Allergy Care - Hand Eczema

Hand eczema is a common condition affecting up to 10% of the population. It results from a combination of factors, both internal (eg your genetic make-up), and external (eg contact with chemicals). The irritant nature of some chemicals means that hand eczema is particularly common in people with jobs involving cleaning, catering, hairdressing, healthcare and mechanical work.

Hand eczema may affect the backs of the hands, the palms or both. It often starts as a mild intermittent complaint, but can become increasingly severe and persistent. The affected skin is initially itchy, red and dry which may be followed by the appearance of small fluid filled blisters. In severe cases the skin may become cracked and swollen, and start weeping. This can lead to secondary bacterial infection resulting in pustules, crusting and pain. Hand eczema can spread to other sites, particularly the forearms and feet.

Types of Hand eczema

There are five main types of hand eczema:

1. Irritant contact eczema

This is caused by repeated exposure to irritant chemicals, eg shampoos, oil, cement. It usually affects the back of the hands and is most commonly seen in people whose job brings them into regular daily contact with the offending irritant. For example, hairdressers, mums with new babies and nurses constantly have their hands in and out of water with various cleansing agents. This persistent assault on the skin can gradually result in the development of hand eczema.

2. Allergic contact eczema

This is an allergic reaction to sensitising chemicals. Unlike irritant contact eczema, it will only occur in people with a genetic tendency towards such a reaction. Typical examples are people who are allergic to nickel (in costume jewellery) or hair dye.

3. Atopic eczema

This the usual cause of hand eczema in children. It is part of the more widespread skin problems caused by atopic eczema.

4. Pompholyx

Pronounced Pom-foe-licks, the name comes form the Greek word for bubble. The cause is unknown and it tends to occur more commonly in women. The condition may come and go over the course of many years. Each outbreak consists of the appearance of itchy small blisters on the palms of the hands.

5. Hyperkeratotic eczema

The cause of this relatively rare form of hand eczema is also unknown. It tends to affect mainly middle aged and elderly men, and results in the development of thick scaly patches of skin on the palms of the hands.

Treatment

The key to successful treatment is to try and identify the cause of the problem. In irritant and allergic contact eczema, avoiding contact with the offending chemicals and protection of the hands is often sufficient.

Moisturisers are essential to help maintain the hydration and integrity of the skin. Steroid creams and ointments are used to relieving the inflammation of the skin. Occasionally in severe cases, oral steroids are used, and antibiotics may be required if the eczema becomes infected.

Long term severe cases of hand eczema can be very difficult to treat successfully. In hyperkeratotic eczema, for instance, a number of powerful drugs have been tried such as retinoids (vitamin A derivatives used in other severe skin conditions such as acne and psoriasis) and cyclosporin (originally developed for the treatment of rejection in organ transplantation). The good news is that research into this area is making good strides towards more effective treatments for the future.  

 

Page created: 1 July 2008