Hand Eczema- treatment, symptoms and cause of Hand Eczema

Hand eczema is a very common, chronic skin disorder. It represents a large proportion of occupation-associated skin disease. It may be associated with other cutaneous disorders such as atopic dermatitis or may occur by itself. Similar to other forms of dermatitis, both exogenous and endogenous factors play important roles in the expression of hand dermatitis. Chronic, excessive exposure to water and detergents may initiate or aggravate this disorder. It may present with dryness and cracking of the skin of the hands as well as with variable amounts of erythema and edema. Often, the dermatitis will begin under rings where water and irritants are trapped. A variant of hand dermatitis, dyshidrotic eczema, presents with multiple, intensely pruritic, small papules and vesicles occurring on the thenar and hypothenar eminences and the sides of the fingers. Lesions tend to occur in crops that slowly form crusts and heal.

The evaluation of a patient with hand eczema should include an assessment of potential occupation-associated exposures. Predominant involvement of the dorsal surface of the hands with sparing of the palmar surface suggests a possible contact dermatitis. The history should be directed to identifying possible irritant or allergen exposures. The use of rubber gloves to protect dermatitic skin is sometimes associated with the development of delayed type hypersensitivity reactions to agents used for cross-linking rubber. Such reactions can be detected by patch testing. Less commonly, patients may manifest hand dermatitis as a consequence of developing immediate type hypersensitivity reactions to latex. These are of particular concern since these patients are at risk for anaphylactic reactions. The most sensitive method of detection is the use of scratch testing with latex extract. However, this should be done with extreme caution only in a setting where an anaphylactic reaction can be treated. A latex radioallergosorbent test is available but is only about 60% sensitive.

Treatment of Hand Eczema

Therapy of hand dermatitis is directed toward avoidance of irritants, identification of possible contact allergens, treatment of coexistent infection, and application of topical glucocorticoids. Whenever possible, the hands should be protected by gloves, preferably vinyl. Most patients can be treated with cool moist compresses (dressings) to dry and debride acute inflammatory lesions and to decrease swelling, followed by application of a mid- to high-potency topical glucocorticoid in a cream or ointment base. As with atopic dermatitis, treatment of secondary infection by staphylococci or streptococci is essential for good control. Additionally, patients with hand dermatitis should be examined for dermatophyte infection by KOH preparation and culture.