Hand dermatitis

Hand dermatitis (hand eczema). DermNet NZ
12/24/2007 06:39 PM
DermNet NZ
Authoritative facts about the skin from the New Zealand Dermatological Society Incorporated.
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Hand dermatitis
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.
Hand dermatitis
Aggravating factors
Constitutional factors
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.
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Hand dermatitis (hand eczema). DermNet NZ
12/24/2007 06:39 PM
Contact with irritants
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
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.
Patch tests
If you have troublesome dermatitis, consult a dermatologist for advice. Often it is advisable to arrange for patch
tests to distinguish contact allergies from irritant reactions. A batch of materials including the suspected allergen
are applied to the upper back in a concentration that would produce no reaction if the patient were not
sensitised. The patch tests are removed 48 hours later and a final reading is made at 96 hours.
Patch tests in patients with hand dermatitis



Patch tests applied
Multiple patch test reactions
Typical positive reaction
Treatment
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.
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Hand dermatitis (hand eczema). DermNet NZ
12/24/2007 06:39 PM
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.
See a dermatologist if your dermatitis persists more than a few months or is severe. You may be treated with a
course of oral steroids (prednisone) or other immunosuppressive medication. A form of ultraviolet radiation
treatment called (PUVA) may be recommended.
Related information
On DermNet NZ:
Dermatitis
Allergic contact dermatitis
Irritant contact dermatitis
Pompholyx
Nummular dermatitis
Patch testing
Other websites:
Hand eczema: Occupational Dermatology Research and Education Centre, Austrlia
Contact Dermatitis, Irritant – emedicine dermatology, the online textbook
Books:
See the DermNet NZ bookstore
DermNet does not provide an on-line consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.
Created 1997. Last updated 15 Mar 2007. © 2007 NZDS. Disclaimer.
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