Chronic hand eczema is defined as a persistent (6 months’ duration) noninfectious skin inflammation of the hands. It is twice as common in women as men. Although genetic factors have been considered, greater exposure of women to wet work, such as housework, is assumed to be the most likely explanation. It has been debated whether lifestyle factors may be associated with chronic hand eczema.
Hand dermatitis is a common disorder with different symptoms that can present acutely or with a chronic and relapsing pattern. The subtypes discussed in this blog include:
- contact irritant dermatitis
- contact allergic dermatitis
- atopic dermatitis (AD)
- dyshidrosis (also known as pompholyx)
- hyperkeratotic dermatitis.
Hand dermatitis represents a major occupational problem and accounts for more than 80% of all occupational dermatitis, especially with frequent water exposure (wet work) such as hair- dressing, baking, nursing, midwife’s, age care workers and other healthcare professional occupations, homemaking, and bartending, and constant use of antibacterial hand washes. The hands of essential healthcare professionals with eczema that have an impaired skin barrier, increasing the risk for the transfer of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Preventive measures against contact dermatitis need to be initiated in the workplace, including proper hand-washing, alcohol hand rinses, and the use of hydrating moisturisers to help soothe the conditions.
The impact of hand eczema and dermatitis on daily life
Chronic hand dermatitis interferes significantly with activities of daily living by causing discomfort and embarrassment for some individuals. hand eczema can have a devastating effect on an individual’s quality of life and may even necessitate a change in occupation. It can be itchy and painful and may interfere with recreational activities, as well as psychosocial functions.
Anyone suffering from itchy skin conditions should consider the following when they consult their health provider. A careful history, physical examination of the hands and nails, and skin changes elsewhere may help identify a diagnostic pattern. Clinical investigation of the presenting skin condition may include the following;
- known allergies, including asthma and hay fever, which are more common in persons with atopy
- other preexisting medical conditions (eg, arthritis that is more common with psoriasis)
- topical and systemic medications
- swabs or scrapes of the skin on the hands to test and identify any secondary infections,fungus, including S aureus that may also be multiresistant to many common antimicrobial agents (MRSA)
The individual’s history should focus on key information, such as:
- the onset and duration of the eruption;
- any associated symptoms—itching, burning, pain;
- presence of the eruption on other parts of the body; many disorders of the hands also involve the feet; and
- history of previous infections or other complications, such as lost time at work or inability to participate in hobbies or activities of daily living.
Contact dermatitis: irritant contact dermatitis
Contact dermatitis is the most common subtype of hand dermatitis and may be classified as irritant or allergic. Irritant contact dermatitis involves the majority (>80%) of contact hand dermatitis and represents non-specific reaction of the skin to the contact of a toxic chemical or irritant.
Irritant dermatitis can occur on the first exposure and represents a local noxious stimulus to the skin integrity. Some agents will cause damage to the skin, and others trigger the release of inflammatory cytokines from the damaged cells in the skin epidermis. They remove the surface lipids, denature epidermal keratins, and damage the cell membranes. The damaged lipids in the stratum corneum decrease barrier function, and this results in low epidermal water content below the 10% required to maintain the skin integrity. This defective barrier facilitates the penetration of harmful chemical agents, including ammonia, organic solvents, and other contact irritants. Two major types of ICD are acute and chronic (repeat and multiple or cumulative exposure).
Irritant contact hand dermatitis is most common on the palms and end the fingers. Involvement on the sides of the fingers is more common with the coexistence of atopy. If the dermatitis is predominant on the back of the hands, contact allergy is more likely to be a component.
Contact dermatitis: allergic contact dermatitis
Allergic contact dermatitis (ACD) usually involves back of the hands, fingers, web spaces, and the wrists, where the skin is thinner and the allergen has more potential penetration. The acute phase is often associated with distinct skin inflammed and, in more severe cases can result in blisters or small fluid-filled blisters
Atopic hand dermatitis
Atopy is a condition with an increased personal or family history of hay fever, asthma, or eczema, occurring as a single manifestation or with a combination of 2 or 3 of the disorders. Individuals with atopy are more likely to have an elevation of the serum IgE antibodies. Atopic dermatitis is a common disorder with genetic predisposition and lifetime prevalence of approximately 30% in the global population. Atopic hand dermatitis has a variety of presentations. In the acute stage, symmetrical blisters (vesicles) are often present on the sides of the fingers. The fluid will consist of serum, blood, or pus, which becomes a crust when it dries. If there are pustules or hemorrhagic crusts, the acute dermatitis is most often associated with secondary S aureus bacterial infections. Cutaneous fungal and viral infections also occur frequently in patients with Atopic Dermatitis (AD).