Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997.
Hand dermatitis is a common group of acute and chronic eczematous disorders that affect the dorsal and palmar aspects of the hand.
Hand dermatitis is also known as hand eczema.
Hand dermatitis is common (especially in young adult females) and accounts for 20–35% of all dermatitis. It may occur at any age, including during childhood. It is particularly prevalent in people with a history of atopic eczema.
Hand dermatitis is particularly common in industries involving cleaning, catering, metalwork, hairdressing, healthcare, housework, painting and mechanical work. This is mainly due to the contact with irritants, but specific contact allergies can contribute.
Hand dermatitis often results from a combination of causes, including:
Hand dermatitis is frequently caused or aggravated by work, when it is known as occupational dermatitis.
Irritants include water, detergents, solvents, acids, alkalis, cold, heat and friction. These damage the outer stratum corneum, removing lipids and disturbing the skin’s barrier function. Water loss and inflammation lead to further impairment of barrier function.
Contact allergy is a delayed hypersensitivity reaction with elicitation and memory phases involving T lymphocytes and release of cytokines.
Hand dermatitis may affect the backs of the hands, the palms or both. It can be very itchy, often burns, and is sometimes painful. It has acute, relapsing and chronic phases.
Acute hand dermatitis presents with:
Features of chronic hand dermatitis include:
There are various causes and clinical presentations of hand dermatitis.
Atopic hand dermatitis depends on constitutional weakness of the skin barrier function and is triggered by contact with irritants. It may affect one or both dorsal hands and palms. It may manifest as a discoid pattern of eczema. Patients may also have eczema in other sites including feet, hands, flexures.
Nummular dermatitis or discoid eczema tends to affect the dorsal surfaces of the hands and fingers as circumscribed plaques. Other sites of the body may or may not be affected.
Vesicular hand dermatitis is also known as pompholyx, cheiropompholyx and dyshidrotic eczema. Intensely itchy crops of skin-coloured blisters arise on the palms and the sides of the hands and fingers. Similar symptoms often affect the feet. It is likely this form of dermatitis is triggered by emotional stresses via sweating (hyperhidrosis).
Chronic relapsing vesiculosquamous dermatitis is a common pattern of palmar and finger dermatitis, in which episodes of acute vesicular dermatitis are followed by chronic scaling and fissuring.
Hyperkeratotic hand dermatitis is a chronic, dry, non-inflammatory palmar dermatitis. It can appear similar to palmar psoriasis, but is less red and less well circumscribed.
Fingertip dermatitis can be isolated to one or several fingers.
The hands are the most common site for irritant contact dermatitis, and is often due to wet work and repeated exposure to low-grade irritants. The finger-webs are the first place to be affected, but inflammation can extend to fingers, the backs of the hands and the wrists. Irritant contact dermatitis often spares the palms.
Allergic contact dermatitis may be difficult to distinguish from constitutional forms of hand dermatitis and irritant contact dermatitis. There are about 30 common allergens and innumerable uncommon or rare ones. Common allergens include nickel, fragrances, rubber accelerators (in gloves) and p-phenylenediamine (permanent hair-dye). Clues to contact allergy depend on the allergen, but may include:
Hand dermatitis is usually straightforward to diagnose and classify by history and examination, considering:
Differential diagnosis includes:
Patients with chronic hand dermatitis may have patch tests to detect contact allergens.
Patients with all forms of hand dermatitis should be most particular to:
Vinyl gloves are less likely than rubber gloves to cause allergic reactions.
Topical steroids reduce inflammation.
Secondary infection may require oral antibiotic, usually flucloxacillin.
Severe acute flares of hand dermatitis are treated with prednisone (systemic steroids) for 2–4 weeks.
Contact irritant hand dermatitis can be prevented by careful protective measures and active treatment. It is very important that people with atopic dermatitis (eczema) are made aware of the risk of hand dermatitis, particularly when considering occupation.
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.
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