Hand Dermatitis (Eczema of the Hands)

What is hand dermatitis?

Hand dermatitis is the term for irritation, inflammation and a rash of the skin on the hands, often including the fingers. The hands are a fairly common site of skin problems since it is exposed to the environment and in contact with various substances that may act as allergens or irritants for the development of a rash. Dermatitis literally means inflammation of the skin and is used interchangeably with the term eczema. Although the condition is more likely to affect a person with an allergic constitution or people constantly touching harsh chemicals, hand dermatitis can sometimes occur spontaneously.

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Type of Hand Dermatitis

Various skin diseases can affect the hands, thereby causing hand dermatitis. The three conditions that are more likely to be considered as hand eczema include contact dermatitis (allergic and irritant), pompholyx (dyshidrotic eczema), tinea manuum (fungal infection of the hand) and xeroderma (dry skin). Some of these condition do not cause inflammation of the skin as such. However, it is still referred to as hand eczema since it presents with itching, a rash and peeling of the skin on the hands and fingers.

Contact dermatitis of the hands

There are two types of contact dermatitis – allergic and irritant. Both are more likely to affect the hands and fingers more than any other site on the body, especially irritant contact dermatitis. Contact dermatitis as the name suggests is skin inflammation caused by contact with certain substances. Sometimes these substances are harmless but a person is sensitive to it due to an abnormal immune reaction. In this instance it is known as allergic contact dermatitis. Irritation of the skin with harsh chemicals and abrasive substances damages the skin of any person, irrespective of individual sensitivity. This type of contact dermatitis is therefore known as irritant contact dermatitis.

Pompholyx of the hands

Pompholyx is a skin condition that mainly affects the hands. It can also occur on the feet in some instances. Pompholyx of the hands is more specifically known as cheiropompholyx. The cause of pompholyx is unknown. First tiny fluid-filled blisters appears on the hands, especially on the fingers and palms. It is itchy and may have a burning sensation. The blisters burst and the skin peels at the site. In chronic cases, blisters may not occur. Due to its characteristic appearance of blisters, the condition is also know as vesicular eczema. Another name for pompholyx is dyshidrotic dermatitis.

Fungal infection of the hands

Superficial infections caused by fungi commonly cause an itchy skin rash with peeling of the skin. These infections are mainly caused by dermatophytes, a type of fungus that is only limited to the skin. Dermatophyes cause a fungal infection of the skin at many sites throughout the body with the feet, groin and scalp being the most common sites. Due to the circular rash caused by dermatophytes, it is also commonly known as a ringworm infection. However, fungi are not worms. A dermatophyte infection of the hand is known as tinea manuum and when it affects the fingernails specifically then it is known as tinea unguium.

Dry skin of the hand

Excessive dryness of the skin is known as xeroderma. Sometimes it is caused by various skin diseases that affected the skin’s natural ability to moisturize itself and prevent dryness. However, the more common cause of xeroderma of the hands are environmental conditions. It is mainly seen in winter when the air is dry. Contact with strong chemicals, abrasives and antibacterial hand washes can also cause xeroderma, which is often more pronounced on the fingers, especially the finger tips and knuckles. The dryness of the skin may lead to itching, peeling and cracking of the skin.

Other skin conditions

  • Atopic dermatitis
  • Bacterial infections
  • Discoid eczema
  • Psoriasis vulgaris
  • Nummular dermatitis

Rash and Symptoms

A rash is the main symptom of hand eczema. The rash in hand eczema can vary in presentation depending on the type of disease and cause. Common rash symptoms include :

  • Dryness of the skin
  • Redness
  • Cracking of the skin
  • Discharge – oozing from the rash
  • Blisters, papules or plaques
  • Swelling of the skin

Other symptoms

Itching is the most common symptom of hand eczema that accompanies the rash. It can vary in intensity and duration. The itching may be related to the skin problem itself, or arise with dryness of the skin seen in most types of hand dermatitis. The itching tends to be a vicious cycle – scratching further damages and inflames the skin thereby worsening the itch.

Apart from a prominent rash and itching, there are few other symptoms that occur with hand eczema apart from a burning sensation at times or pain in rare instances. Secondary bacterial infections may arise at the site of the rash, often as result of scratching and contamination of the affected area. This may lead to other symptoms such as pain, foul smelling pustular discharge, fever and sometimes even partial loss of function of the affected hand.

Hand Eczema Causes

The causes of hand eczema varies based on the type of skin condition. Some of these causes and triggers include :

  • Allergens – latex, wool, metals, plant and plant material, fragrances and certain textiles.
  • Autoimmune diseases
  • Drug hypersensitivity
  • Irritants – soaps, detergents, bleaches, saliva, jewelry, soil, industrial dusts, fibers, dry cold air and water.
  • Liver failure
  • Sun exposure

Diagnosis of Hand Dermatitis

Hand eczema is not a condition on its own. Rather it is one of various types of skin diseases that affects the hand. Therefore it is important to identify the causative condition in order to initiate the appropriate treatment. The clinical presentation coupled with the medical history may be sufficient for a diagnosis. Ideally this diagnosis should be made by a dermatologist. Further investigations may also be necessary such as :

  • Allergy skin patch testing
  • Examination under a Woods lamp
  • Skin scrapings and microscopic examination
  • Skin biopsy and microscopic examination of the tissue sample
  • Various blood tests such a complete blood count (CBC), IgE, RAST and liver function test

Hand Dermatitis Pictures

Pictures sourced from Dermatology Atlas Brazil (courtesy of Samuel Freire da Silva, M.D.) and Wikimedia Commons.

Picture of irritant contact dermatitis

Picture of pompholyx on the hand

Picture of fungal infection of the hands (tinea manuum)

Picture of xeroderma (dry skin) on the knuckles

Treatment

The treatment of hand eczema has to be directed at the underlying cause. Therefore proper diagnosis of the causative skin condition is essential. Some of these treatment measures include :

  • Antihistamines
  • Corticosteroids (topical and oral)
  • Emollients and moisturizers
  • Antifungal (topical and oral)
  • Antimicrobial agents
  • Antibiotics
  • Immune modulators and immunosuppressants
  • Coal tar
  • Salicylic acid

Prevention

There is no specific ways of preventing hand eczema. The condition may not arise in every person who are exposed to the same allergens, triggers and irritants. However, certain measures that may apply to most sufferers irrespective of the underlying skin condition includes :

  • Wash the hands with mild soaps.
  • Use gloves when making contact when gardening or washing dishes.
  • Non-scented emollients and moisturizers should be used several times daily.
  • Use sunscreens on the hands and fingers.
  • Avoid scratching as far as possible. Petroleum jelly is an effective means to limit the damage to the skin with unintentional scratching while asleep.

References :

http://dermnetnz.org/dermatitis/hand-dermatitis.html

http://www.nationaleczema.org/living-with-eczema/hand-eczema

http://www.atlasdermatologico.com.br/

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