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Skin Care Today |
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Managing Hand Eczema
First do no harm
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A lmost everyone, except perhaps royalty, will have some form
of hand dermatitis at some point in their lifetimes. Many studies show that 5 percent of the population with European ancestry have had
an overt case of this disorder, and another 10 percent of that population have clinical symptoms, even though their condition may not be
obvious in a physical examination. These patients may have only subjective findings.
The most obvious cases of hand
dermatitis could be diagnosed by medical students—red, scaly, eczematous hands and fingers with cracks and fissures that can
eventually bleed. However, if the plaques are sharply marginated, located in the central palm, and associated with plaques on other parts
of the body, the diagnosis is more likely psoriasis, which affects 3 percent of the Caucasian population. The more
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exogenous. The endogenous form is found in that approximately third of the population that is atopic—those with allergies, asthma,
and eczema. Foods or airborne allergens may cause their hand eczema, as well as substances topically applied to the skin. Exogenous factors
in hand eczema include those to which one has a true allergy and those that are simply irritants.
Allergic contact
dermatitis (ACD) occurs in 10 to 15 percent of the population and is usually caused by a type-IV, delayed-type hypersensitivity. This
typically takes 24 to 96 hours to develop. ACD can be caused by a number of substances, such as plants
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feels stinging and burning and quickly develops dermatitis. This type of reaction is knows to afflict 5 to 8 percent of health care workers
who have extensive use of latex gloves.
Environmental safety has presented a new cause of hand dermatitis in offices.
Many of the hand eczema sufferers now work in offices handling paper or corrugated boxes. The recycled paper contains residual chemicals
that irritate the skin, such as formaldehyde and whiteners, and cause irritant or allergic contact dermatitis. In physician offices there
seem to be as many or more hand
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subtle cases require more clinical expertise. There may be little or no erythema, especially in darker skin types. Magnification may be
required to reveal the scaling. Or there may be no
clinical Topical products
such as Proteque
contain no steroids
yet deliver fast and
long-lasting
results
in many patients. signs whatsoever—simply the symptoms of burning, stinging, sensitive hands that are generally
"uncomfortable."
Possible Etiologies
Hand dermatitis can
be divided in two major categories—endogenous and
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(chrysanthemums, poison oak and ivy), foods (parsley, onion, garlic), fragrances, clothing, dyes, rubber, solvents, metals, chemicals such
as formaldehyde, and many more. Diagnosis of ACD in any part of the body, including the hands, involves patch testing. "Level one"
patch testing is done by most dermatologists. It consists of the application of 20 common allergens to the upper back. These chemicals are
left in place for 48 hours, then the area is observed for allergic reactions to any of the applied substances. More sophisticated ACD
testing is done at tertiary-care dermatology centers to look for more esoteric and unusual allergic reactions. The obvious treatment for ACD
is to avoid the offending antigen, which may be quite difficult at times, for example, nickel is ubiquitous and very hard to avoid
completely.
Sometimes, the allergic reaction is a type-I, IgE-mediated reaction that occurs immediately upon contact
with the antigen. This is frequently seen in the medical setting—the nurse who dons a pair of latex gloves and immediately
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dermatitis problems with the office staff as with doctors and nurses.
Irritant contact dermatitis (ICD) is almost
ubiquitous. It can be caused by any excessive exposure to water or an irritating substance, such as soaps, shampoos, perms, facial cosmetics,
cosmetic nail glues, recycled office papers, nickel in jewelry, powder in gloves, or garden chemicals. Exposure to chemicals in the workplace,
or at home doing hobbies, can also be the cause of ICD. As said before, a full–blown classic case of hand dermatitis may not develop in
everybody, but irritation will be noticed by most. If an irritant were used long enough and in large enough quantities, an irritant contact
dermatitis would develop in anyone.
Less common causes of hand dermatitis include tinea (especially if only one hand is
involved—remember to check both feet for fungus causing the "two foot, one hand" itchy scaliness), which requires a KOH prep
for diagnosis. Psoriasis and other skin disorders are easily diagnosed by dermatologists by coexisting skin findings.
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Laura E. Skellchock, M.D.
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