Hand Dermatitis


Key Points

  • Hand dermatitis may be difficult to treat due to the thickened skin surface of the hands and the frequent exposure of the hands to irritants and potentially exacerbating factors.
  • Hand dermatitis can range from an acute, extremely pruritic or painful eruption, characterized by deep-seated vesicles (dyshidrotic eczema, pompholyx), to the chronic hand dermatitis commonly seen in those in at-risk occupations.
  • The therapeutic strategy is to eliminate any external cause and to control the cutaneous inflammation. Management is typically through topically applied medications. For severe cases, systemic immunosuppression may be necessary.
  • All patients with hand dermatitis, independent of the clinical type, have reduced tolerance to irritants. Avoidance of irritants, including wetness, and frequent use of moisturizers are important.

Introduction

Inflammatory processes may involve the dorsal or palmar surfaces of the hands. Dorsal hand dermatitis is managed as is dermatitis elsewhere on the body; however, given the thickened skin surface of the hands and the frequent exposure of the hands to irritants and potentially exacerbating factors, hand dermatitis can be difficult to treat. This discussion is restricted to dermatitis based primarily on the palmar surface.

Hand dermatitis can range from an acute, extremely pruritic or painful eruption, characterized by deep-seated vesicles (dyshidrotic eczema, pompholyx), to the chronic hand dermatitis commonly seen in those in at-risk occupations. For therapeutic purposes, hand dermatitis can be classified into vesiculobullous types (acute and chronic) and hyperkeratotic hand dermatitis (no vesicles in any phase of the eruption). Both types may also be marked by edema, fissures, nummular plaques, and erosions. Persons who are predisposed with atopic dermatitis are at particular risk to develop hand dermatitis. Workers in certain industries, such as hairdressing, may be at increased risk and may affect quality of life as well as ability to work; in one study, between 0.7 and 1.5 cases per 1000 employees were affected by a hand dermatitis. The therapeutic strategy is to eliminate any external cause and to control the cutaneous inflammation. Management is typically through topically applied medications. For severe cases, systemic immunosuppression may be necessary.

All patients with hand dermatitis, independent of the clinical type, have reduced tolerance to irritants. The most common irritants are soap and water. Hand protection for all manual tasks, wet or dry, prevents exacerbations. Especially important is the use of vinyl gloves when doing any wet work. Moisturizing the hands regularly is critical in controlling most cases of hand dermatitis. Nightly application of a heavy moisturizer is strongly recommended.

There is an important differential diagnosis of hand dermatitis, including: atopic dermatitis involving the hand, tinea (superficial dermatophyte infection), allergic contact dermatitis, psoriasis, lichen planus, scabies, herpes simplex, pityriasis rubra pilaris, and cutaneous lymphoma. A skin biopsy and/or patch testing should be considered in treatment-refractory cases.

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