Hand Dermatitis

Hand dermatitis is also called hand eczema. It is common and can affect about one in every 20 people. It can start in childhood as part of an in-built tendency to eczema but is most familiar in teenagers and adults. 

Hand dermatitis may be a short-lived, transient problem. However, in some people, it lasts for years and can have a significant impact on daily life.

People who have had eczema in childhood (atopic eczema), as well as those who work in jobs with frequent water contact (wet work), have a high risk of getting hand dermatitis. 

In many people, hand dermatitis happens because of direct damage to the skin by harsh chemicals as well as irritants, especially soap, detergent, and repeated contact with water. This condition is called irritant contact dermatitis.

Skin contact with allergens such as perfumes, metals, rubber, or leather can also cause dermatitis in people with an allergy to these substances. This is called allergic contact dermatitis.

In many cases, however, the cause of a patient’s hand dermatitis is unknown, and there is no identifiable trigger. It is also common for someone to have more than one cause of hand dermatitis, for example, a combination of atopic dermatitis and irritant or allergic contact dermatitis.

No, it is not hereditary; however, the tendency to get hand dermatitis can run in families along with atopic dermatitis, asthma, and hay fever.

The affected areas of skin feel hot, painful, rough, scaly, and itchy. There may be itchy little blisters or painful cracks. This skin problem may, in turn, result in pain when moving the hand and fingers.

In hand dermatitis, the skin is inflamed, red, and swollen, with a damaged dried-out or scaly surface, which makes it look flaky. There may be cracked areas that bleed and ooze. 

Sometimes small water blisters can be seen on the palms or sides of the fingers. Different parts of the hand can be affected, such as the finger webs, fleshy fingertips, or center of the palms. 

There are several different patterns of hand dermatitis, but these do not usually tell us its cause, and the pattern can change over time in one person. 

Hand dermatitis may get infected with bacteria called Staphylococcus or Streptococcus. This problem causes more redness, soreness, crusting, oozing, and spots or pimples.

Diagnosing hand dermatitis is done by carefully examining the skin. Examining other body areas will confirm the eczema is isolated to the hands, or suggest a more widespread skin condition is involved.

Identifying a cause for your hand dermatitis involves looking at the pattern of your hand dermatitis and highlighting potential triggers.

Patch testing is used to find out if an allergy (e.g., to metal) is causing allergic contact dermatitis. This testing is usually done in a dermatology department. This cause may be one of several reasons for a person’s hand dermatitis. The tests are done over several days, and on the final day, should be read and explained by an expert. Most adults are tested for 50 or more common allergies. More specific allergens may also be tested depending on the history of a patient’s hand dermatitis.

Psoriasis of the hands can look similar to dermatitis, especially when there are thick, scaly patches on the palms.

Ringworm or fungus infection also causes itchy scaly rashes. These conditions usually start on the feet or groin but can spread to the hands and nails and sometimes affect only one hand.

Occupations with a high chance of hand dermatitis include cleaners, carers, people who look after young children, chefs, hairdressers, mechanics, doctors, dentists, nurses, florists, machine operators, aromatherapists, beauticians, and construction workers. Any job which involves repeated contact with water or hand washing more than ten times a day (‘wet work’) has an increased chance of causing hand dermatitis.

In most cases, treatment controls the condition but does not cure it. Early identification and treatment may avoid long-standing issues related to hand dermatitis. In people with allergic contact dermatitis, avoiding the allergen(s) may help or even clear the hand dermatitis.

Moisturizers (emollients) are an essential part of treating hand dermatitis.

Using moisturizers as soap substitutes are vital as they clean the skin without drying and damaging it like liquid soap and bar soap can.

Steroid creams and ointments are the most expected prescribed treatment for hand dermatitis. They relieve symptoms and calm inflamed skin.

If they are overused, there is a risk of skin thinning. However, when used as suggested by your doctor or nurse, topical steroids do not usually cause these problems.

Antihistamine tablets are not often helpful in hand dermatitis.  Sedating antihistamines are sometimes taken for a few days when eczema flares up to help sleep. Sedating antihistamines cause drowsiness and should not be taken before driving and using machinery.

Calcineurin inhibitors are creams and ointments used to treat dermatitis instead of steroids. While they may work less well than strong steroids, they do not carry any risk of skin thinning. They can often cause burning or stinging after application. 

Ultraviolet (UV) Therapy is a hospital-based treatment for very severe hand dermatitis. It involves visiting the hospital for treatment two or three times a week for about six weeks.

Steroid tablets may be given for a few weeks for a severe flare of hand dermatitis. The dose is usually decreased gradually over a few weeks. Longer-term use is not advisable due to the side effects.

Systemic immunosuppressants are powerful treatments sometimes prescribed by specialists to treat severe hand dermatitis. 

These medications used include azathioprine, ciclosporin, and methotrexate. These treatments are usually reserved for more severe cases or when other treatment options have failed to control symptoms. 

They are not suitable for all people. People taking these tablets need to be monitored carefully and have regular blood tests.

Always use protective gloves at work and home when in contact with irritating chemicals and water. Wear cotton gloves underneath or chose cotton-lined gloves if you have to work for more extended periods.

The best choice of glove material (rubber, PVC, nitrile, etc.) will depend on which chemicals or allergens are being handled. Gloves should be clean and dry inside and not broken. Some people have boxes of nitrile gloves in the kitchen and bathroom, to help remember to use these when preparing food, cleaning surfaces, and washing hair. 

If gloves cannot be worn, a barrier cream should be applied before exposure to irritants. After exposure, wash the hands carefully with a soap substitute, rinse, dry thoroughly, then moisturize.