation rates were measured at baseline and day 60. Adverse events and functional improvements were recorded. Both participants showed improvement from severe to mild disease activity by day 60, with >75% reduction in severity scores, recovery of hand function, and no adverse events. Laboratory trends were concordant with clinical recovery. No relapse occurred during the 8-month follow-up. A standardized Faṣd protocol demonstrated feasibility and clinical benefit in two refractory post-COVID-19 pompholyx cases. Controlled trials with blinded assessments and validated clinical and mechanistic endpoints are warranted.