Eczema Care - Hand Eczema

Hand Eczema

Hand eczema (also known as hand 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). 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. 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.

Hand 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, crusting and pain. Over time the skin may gradually becomes thicker and more prone to painful cracks or fissures. 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:

1. 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 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.

2. 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.

3. Atopic eczema

This is the most common type of eczema where people have a genetic or hereditary tendency (i.e. they are born with the tendency) to have allergic reactions that affect their skin. People with atopic eczema often have hayfever and/or asthma as well, and this is particularly common in children.

The main symptoms of hand eczema include one or more of the following:

Redness (erythema)

Itching

Pain

Dryness, to the point of peeling and flaking

Cracks (fissures)

Blisters (vesicles)

There is also a specific type of hand eczema called pompholyx (pronounced Pom-foe-licks, from the Greek word for bubble). The cause of pompholyx is unknown and it tends to occur more commonly in women. Each outbreak consists of the appearance of itchy small blisters on the palms of the hands. The condition may come and go over the course of many years, and is notoriously difficult to treat effectively.

Swelling (oedema)

Thickened, scaly skin (hyperkeratosis)

This tends to affect mainly older patients who have had the hand eczema for a number of years, and men in particular.

Treatment

The key to successful treatment is to try and identify the cause of the problem, and doctors may even do patch testing to blood test to help identify the specific substances. 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) immunosuppressants 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 immunosuppressants. Azathioprine and ciclosporin are powerful immonosuppressants that were originally developed to prevent the rejection of organ transplants and they are sometimes used in eczema even though there is a relative lack of evidence of their effect.

In the September 2008, a new treatment was launched for severe chronic hand eczema. It is a member of the retinoid group of medicines which are derived from vitamin A and have been used effectively in the treatment of many skin diseases such as psoriasis and acne for the past 40 years. It is a capsule that is taken once a day and is called alitretinoin (Toctino). In clinical trials it has been shown to be effective in producing clear/almost clear hands in nearly 50% of patients within six months and has recently been recommended for use in the NHS by NICE.

Like all medicines it has a number of possible side effects including headache and increasing your cholesterol levels. As a retinoid it can cause severe birth defects so women of child bearing age need to adhere to strict pregnancy prevention measures.  Alitretinoin is only available from dermatologists (usually based in hospital) or GPs with expertise in the use of oral retinoids.  

This availability of alitretinoin on the NHS brings much needed hope to sufferers of severe hand eczema as it is the first new treatment specifically developed for this debilitating condition.

For more information about hand eczema and ways to manage the condition visit www.myhandeczema.co.uk