Dermatitis of the hand

what is hand dermatitis?

Hand dermatitis is a common group of acute and chronic eczematous disorders that affect dorsal and palm hand aspects.

Hand dermatitis is also known as hand. eczema.

See more images of hand dermatitis.

Who gets hand dermatitis?

Hand dermatitis is common (especially in young adult women) and accounts for 20 to 35% of all dermatitis. It can occur at any age, even during childhood. It is particularly predominant in people with a history of atopic eczema.

Chronic hand dermatitis is estimated to affect 10-15% of the population. [1].

Hand dermatitis is particularly common in the cleaning, catering, metalwork, hairdressing, health care, housekeeping, painting, and mechanical industries. This is mainly due to contact with irritants, but specific contact allergies You can contribute [2].

What causes hand dermatitis?

Hand dermatitis often results from a combination of causes, including:

• Genetic and unknown factors (constitutional hand dermatitis)
• injuries (contact irritating dermatitis)
• Immune reactions (allergic contact dermatitis).

Hand dermatitis is often caused or aggravated by work when it is known as occupational dermatitis.

Irritants include water, detergents, solvents, acids, alkalis, cold, heat, and friction. These can damage the exterior stratum corneum, removing lipids and disturbing the barrier function of the skin. loss of water and inflammation lead to further impairment of the barrier function.

In atopic dermatitis, a deficiency of proteins such as filaggrin in the stratum corneum leads to a barrier. dysfunction resulting in water loss and easy penetration by irritants and Allergens [3].

Contact allergy it's a delay hypersensitivity reaction with activation and memory phases involving T lymphocytes and release of cytokines [2].

What are the clinical features of hand dermatitis?

Hand dermatitis can affect the backs of the hands, the palms, or both. It can be very itchy, often burns, and is sometimes painful. It has acute, recurrent and chronic phases.

Acute hand dermatitis presents with:

• Red macules, papules and plates
• Swelling
• blisters and crying
• Fissure.

Characteristics of chronic hand dermatitis include:

• dryness and scale
• Lichenification.

There are various causes and clinical presentations of hand dermatitis.

Atopic dermatitis of the hand

Atopic hand dermatitis is caused by constitutional weakness of the skin barrier function and is triggered by contact with irritants. It can affect one or both hands and dorsal palms. It can manifest as a discoid Eczema pattern. Patients may also have eczema on other sites, such as feet, hands, push-ups.

Nummular dermatitis

Nummular dermatitis (discoid eczema) tends to affect the dorsal surfaces of the hands and fingers as circumscribed plaques Other body sites may or may not be affected.

Vesicular hand dermatitis

Vesicular dermatitis of the hand is also known as pompholyx, cheiropompholyx, and dyshidrotic eczema. Cultures of skin-colored blisters with intense itching develop on the palms and sides of the hands and fingers. Similar symptoms often affect the feet. This form of dermatitis is likely to be triggered by emotional stress through sweating (hyperhidrosis)

Chronic recurrent vesiculosquamous dermatitis

Chronic recurrent vesiculosquamous dermatitis is a common pattern of finger and palm dermatitis, in which episodes of acute vesicular dermatitis are followed by chronic climbing and cracking.

Hyperkeratotic hand dermatitis

Hyperkeratotic dermatitis of the hand is chronic, dry,inflammatory Palmar dermatitis May appear similar to palmar psoriasis, but is less red and less circumscribed.

fingertip dermatitis

Fingertip dermatitis can be isolated to one or more fingers.

Irritant contact dermatitis

The hands are the most common site for irritant contact dermatitis and are often due to wet work and repeated exposure to low-grade irritants. The webs of the fingers are the first place affected, but the inflammation can spread to the fingers, the back of the hands and the wrists. Irritant contact dermatitis often spares the palms.

• Acute irritant contact dermatitis is due to injuries caused by strong irritants such as acids and alkalis, often in a work setting.
• Repeated exposure to low-grade irritants, such as water, soaps, and detergents, leads to chronic disease. cumulative irritant dermatitis

Allergic contact dermatitis

Allergic contact dermatitis can be difficult to distinguish from constitutional forms of hand dermatitis and irritant contact dermatitis. There are about 30 common and countless allergens, uncommon or rare. Common allergens include nickel, fragrances, rubber accelerators (in gloves), and p-phenylenediamine (permanent hair-Colorant). Clues for contact allergy depend on allergen, but can include:

• Periodic outbreaks associated with certain tasks or places hours or days before
• Irregular, asymmetric distribution of the eruption
• Sharp edge to rash (eg, on the wrist, which corresponds to the cuff of the rubber glove).

What are the complications of hand dermatitis?

• Bacterial Skin infections (staphylococci and/or streptococci) can lead to pustules, crust and pain.
• Dermatitis on the ends of the fingers can cause deformation nail.
• The dermatitis can spread to affect other sites, particularly the forearms and feet.

How is hand dermatitis diagnosed?

Hand dermatitis is generally easy to diagnose and classify based on history and examination, considering:

• Acute, relapsing, or chronic course
• History of skin disease.
• Dermatitis at other sites.

Differential diagnosis It includes:

• Contact urticaria – for example, to latex gloves (immediate redness, itching and swelling that resolves within an hour)

• Protein contact dermatitis, most often affecting caterers (a combination of urticaria and dermatitis induced by reactions to meat)

• Psoriasis (symmetricalwell circumscribed, red, scaly plates)

• Tinea manuum (unilateral or asymmetric peripheral scale).

Patients with chronic hand dermatitis may have patch Testing for contact allergens.

A hit biopsy and skin scrapings (mycology) may be necessary to exclude other causes of hand swelling.

What is the treatment for hand dermatitis?

Patients with all forms of hand dermatitis should be more particular about:

• Minimize contact with irritants, including water
• Use a soap-free cleanser when washing your hands, rinse thoroughly and make sure hands are completely dry afterward
• Note that cream cleaners are not antimicrobial; Soap and water or a disinfectant is needed to wash your hands in order to destroy pathogens like the SARS-CoV-2 virus responsible for COVID-19
• Completely avoid touching allergens that have been identified by patch testing
• Wear protective gloves appropriate for the task.
• apply thick emollients before work/school and reapply after washing or when skin dries (this may be 10-20 times in a day).

Vinyl gloves are less likely than rubber gloves to cause allergic reactions.

• They must be scrupulously clean and must not have holes.
• They should not be used for long periods.
• Sweating under gloves aggravates dermatitis.
• Lined gloves or inner cotton gloves improve comfort.

Current Steroids reduce inflammation.

• Use a strong topical steroid for dermatitis on the backs of the hands and an ultra-strong topical steroid on the palms.
• The cream formulation is generally better for vesicular dermatitis of the hand, and ointment for chronic dermatitis
• They should be applied to areas of active dermatitis once or twice daily for several weeks, then discontinued or reduced in frequency/strength.
• short term occlusion increases potency and is guaranteed if standard applications have not been effective.

Calcineurin inhibitors (tacrolimus and pimecrolimus) have some evidence to show effectiveness hand eczema and can be used as a steroid-sparing agent [4].

secondary bacterial infection may require an oral antibiotic, usually flucloxacillin.

Severe acute flare-ups of hand dermatitis are treated with prednisone (systemic steroids) for 2 to 4 weeks.

Chronic intractable hand dermatitis can be treated with second-line agents such as azathioprine, methotrexate, cyclosporine, alitretinoin, or phototherapy.

How can hand dermatitis be prevented?

Irritant contact dermatitis of the hands can be prevented by careful protective measures and active treatment. It is very important that people with atopic dermatitis (eczema) are aware of the risk of hand dermatitis, especially when occupation is considered.

What is the prognosis for hand dermatitis?

With careful management, hand dermatitis usually recovers completely. A few days off can be useful. When occupational dermatitis is severe, it may not be possible to work for weeks or months. Occasionally a change of occupation is necessary.