What is hand eczema (hand dermatitis)?
Hand eczema, also called hand dermatitis, is a skin condition in which the hands develop a rash and become red, dry, cracked, and inflamed. Hand eczema is not contagious. The condition can eventually cause pain on contact with even simple solutions such as water. Hand dermatitis (also known as hand eczema) often results from a combination of causes, including genetic makeup (constitutional factors), injury (contact with irritants) and allergy. It is frequently caused or
aggravated by work, when it is known as occupational dermatitis. Hand dermatitis is particularly common in industries involving cleaning, catering, metalwork, hairdressing, healthcare and mechanical work.
Hand dermatitis varies in severity. It may affect the backs of the hands, the palms or both sites. Often it starts as a mild intermittent complaint, but it can become increasingly severe and persistent. The affected skin initially becomes red and dry, then progresses to itchy papules (bumps) and fluid-filled blisters (vesicles), scaling, cracking (fissures), weeping (exudation) and swelling (oedema). Bacterial infection can result in pustules, crusting and pain. Longstanding dermatitis at the ends of the fingers may result in deformed nails. Hand dermatitis can spread to affect other sites, particularly the forearms and feet.
Determine whether the hand eczema is caused by endogenous or exogenous factors by analyzing patient history, close relatives, previous dermatitis, careful inquiry as to the nature of their work, substances encountered at work, and relationship of the dermatitis to vacation periods. Patch testing is the only scientific ‘proof’ that a contactant is a dermatitis-producing allergen in a particular case. Dermatitis limited to the palms is often a sign of endogenous factors. Suspect endogenous causes if the dermatitis on the palms is symmetric. External irritants or allergens are more likely to penetrate the dorsal skin areas and therefore sign exogenous factors are likely in play.
Not everyone gets hand dermatitis. Many people are fortunate enough to have “tough” skin but, unfortunately, some people have skin that is easily damaged and thus, more susceptible to dermatitis. Those with hand dermatitis often have dermatitis elsewhere, and frequently blood relatives have hand dermatitis. You may not be able to toughen your skin, but there is an effective treatment to heal your dermatitis. Some people are more prone to hand dermatitis than others. They often have a personal or family history of atopic dermatitis, asthma or hay fever. They may have discoid eczema. Some have psoriasis, a common skin complaint best known for causing red scaly patches on elbows, knees and scalp. Sometimes emotional stresses make hand dermatitis worse, especially the type known as pompholyx in which crops of very itchy vesicles erupt on the palms.
The most common occupational factor leading to dermatitis is frequent immersion of the hands in water. This is particularly likely if the skin is exposed to detergents (e.g. hairdresers and shampoos) and solvents (e.g. painters and turpentine), as these eventually strip the skin of its natural protective layer. Friction and repetitive injury also damage the skin. Irritants result in much more damage once dermatitis has become established; a few minutes indiscretion can result in a flare-up that can last for several months. This is called irritant contact dermatitis. Allergy refers to specific immunological hypersensitivity: the skin reacts abnormally to a substance that doesn't affect others. An immediate reaction is known as contact urticaria; for example some people cannot use latex gloves because as soon as they put them on, their hands become red, swollen and itchy. Contact urticaria usually lasts for about 20 minutes; however latex allergy can be dangerous because there is a risk of anaphylaxis (generalised hives, difficulty in breathing and collapse). Luckily this is rare. Allergic contact dermatitis occurs hours to days after the contact has occurred, so it can be difficult to identify the cause. There are a huge number of items that can cause allergic contact dermatitis, including nickel, fragrances, rubber accelerators (in gloves) and p-phenylenediamine (permanent hair-dye). Caterers are prone to a combination of immediate and delayed allergic reactions to various proteins in food (protein contact dermatitis). Once a specific allergy has been identified, contact with the causative material must be strictly avoided long term to clear up the dermatitis and to prevent its recurrence.
With careful management, hand dermatitis usually recovers completely. A few days off work may be helpful. When occupational dermatitis is severe, it may not be possible to work for weeks or months. Occasionally a change of occupation is necessary. Where possible, avoid wet-work and contact with irritants. Protect your hands using vinyl gloves, which are less likely than rubber to cause allergic reactions. Don't wear these for long periods, as sweating will also aggravate dermatitis. Always make sure the gloves are scrupulously clean inside. Use emollients frequently. A thin smear of a thick barrier cream should be applied to all affected areas before work, and reapplied after washing and whenever the skin dries out. Your doctor will prescribe topical steroids to reduce inflammation. These come in various strengths and should only be applied to areas of active dermatitis once or twice daily. Generally a potent topical steroid is used for several weeks. If your dermatitis is infected, your doctor will prescribe a topical or oral antibiotic such as flucloxacillin for about a week.
More information on eczema
What is eczema? - Eczema is a heterogeneous group of different non-infectious skin diseases. Eczema occurs in both children and adults, but usually appears during infancy.
What types of eczema are there? - There are various types of eczema, including atopic eczema (atopic dermatitis), contact dermatitis, varicose eczema, discoid eczema, nummular eczema, stasis dermatitis.
What are the symptoms of eczema? - Symptoms of eczema are itching and redness, and may make the skin dry and flaky. Eczema makes the skin more sensitive.
What causes eczema? - The most common cause of eczema is a general allergic over-sensitivity. Other types of eczema arise as a result of causes within the body.
How does eczema affect people? - In eczema, the main problems occur in the epidermis where the keratinocytes become less tightly held together.
How is eczema diagnosed? - Eczema is usually diagnosed through a physical examination. Further tests may include skin biopsy or patch tests.
What are the treatments for eczema? - Avoidance of the aetiological factors is one important therapeutical approach. Symptomatic treatment includes topical and systemic treatment regimens.
How can eczema be prevented? - Eczema flare-ups can be prevented by avoiding exposure to extreme temperatures, dry air, harsh soaps and bubble baths.
How to deal with infant or baby eczema? - For mild to moderate baby eczema, the application of moisturizer on a regular basis can be very helpful. Avoid as many eczema triggers as possible.
What is atopic eczema and its treatment? - Atopic eczema (atopic dermatitis) is the commonest form of eczema and is closely linked with asthma and hayfever.
What is dyshidrotic eczema? - Dyshidrotic eczema is a form of eczema often seen on the hands and feet where tiny blisters of serum form just below the skin's surface.
What is nummular eczema? - Nummular eczema is a chronic eczema characterised by coin-shaped, sharply demarcated lesions. Nummular eczema is more common in males.
What is hand eczema (hand dermatitis)? - Hand eczema, also called hand dermatitis, is a skin condition in which the hands develop a rash and become red, dry, cracked, and inflamed.
What is varicose eczema? - Varicose eczema is due to increased pressure within the veins in the leg. Varicose eczema affects the lower legs people in their middle to late years.
What's seborrhoeic eczema? - Seborrhoeic eczema is a common skin disease affecting any sebum-(natural oil) producing area of the skin.