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Hand Dermatitis (Eczema)

http://www.skincarephysicians.com/eczemanet/hand_dermatitis.html American Academy of Dermatology

Signs and Symptoms
The signs and symptoms may initially come and go. Without treatment and preventive measures, hand dermatitis can become severe. The following are common signs and symptoms:

• Dry, chapped hands (may be first sign)
   

• Later the hands tend to develop patches of red, scaly, and inflamed skin that can itch
   

• Itchy blisters or other lesions may form, skin may crack and weep
   

• Pus-filled lesions, crusting, and pain if skin becomes infected
   

• Can spread beyond the hands, particularly to the forearms and feet, if a skin infection develops or an allergic reaction is not treated
   

• Deformed nails when hand dermatitis persists for a long time

Who Gets

• Newborns to senior citizens develop hand dermatitis. 
   

• Estimates indicate that between 2% and 10% of Americans have some form of hand dermatitis and hand dermatitis may account for 80% of all job-related skin conditions. 
   

• Women may develop it more often according to several studies. The reason: Women tend to work in occupations that involve frequently immersing their hands in water, such as nursing and hair styling. It is believed that 1 in 3 nurses has hand dermatitis. 
   

• Between the ages of 20 and 39, it appears that hand dermatitis is most common, according to one study.

Causes 
Hand dermatitis usually does not have one clear-cut cause. It appears that many factors interact, including:

• Genes. A tendency to develop skin reactions or a certain type of eczema is often inherited.
   

• Irritation. With repeat use or short but heavy exposure, numerous everyday items can irritate skin. Water is probably the most common irritant. Frequent hand washing or immersing the hands in water too often can remove protective oils from the skin. When the oils are removed faster than they can be replaced, the skin becomes less pliable and more susceptible to hand eczema. For more information about potential irritants, visit Contact Dermatitis. 
   

• Allergy. An allergic reaction occurs when the body’s immune system overreacts to something that does not cause everyone’s immune system to overreact. Common allergens (substances that cause an allergic reaction) that lead to hand dermatitis include nickel, Balsam of Peru (added to fragrances, foods, and skin care products), rubber, and topical vitamin E. For more information about potential allergens, visit Contact Dermatitis.
   

• Poor glove hygiene. Wearing gloves can protect the skin from substances found in the workplace and while working around the home. However, slipping gloves on and off may allow irritants or allergens to get inside the gloves. This can trigger a flare-up. If this occurs, be sure to talk with a dermatologist about best practices for wearing gloves.

Risk Factors

• Medical condition. Having an atopic condition (atopic dermatitis, asthma, or hay fever) increases the risk. When combined with frequent hand washing or even frequently immersing the hands in water or chemicals, the risk is even greater. An estimated 7% to 23% of people who have atopic dermatitis also have hand eczema. In fact, some patients who have atopic dermatitis during childhood find that their skin clears during adolescence and that the eczema returns later, but affects only the hands and feet. 
   

• Occupation. On-the-job tasks, such as frequent hand washing, immersing your hands in water several times a day, as well as using solvents and other chemicals can strip the skin of its protective barrier. Nurses, hair stylists, bartenders, chefs, caterers, mechanics, manual workers in chemical companies, painters, and metalworkers — to name a few — have an increased risk of developing hand eczema.
   

• Stress. Periods of stress worsen all types of eczema as well as increase the risk of developing hand dermatitis. 
   

• Environment. Low humidity and cold weather can rob the skin of moisture, which increases the risk of developing some types of hand dermatitis. In other cases, heat and high humidity increase the risk. For example, wearing gloves in a hot and humid environment for long periods can irritate the skin, leading to a flare-up.
   

• Perspiration. Perspiring heavily can increase the risk, especially if the person wears gloves and the hands become overheated. Trapped inside the glove, the perspiration can irritate the skin and increase the risk of developing hand dermatitis.

Duration
Without proper diagnosis and treatment, hand dermatitis can become chronic (long lasting), interfering with everyday activities and on-the-job tasks. This can significantly diminish one’s quality of life.

 

How Diagnosed 
Diagnosis can be challenging and require a bit of detective work because so many factors often interact to cause hand dermatitis. The following may be used to diagnose hand dermatitis:

• Visual exam and medical history. Diagnosis usually begins with a complete medical history and visual examination of the skin. While collecting the patient’s medical history, the dermatologist typically asks when the hand dermatitis first occurred, if it has spread, treatments used, and other specific questions. 
   

• Patch testing. Extensive patch testing may be necessary to identify the cause. Patch testing involves applying suspected allergens (substances to which a patient is allergic) on the patient’s back. The amounts applied do not cause a reaction if the patient is not allergic. If the patient is allergic, an immediate reaction may occur; however, most reactions are delayed. The patient returns to the doctor’s office after 48 hours and again at 96 hours to be evaluated. 
   

• Scraping. Sometimes the skin becomes infected. Scraping off a bit of the affected skin so that it can be examined under the microscope will allow the dermatologist to see if a fungal infection or other condition exists.

Treatment
Before prescribing a treatment plan, a dermatologist considers several factors, including the test results, extent and severity of the hand dermatitis, past treatment, patient’s age, and the patient’s preference. A treatment plan often involves using medication as directed and adding preventive measures:

Medication

• Topical corticosteroids and tars. These medications help reduce inflammation. Available in various strengths ranging from mild to very potent, these medications should be used as instructed. Applying larger amounts or more often than directed can cause unwanted side effects, including thinning skin. 
   

• Topical calcineurin inhibitors. An alternative to topical corticosteroids, these medications also treat inflammation. Pimecrolimus, one type of topical calcineurin inhibitor, has relieved chronic hand dermatitis in some patients.
   

• Antibiotics. A topical or oral antibiotic may be prescribed to clear an infection in the skin.
   

• Botulinum toxin type A. Studies show that patients whose hands perspire excessively may get relief with periodic injections of this popular cosmetic treatment.
   

• Phototherapy. A type of light therapy called PUVA, which combines a medication called psorlen with UVA light treatment, can help clear chronic hand dermatitis. 
   

• Oral corticosteroid, cyclosporine, methotrexate, and mycophenolate mofetil. These medications suppress the body’s immune system and may be prescribed if other treatments have not effectively cleared a severe case of hand dermatitis.

Prevention

• Apply emollients and moisturizers. These products help soften the skin and lock in moisture. For best results, these should be applied after bathing and frequently throughout the day.
   

• Avoid allergens. If the results of the patch testing indicate an allergy, the patient should avoid all items that contain the allergen (substance causing the allergy). For example, if the patch test shows an allergy to nickel, the patient should avoid wearing costume jewelry and eating foods that contain nickel, such as tomatoes and canned foods. Some allergens are so common that it is best to ask a dermatologist for a list of products that contain the allergen. 
   

• Avoid irritants. After asking some questions, a dermatologist often can determine if an irritant is causing the reaction. If this is the case, the dermatologist will talk about options for avoiding the substance(s) that is irritating the skin. 
   

• Change work habits. A few days away from the job may clear a mild case. Changing a few habits can help keep the skin clear. For example, if the patient wears gloves at work, it is important to realize that substances on the hands can get inside the gloves and irritate the skin, especially when more than one substance gets inside the gloves. 
   

• Switch gloves. Sometimes a material used to make the gloves causes hand dermatitis. For example, some medical professionals develop raw, inflamed hands after wearing latex gloves. Switching to a glove that does not contain latex usually brings relief. A dermatologist can help a patient find alternative gloves by accessing a database that lists hundreds of gloves and alternatives that offer the same protection.

Hand dermatitis often looks worse while healing. This can be discouraging. Be sure to continue using the medication as directed and keep all appointments.

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