Hand Eczema

• What is hand eczema?

• What causes hand eczema?

• Aggravating factors in hand eczema

• How to manage hand eczema

• Severe cases

• Contact with skin irritants such as water, especially wetting and drying, soap, shampoos and conditioners, household cleaning preparations, paper towels, solvents, cement, oils, grease
• Sweating, often aggravated by gloves worn for long periods in hot conditions
• Heat, such as exposure to hot water or hot environments
• Stress, often an aggravating factor
• Sometimes severe inflammatory tinea or fungal infection of the feet may precipitate hand eczema

• understanding of aggravating factors in each particular case, and subsequent avoidance of those factors, is particularly important
• appropriate skin protection with protective gloves. Different gloves may be required for different activities, such as cotton gloves underneath rubber gloves for dishwashing, material gloves for gardening, vinyl gloves for food handling. Even cotton gloves used for housework may reduce the need for handwashing. Avoidance of direct contact with rubber gloves, especially disposable latex gloves, is recommended, since some people may develop allergies to latex, the protein found in natural rubber
• use of a soap substitute, such as emulsifying ointment or commercially available skin cleansers which match the skin's pH of 5.5. Some examples include Cetaphil Cleanser, Hamilton's Wash, Ego QV Wash, DermaVeen Shower and Body Oil.
• Normal bath soaps are often quite alkaline and irritating even to normal skin and sometimes perfumed liquid soaps are also quite irritating, especially if the skin is easily irritated.
• frequent use of moisturizing cream. This helps to restore the damaged outer barrier layer of the skin, and helping it to withstand irritation. While greasier ointments are more effective for dry skin than creams, they are messier and often only tolerated at night (such as 50% liquid paraffin in 50% soft paraffin). Use of moisturizing creams (often supplied in jars, tubs or tubes) after work to replace natural oils has been shown to be particularly beneficial. A common generic preparation is 10% glycerine in sorbolene cream. Some of the proprietary products available in Australia include Hydraderm Cream, Ego QV Cream, Neutrogena Hand Cream, Hamilton Cream, DermaVeen Eczema Cream and Dermadrate Cream. Moisturizing lotions from a pump pack, are less greasy, and so may not be as helpful, but have the advantage that they can be rubbed in quickly and so may be good ditto re products).
• generally it is best to use products with fewer additives, such as fragrances, to decrease the likelihood of developing allergy
• topical corticosteroids are most effective if used frequently and early during the itchy or inflammatory stage of hand eczema. Once the rash becomes dry, cracked and scaly, they will be less effective, therefore greasy moisturizers are most useful at this time. Since the skin on the palms and sides of the fingers is one of the thickest skin areas on the body, often a stronger topical steroid is required. These include Diprosone OV, Diprosone, Eleuphrat, Novasone, Elocon, Advantan and Betnovate and Celestone V full strength products. Topical steroids are available as either white creams or greasy clear ointments (although Advantan ointment is an exception which is a slightly greasier white cream). Dermatologists usually prefer to prescribe ointments rather than creams, as they are more moisturizing and in addition do not have preservatives which may cause allergy. Sometimes two different cortisone preparations are used, a so called stronger "top shelf" steroid to treat the initial phase and a less strong one to follow on with for maintenance treatment. Novasone, Elocon and Advantan products are preferred for maintenance use.
• if sores have developed which sometimes follow skin splitting, this may indicate secondary infection, and a prescription antibacterial ointment can be helpful, such as Bactroban or Fucidin.
• in some cases, a tar based cream may be helpful to help treat thickened scaly skin.

• Ultra-violet light treatment with UVB or PUVA 2-3 times weekly to the hands
• Oral corticosteroid therapy (Solone, Sone, Panafcort, Dexamethasone), generally reserved for short-term use of severe cases
• "Steroid sparing" tablets such as azathiopine, metrotrexate, and Cyclosporin A, are often used for longer durations of 6-18 months, particularly to reduce dependence on oral corticosteroids