The hands are in constant contact with our environment and the skin on the hand has to deal with a range of different substances and forces throughout the day. Like skin anywhere on the body it is prone to irritation, damage and disease but more so considering its daily exposure. Sometimes irritation and inflammation of the skin arises with a rash, itching, peeling and swelling.
What is hand eczema?
Eczema of the hand is a term to describe hand dermatitis. This is inflammation of the skin on the hand and the main causes of hand dermatitis is injury, irritation and allergies. Although the skin is soft but tough and resilient to deal with the daily stresses, sometimes the skin is affected by various substances or skin diseases. If hand dermatitis is not treated properly, secondary bacterial infections can arise on the affected skin thereby complicating it further.
Hand dermatitis is not just about itchy skin. This can occur for various reasons. In dermatitis there is usually redness of the skin, a skin rash, burning, pain, tenderness, heat over the affected area in addition to itching. There is no single treatment for all cases. The treatment of hand dermatitis depends on the underlying cause. It is therefore important that hand dermatitis is assessed by a medical professional and treated accordingly.
Read more on eczema.
Signs and Symptoms
Dermatitis refers to inflammation of the hand. In any inflammatory condition there are specific features of inflammation – redness, swelling, pain and heat. In addition the function of skin is compromised and itching as well as burning is present. These symptoms include:
- Redness of the skin and skin rash.
- Heat over the affected area.
- Itchy hands.
- Peeling of the skin.
- Pain and tenderness of the hands.
- Burning sensation of the skin.
The exact signs and symptoms may vary and depends on the underlying cause. If an area becomes infected with bacteria, then the symptoms may be more intense with an oozing discharge and possibly a fever as well.
Read more on itchy hands.
Causes of Hand Dermatitis
There are several different causes of hand dermatitis. This can range from injury and infections to irritation and allergies. It is important to consult with a doctor to identify the exact cause. Many of the below mentioned conditions may appear similar despite the underlying disease mechanism being different.
Injury to the skin on the hand is the most likely cause of dermatitis that arises suddenly, especially where there is intense itching, burning, redness, swelling and heat. This injury may be mechanical, chemical and electromagnetic in nature. For example, touching pool chlorine or bleach with the bare skin can injure the skin and lead to inflammation if not removed or neutralized immediately. Another example of trauma to the skin is sunburn which arises from prolonged exposure to intense sunlight.
There are a number of irritants that do not cause overt trauma but may still trigger inflammation. These irritants can be as innocuous as water and soap. Normally these substances do not cause a problem but if the skin is in contact with it for long periods then it may lead to contact dermatitis, and specifically irritant contact dermatitis. This type of dermatitis is seen in a condition known as dishpan hands which is frequently seen in people who wash dishes as an occupation.
Infections of the hand may occur with viruses, bacteria and fungi. Bacterial infections are more likely to arise when there is a break in the skin that allows the bacteria to gain entry into the deeper tissue. These infections tend to be acute but can be serious if left untreated and it spreads. Fungal infections of the hand like tinea manuum are not uncommon. It is also known as ringworm and caused by various skin fungi (dermatophytes) that is easily spread from one person to another, from animals and even soil. These infections are usually chronic and tends to occur in the web of fingers.
Allergic reactions of the skin on the hand are not uncommon. These reactions are a result of the immune system responding to the presence of harmless substances as is seen in allergic contact dermatitis. People who develop thsi condition tend to have an allergic disposition. The first exposure to the substance may not trigger any reaction but upon successive encounters the immune systems triggers an allergic reaction at the site of contact.
Dry skin is a common and often overlooked problem. The hands are particularly prone to drying with repeated washing and drying as well as contact with various substances throughout the day. This is further aggravated by the lack of skin oil glands on the palms. Dryness makes the skin more prone to injury, irritation and infections like ringwom (fungal) infections of the hand.
Although there are many skin conditions that can also involve the skin on the hand, one of the most notable is pompholyx. This condition is specific to the hand although it can affect other parts of the hand in some cases. The exact cause of pompholyx is unknown. It is a chronic condition whereby tiny fluid-filled vesicles arise on the skin of the hands. There is usually itching and burning at the affected site.
- Atopic dermatitis
- Psoriasis vulgaris
- Discoid eczema
Treatment of Hand Dermatitis
The treatment for hand dermatitis depends on the underlying cause. Symptomatic treatment may also be prescribed to ease the symptoms while the causative condition resolves. Therefore treatment may includes:
- Antifungal agents for fungal infections.
- Antibiotics for bacterial infections.
- Antihistamines to relieve itching.
- Corticosteroids to reduce inflammation.
- Immunosuppressants for chronic allergic conditions and autoimmune skin diseases.
- Coal tar or salicylic acid for psoriasis.
Emollients and barrier creams are also helpful for moisturizing the skin and protecting it from the elements until it heals. It is also important to avoid the causative and trigger factors. This may involve changing lifestyle habits and using protective handwear like gloves. Failure to treat hand dermatitis promptly can worsen the condition, lead to complications like bacterial infections and in the long term even result in darkening and scarring of the skin.