splitting fingertips

[paljarrat@yahoo.com]

Hello
I don't know if your team can help but sincerely hope so !
I have had an ongoing problem for just over two years now with skin on my fingertips (pads of fingers) splitting and bleeding...I have the same problem on the skin on my heels as well..with deep crevices that bleed constantly.
I have seen a skin specialist, I have been tested for a whole raft of allergies all of which have come up negative...I wear gloves to apply make-up....never wash up without gloves and similarly for all household tasks.
I work at a computer terminal 9 hrs a day and wear gloves for my key-board.
I have tried very many creams, both prescribed and off the shelf with very minimal short term effect. I am getting pretty desperate as I am in constant pain
I would appreciate a reply

In anticipation

Paula Eljarrat

[Dr Jonathan Bowling]

Dear Paula,

If your skin specialist has excluded any allergic components by patch testing then topical products to help symptoms would be the first option, but buy no means the only option.

Avoidance of soap is very important as this will aggravate any type of eczema. Use a moisturizer to wash with, ask you chemist or GP regarding products as there are a range available (E45, Cetraben, Doublebase, Diprobase to name a few). To increase skin hydration try a topical mosituriser which includes urea as an actiuve ingredient. 'Flexitol heel' and 'Flexitol hand' balm can be very helpful as they contain urea up to 25% concentration. Unfortunately the urea component can sting deep fissures. Also for deep fissures in fingertips and heels add haelan tape daily, which your GP can prescribe. This tape includes a steroid which elutes into the skin to help healing and reduce discomfort.

If strong topical products and the above regime fails to provide any improvement see yor specialist to discuss the pros and cons of systemic treatment, including alitretinoin, a tablet used for resistant hand eczema.

I hope this helps

[Adam Eason]

Paula, you may be interested in a post I have made elsewhere in this clinic;

With my own field, I can really only comment or offer up psychological advice and in particular based upon the research supporting my own specialist field. However, there is a good depth of evidence to support the use of hypnosis in conjunction with ongoing treatments. I wrote a blog entry here about the evidence base, which also includes a great deal of reference to eczema, you can read the article here at this website:

http://www.talkhealthpartnership.com/bl ... disorders/

If you would like to engage in a psychological process to help (though I'd recommend seeking out a professional first and foremost), you might also like to read and follow the steps in this evidence-based technique too. Though it was primarily used with psoriasis sufferers, it has been used with eczema too. Here is the technique in a step-by-step guide here at this website:

http://www.talkhealthpartnership.com/bl ... onditions/

It is not the kind of advice that you are directly seeking which Dr Bowling has offered comprehensively, it is aimed at offering some sort of psychological adjunct to the conventional treatments you are using.

I hope it offers an additional avenue to explore at the very least.

Best wishes, Adam.

[Wendy Green]

Hi Paula,

Your eczema sounds really painful - no wonder you're feeling desperate!

Since tests suggest that your eczema isn't due to allergy, and it doesn't it sound like it's contact irritant eczema, since you say you wear gloves for household tasks, using the computer etc. it sounds as though there must be another trigger.

I wonder if you were under more stress than usual when your eczema first flared up two years ago? Or have you been under continuous stress during that time? Stress is a definite trigger for eczema. If you think it might be involved it's worth looking at trying to avoid or cut back on activities you find stressful (though I know this isn't always possible). Also taking exercise such as walking, swimming, or yoga and learning how to meditate could help.

Something else that might help you is to ensure you eat plenty of foods that provide essential fatty acids (EFAs). Research suggests that some eczema sufferers may be lacking in EFAs, or have problems metabolising them. Omega 3 EFAs are anti-inflammatory. Good sources include oily fish, nuts, seeds, rapeseed and sunflower oils and egg yolks. Omega 6 EFAs are also anti-inflammatory and are found in
rapeseed, olive and sunflower oils, as well as olives, nuts, seeds and some vegetables and grains. These oils will also lubricate your skin from the inside, helping to form a protective barrier on your skin's surface.

You may also want to try taking an EFA supplement - there is some evidence that taking evening primrose oil, which is rich in a type of Omega 6 fat called gamma linoleic acid (GLA), helps eczema by blocking the chemical messengers that trigger itching and inflammation. I am an eczema sufferer myself and have rarely had an attack since starting to take a Boots Omega Oils 3, 6 and 9 capsule daily, a few years ago; these contain fish oil, evening primrose oil and olive oil.

Finally, if you try all of the above and experience no improvement, it may be worth checking to see if you have a food sensitivity. Common culprits include wheat, dairy foods, peanuts, citrus fruits and even tea or coffee. If you think a food intolerance could be be behind your eczema symptoms ask your GP if you can be referred to a dietician, who may advise following an Exclude and Challenge Test which involves stopping eating a suspect food to see if there's an improvement in your symptoms and then reintroducing it to see if they worsen again. It's always best to do this under medical supervision, as if you cut out whole food groups you could end up malnourished.

I hope you find something in my response that helps you. Good luck!

Wendy

[Dr Anton Alexandroff]

Dear Paula,

your eczema/dermatitis sounds dreadful! I completely agree with Dr Bowling and Wendy advice.

I have a number of patients in my clinics with very difficult hands and/or feet dermatitis (which can be so disabling!). I found that alitretinoin (Toctino) tablets usually get it under control. Have you discussed tablet treatments with your dermatologist?

I hope this is helpful.
With best wishes,
Dr Anton Alexandroff MRCP(UK) PhD FAAD FRSM
Consultant Dermatologist in Leicester and Bedford
www.alexandroff.org.uk
twitter @bedford_skin_dr
blog: http://privatehealthnews.co.uk/category ... rmatology/