Hand eczema (contact dermatitis)

Hand eczema (also known as contact dermatitis) is a common condition affecting up to 10% of the population. It results from a combination of factors, both internal (e.g. your genetic make-up), and external (e.g. contact with irritants and allergens such as chemicals). Hand eczema is the most common work related skin condition. 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. The most harmful exposure has been found to be unspecified chemicals, water and detergents and dust and dry dirt.In addition to chemical exposure, frequent and prolonged contact with water plays a major role in eczema; however it is difficult to tell whether it is caused by chemicals or frequent exposure to water.  It is an inflammatory condition and is not contagious, but it can still have a major effect on people’s work, social lives and self-esteem.

Information about the different types of hand eczema and how to treat the conditionHand eczema may affect the fingers, and/or the backs of the hands, and/or the palms. 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 bacterial infection resulting in pustules (pus filled blisters), crusting (scabs) and pain. Over time the skin may gradually become thicker and more prone to painful cracks or openings. People with hand eczema may also have eczema in other areas such as the forearms and feet, or even all over their bodies.

Types of hand eczema

There are three main causes of hand eczema:

  • Irritant contact eczema- this is caused by repeated exposure to irritant chemicals, e.g. 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 who 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, and some people even have to change jobs or give up work if the eczema gets severe and cannot be effectively treated.
  • Allergic contact eczema - this is an allergic reaction to sensitising chemicals, and usually occurs after being repeatedly exposed to a particular substance. Unlike irritant contact eczema, it will only occur in people with a genetic tendency towards such a reaction. Because it doesn’t occur immediately, it can be difficult to identify the cause, but avoiding the substance causing the allergy is usually the first step in treating this type of eczema. Typical examples are people who are allergic to nickel (in costume jewellery), latex in gloves, or hair dye.
  • Atopic eczema - this is the most common type of eczema where people have a genetic or hereditary tendency (i.e. something in their genetic make-up) to have allergic reactions that affects their skin. People with atopic eczema often have hay fever and/or asthma, and this is particularly common in children.

Because your hands are in constant use, it is much more difficult to treat hand eczema after it has been present for a while so it is advisable to seek advice from your GP as soon as possible.

Treatment

The key to successful treatment is to try and identify the cause of the problem. Doctors may consider options such as patch testing or a blood test to help identify the specific allergens. In irritant and allergic contact eczema, avoiding contact with the offending chemicals and protection of the hands using silk or cotton gloves is often sufficient.

Moisturisers (emollients) are essential to help maintain the hydration and integrity of the skin and avoiding soaps by using soap substitutes also helps. Steroid creams and ointments of varying strengths are often used to relieve the inflammation of the skin and antibiotics may be required if the eczema becomes infected. Other therapeutic options include topical (i.e. creams/ointments applied directly to the skin), immunosuppressant’s (a form of medication which reduces the strength and response of the body’s immune system) and ultra-violet light treatment (commonly PUVA).

Long term (chronic) severe cases of hand eczema can be very difficult to treat successfully and it may be necessary to use oral formulations of potent steroids or immunosuppressant’s.

Alitretinoin can be used for hand eczema that has not responded to other treatments. Treatment with Alitretinoin (a type of medication from a group called Retinoid which is thought to work by altering the body’s response to the allergen and the sensitivity of the persons immune system – a derivative of vitamin A) should be started and monitored only by doctors who are skin specialists (dermatologists)or have experience in both treating people with severe chronic hand eczema and using drugs like Alitretinoin.

Advice for hand eczema that is caused by work conditions is to:

  • Use heavy-duty vinyl or neoprene gloves in tandem with cotton glove liners when doing wet work. Wash the cotton gloves regularly, as well as the vinyl gloves if they aren’t disposable.
  • Wear leather or clean, heavy-duty fabric gloves for dry work.
  • Avoid using industrial hand cleansers or waterless or antibacterial cleansers that contain irritating ingredients such as alcohol and solvents.
  • Use a hand cleanser, moisturiser, and prescription medication advised by your GP
  • Keep your work clothes, protective clothing, tools, and work surfaces clean; irritant residues on them can aggravate your skin.
  • Treat all minor wounds on your hands, and bandage them, in order to avoid giving irritants and allergens an easy route into your skin.

Sources used in writing this article are available on request

Information contained in this Articles page has been written by talkhealth based on available medical evidence. Our evidence-based articles are certified by the Information Standard and our sources are available on request. The content is not, though, written by medical professionals and should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands, or treatments.

Information written by the talkhealth team

Last revised: 20 October 2016