Author: Dr. Louise Reiche, Dermatologist, Palmerston North, New Zealand, 2009.
Good hygiene practice and prevention of cross infection are essential for healthcare workers working in hospitals, clinics, rest care facilities and private homes. Hand care is necessary because healthcare workers are prone to hand dermatitis mostly due to contact with irritants during frequent hand washing or cleaning using aggressive disinfectants and detergents. The use of surgical gloves may also cause dermatitis in some individuals.
Exposure to irritants at home or during recreation may exacerbate the problem. Chemicals, extremes of temperature and humidity, mechanical injury (eg, rough surfaces and friction), plants, paints, some foods and ultraviolet radiation may injure the skin.
The skin barrier may be disrupted by:
Disruption of the skin barrier manifests as frank eczema or irritant contact dermatitis. Damaged skin is then susceptible to secondary bacterial infection and development of allergies (contact allergic dermatitis), aside from being itchy, sore and less supple.
Staphylococcus aureus and Streptococcus pyogenes are the usual causes of a bacterial infection. Hand dermatitis and wet work also predispose to yeast infection, generally presenting as paronychia infected by Candida albicans or as intertrigo between the fingers, and can be confused with tinea manuum (a type of fungal infection).
Evidence-based Cochrane reviews reveal that alcohol-based hand rubs are superior to regular hand washing for reducing transmission of diseases in hospitals and healthcare services. They can also minimise irritation compared with soap and water.
Gloves provide some barrier for the skin, but no one glove will resist all chemicals indefinitely. Choosing the right glove design and construction will give the best protection, provided it also fits well. Similarly, protection against mechanical risk varies with different gloves providing different strengths of abrasion, blade cut, tear and puncture resistance.
Healthcare facilities often have a health and safety officer with knowledge about suitable gloves. Safety shops also offer advice and a wide choice.
If hand eczema is slow to improve, seek a referral to a dermatologist for patch tests. Patch tests help decide if a contact allergy is contributing. About 60% of patients with chronic hand eczema have one or more positive contact allergens on patch testing. Loss of barrier function due to irritant contact dermatitis increases the risk of developing a contact allergy.
Management of hand eczema entails:
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