Hand dermatitis is not one specific
type of eczema as is atopic dermatitis or seborrheic dermatitis. Any
type of eczema that develops on the hands can be classified as “hand
dermatitis.” Why this special classification? Hand dermatitis often
has unique causes — frequently job-related — and can require special
Testing revealed that this
patient develops an allergic reaction after touching an
ingredient added to hundreds of diverse products — from
calamine lotion to shampoos.
with permission of the American Academy of
National Library of Dermatologic Teaching Slides)
Signs and Symptoms
The signs and symptoms may initially come and go. Without
treatment and preventive measures, hand dermatitis can become
severe. The following are common signs and symptoms:
Dry, chapped hands (may be first
Later the hands tend to develop
patches of red, scaly, and inflamed skin that can itch
Itchy blisters or other lesions may
form, skin may crack and weep
Pus-filled lesions, crusting, and
pain if skin becomes infected
Can spread beyond the hands,
particularly to the forearms and feet, if a skin infection
develops or an allergic reaction is not treated
Deformed nails when hand dermatitis
persists for a long time
Newborns to senior citizens develop
Estimates indicate that between 2%
and 10% of Americans have some form of hand dermatitis and hand
dermatitis may account for 80% of all job-related skin conditions.
Women may develop it more often
according to several studies. The reason: Women tend to work in
occupations that involve frequently immersing their hands in
water, such as nursing and hair styling. It is believed that 1 in
3 nurses has hand dermatitis.
Between the ages of 20 and 39, it
appears that hand dermatitis is most common, according to one
Hand dermatitis usually does not have one clear-cut cause. It
appears that many factors interact, including:
Genes. A tendency to develop
skin reactions or a certain type of eczema is often inherited.
Irritation. With repeat use or
short but heavy exposure, numerous everyday items can irritate
skin. Water is probably the most common irritant. Frequent hand
washing or immersing the hands in water too often can remove
protective oils from the skin. When the oils are removed faster
than they can be replaced, the skin becomes less pliable and more
susceptible to hand eczema. For more information about potential
irritants, visit Contact
Allergy. An allergic reaction
occurs when the body’s immune system overreacts to something that
does not cause everyone’s immune system to overreact. Common
allergens (substances that cause an allergic reaction) that lead
to hand dermatitis include nickel, Balsam of Peru (added to
fragrances, foods, and skin care products), rubber, and topical
vitamin E. For more information about potential allergens, visit
Poor glove hygiene. Wearing
gloves can protect the skin from substances found in the workplace
and while working around the home. However, slipping gloves on and
off may allow irritants or allergens to get inside the gloves.
This can trigger a flare-up. If this occurs, be sure to talk with
a dermatologist about best practices for wearing gloves.
Medical condition. Having an
atopic condition (atopic dermatitis, asthma, or hay fever)
increases the risk. When combined with frequent hand washing or
even frequently immersing the hands in water or chemicals, the
risk is even greater. An estimated 7% to 23% of people who have
atopic dermatitis also have hand eczema. In fact, some patients
who have atopic dermatitis during childhood find that their skin
clears during adolescence and that the eczema returns later, but
affects only the hands and feet.
Occupation. On-the-job tasks,
such as frequent hand washing, immersing your hands in water
several times a day, as well as using solvents and other chemicals
can strip the skin of its protective barrier. Nurses, hair
stylists, bartenders, chefs, caterers, mechanics, manual workers
in chemical companies, painters, and metalworkers — to name a few
— have an increased risk of developing hand eczema.
Stress. Periods of stress
worsen all types of eczema as well as increase the risk of
developing hand dermatitis.
Environment. Low humidity and
cold weather can rob the skin of moisture, which increases the
risk of developing some types of hand dermatitis. In other cases,
heat and high humidity increase the risk. For example, wearing
gloves in a hot and humid environment for long periods can
irritate the skin, leading to a flare-up.
heavily can increase the risk, especially if the person wears
gloves and the hands become overheated. Trapped inside the glove,
the perspiration can irritate the skin and increase the risk of
developing hand dermatitis.
Without proper diagnosis and treatment, hand dermatitis can become
chronic (long lasting), interfering with everyday activities and
on-the-job tasks. This can significantly diminish one’s quality of
Diagnosis can be challenging and require a bit of detective
work because so many factors often interact to cause hand
dermatitis. The following may be used to diagnose hand dermatitis:
Visual exam and medical history.
Diagnosis usually begins with a complete medical history and
visual examination of the skin. While collecting the patient’s
medical history, the dermatologist typically asks when the hand
dermatitis first occurred, if it has spread, treatments used, and
other specific questions.
Patch testing. Extensive patch
testing may be necessary to identify the cause. Patch testing
involves applying suspected allergens (substances to which a
patient is allergic) on the patient’s back. The amounts applied do
not cause a reaction if the patient is not allergic. If the
patient is allergic, an immediate reaction may occur; however,
most reactions are delayed. The patient returns to the doctor’s
office after 48 hours and again at 96 hours to be evaluated.
Scraping. Sometimes the skin
becomes infected. Scraping off a bit of the affected skin so that
it can be examined under the microscope will allow the
dermatologist to see if a fungal infection or other condition
Before prescribing a treatment plan, a dermatologist considers
several factors, including the test results, extent and severity
of the hand dermatitis, past treatment, patient’s age, and the
patient’s preference. A treatment plan often involves using
medication as directed and adding preventive measures:
Topical corticosteroids and tars.
These medications help reduce inflammation. Available in various
strengths ranging from mild to very potent, these medications
should be used as instructed. Applying larger amounts or more
often than directed can cause unwanted side effects, including
Topical calcineurin inhibitors.
An alternative to topical corticosteroids, these medications also
treat inflammation. Pimecrolimus, one type of topical calcineurin
inhibitor, has relieved chronic hand dermatitis in some patients.
Antibiotics. A topical or oral
antibiotic may be prescribed to clear an infection in the skin.
Botulinum toxin type A.
Studies show that patients whose hands perspire excessively may
get relief with periodic injections of this popular cosmetic
Phototherapy. A type of light
therapy called PUVA, which combines a medication called psorlen
with UVA light treatment, can help clear chronic hand dermatitis.
Oral corticosteroid, cyclosporine,
methotrexate, and mycophenolate mofetil. These medications
suppress the body’s immune system and may be prescribed if other
treatments have not effectively cleared a severe case of hand
Apply emollients and moisturizers.
These products help soften the skin and lock in moisture. For best
results, these should be applied after bathing and frequently
throughout the day.
Avoid allergens. If the
results of the patch testing indicate an allergy, the patient
should avoid all items that contain the allergen (substance
causing the allergy). For example, if the patch test shows an
allergy to nickel, the patient should avoid wearing costume
jewelry and eating foods that contain nickel, such as tomatoes and
canned foods. Some allergens are so common that it is best to ask
a dermatologist for a list of products that contain the allergen.
Avoid irritants. After asking
some questions, a dermatologist often can determine if an irritant
is causing the reaction. If this is the case, the dermatologist
will talk about options for avoiding the substance(s) that is
irritating the skin.
Change work habits. A few days
away from the job may clear a mild case. Changing a few habits can
help keep the skin clear. For example, if the patient wears gloves
at work, it is important to realize that substances on the hands
can get inside the gloves and irritate the skin, especially when
more than one substance gets inside the gloves.
Switch gloves. Sometimes a
material used to make the gloves causes hand dermatitis. For
example, some medical professionals develop raw, inflamed hands
after wearing latex gloves. Switching to a glove that does not
contain latex usually brings relief. A dermatologist can help a
patient find alternative gloves by accessing a database that lists
hundreds of gloves and alternatives that offer the same
Hand dermatitis often looks worse
while healing. This can be discouraging. Be sure to continue using
the medication as directed and keep all appointments.
Belsito DV et al. “Pimecrolimus Cream 1%: A Potential New
Treatment for Chronic Hand Dermatitis.” Cutis. 2004.
Cvetkovski RS et al. “Prognosis of Occupational Hand Eczema. A
Follow-up Study.” Archives of Dermatology. 2006.
Elston DM. “Hand dermatitis.” Journal of the American Academy
of Dermatology. 2002. August;47(2):291-299.
Fowler JF et al. “Hydrocortisone Butyrate 0.1% Cream in the
Treatment of Chronic Dermatitis.” Cutis. 2005.
Fowler, JF. “Contact Dermatitis.” Presented as a forum at: The
64th Annual Meeting of the American Academy of Dermatology. March
2006; San Francisco.
Heymann WR. “Hand Dermatitis.” Journal of the American Academy
of Dermatology. 2006. June;54(6):1078-1080.
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developed by the American Academy of Dermatology
As many as 1
in 6 people living with chronic hand dermatitis do not seek medical
attention. Treatment can ease discomfort — and when combined with
preventive measures — may lead to clearing.