Hand Dermatitis

Hand eczema

L30.9; L25.9; L24.9; L23.9

Hand dermatitis is one of the most common skin conditions, affecting as many as 1 in 10 people and causing red, itchy, and painful skin on the hands that can seriously impact daily life and work.

Table of contents

• What is hand dermatitis?
• Who gets hand dermatitis?
• What causes hand dermatitis?
• What are the symptoms?
• Different types of hand dermatitis
• How is hand dermatitis diagnosed?
• Treatment options
• Prevention and daily care
• Outlook

What is hand dermatitis?

Hand dermatitis is a common condition that causes inflammation of the skin on your hands. It affects the palms, the backs of the hands, or both areas. This condition is also known as hand eczema, and these terms can be used interchangeably^[1].

The condition can appear suddenly or develop gradually over time. It may last for a short period, or it can become a long-term problem that comes and goes in episodes called flares. Hand dermatitis can range from mild irritation to severe symptoms that interfere with your ability to work and carry out daily activities^[2].

Who gets hand dermatitis?

Hand dermatitis is very common, affecting about 10% of the U.S. population^[2]. Some estimates suggest that chronic hand dermatitis may affect between 10-15% of people^[1]. The condition is particularly common in young adult women^[1].

Certain factors increase your risk of developing hand dermatitis. People who had atopic dermatitis (a type of eczema) in childhood are at higher risk. This genetic tendency can run in families along with asthma and hay fever^[6].

Your occupation plays a major role in determining your risk. Hand dermatitis is particularly common in jobs that involve frequent hand washing or contact with water (called “wet work”) and exposure to chemicals. High-risk occupations include^[1][4]:

• Healthcare workers (nurses, doctors)
• Hairdressers and beauticians
• Cleaning staff and housekeepers
• Food service workers (chefs, caterers, dishwashers)
• Metalworkers and mechanics
• Construction workers
• Painters

Hand dermatitis is a major cause of work-related skin disease and accounts for 20-35% of all forms of dermatitis. It is a common reason for missed work days^[1].

What causes hand dermatitis?

Hand dermatitis usually results from a combination of factors rather than a single cause. The main types of causes include^[1]:

Genetic and unknown factors: Some people develop hand dermatitis due to their genetic makeup or for reasons that are not fully understood. This is sometimes called constitutional hand dermatitis.

Irritant contact dermatitis: This happens when substances directly damage your skin. The outer layer of your skin, called the stratum corneum, acts as a protective barrier. When this barrier is damaged, water is lost from the skin and inflammation develops^[4]. Common irritants include:

• Water (especially with frequent exposure)
• Soaps and detergents
• Cleaning products
• Solvents
• Acids and alkalis
• Cold or heat
• Friction

Interestingly, water itself can make hands drier. This happens because frequent water exposure removes the natural oils from the skin’s protective barrier^[4].

Allergic contact dermatitis: This occurs when your immune system reacts to specific substances that touch your skin. This is a delayed reaction involving specialized immune cells called T lymphocytes^[1]. Common allergens include:

• Nickel (in jewelry and metal objects)
• Fragrances and perfumes
• Rubber (in gloves)
• Leather
• Certain preservatives

In people with atopic dermatitis, a deficiency in a protein called filaggrin in the skin barrier leads to increased water loss and makes it easier for irritants and allergens to penetrate the skin^[1].

What are the symptoms?

The symptoms of hand dermatitis can vary from person to person and depend on whether the condition is in an acute (sudden) or chronic (long-lasting) phase^[1].

Common symptoms include:

• Dry, flaky, or scaly skin
• Redness (or darker discoloration on brown or black skin)
• Intense itching
• Burning sensation
• Pain
• Swelling
• Cracked skin that may bleed

Acute hand dermatitis typically presents with^[1]:

• Red patches and bumps
• Swelling
• Blisters that may weep clear fluid
• Crusting
• Painful cracks (fissures)

Chronic hand dermatitis features include^[1]:

• Extreme dryness and scaling
• Thickened skin (lichenification)
• Deep, painful cracks

The affected skin may feel hot and uncomfortable. The itching can be severe and is often accompanied by a burning sensation. These symptoms can make it difficult to use your hands for everyday tasks and can significantly affect your quality of life^[2].

Different types of hand dermatitis

There are several patterns of hand dermatitis, each with slightly different characteristics^[1]:

Atopic hand dermatitis: This type occurs in people with a history of atopic dermatitis. It results from an impaired skin barrier and is triggered by contact with irritants. It usually affects the backs of the hands and around the wrists. People with this type typically have signs of eczema elsewhere on their body^[1].

Discoid eczema: Also called nummular dermatitis, this type creates round, coin-shaped patches of inflamed skin. These typically appear on the backs of the hands and fingers^[1].

Vesicular hand dermatitis (Pompholyx): This type is also known as dyshidrotic eczema. It causes intensely itchy, small blisters that appear on the palms and sides of the fingers. The blisters are often described as looking like tapioca. This form may be related to excessive sweating (hyperhidrosis) and often affects the feet as well^[1][2].

How is hand dermatitis diagnosed?

Your healthcare provider will diagnose hand dermatitis by examining your hands and asking about your medical history, work environment, and activities that might expose your hands to irritants or allergens^[6].

Patch testing may be recommended to identify specific allergens causing your symptoms. In this test, small amounts of different substances are applied to your skin (usually on your back) and covered. Over the next few days, your doctor checks your skin for reactions. This helps diagnose allergic contact dermatitis and can identify which specific substances you should avoid^[6].

Sometimes other tests are needed to rule out conditions that can look similar to hand dermatitis, such as:

• Psoriasis of the hands
• Fungal infections (ringworm)

Your doctor may take skin samples to check for fungal infection if this needs to be ruled out^[6].

Treatment options

The most important treatment for hand dermatitis is avoiding what caused it in the first place. However, medications and other treatments are often needed to control inflammation and help your skin heal^[2].

Self-care and moisturizers

Regular use of moisturizers is essential for all types of hand dermatitis. Moisturizers help restore the skin’s protective barrier and prevent water loss. The most effective moisturizers are those with higher oil content, such as ointments and creams. Apply moisturizer frequently throughout the day and always after washing your hands^[2][4].

Topical medications

Topical corticosteroids are commonly prescribed to reduce inflammation and itching. These come in various strengths as creams, ointments, or gels. Because the skin on the hands is relatively thick, a moderate to strong corticosteroid may be needed. These should be used as directed by your doctor, as overuse can cause side effects such as thinning skin^[7].

Calcineurin inhibitors are non-steroid creams or ointments that can control inflammation. Examples include tacrolimus and pimecrolimus. These may be used as an alternative to corticosteroids^[7].

Systemic treatments

For severe hand dermatitis that doesn’t respond to topical treatments, your doctor may prescribe^[2]:

• Antihistamines to help control itching
• Oral corticosteroids (like prednisone) for short-term use
• Biologics such as dupilumab
• Immunosuppressive medications such as methotrexate, cyclosporine, or mycophenolate mofetil

Other treatments

Phototherapy (light treatment) may be helpful for some people with chronic hand dermatitis. This involves exposing the hands to special ultraviolet light under medical supervision^[3].

If a bacterial infection develops (indicated by increased redness, warmth, oozing, or yellow crusting), your doctor may prescribe antibiotics^[6].

Prevention and daily care

Preventing hand dermatitis and avoiding flare-ups requires consistent attention to hand care^[2]:

Hand washing technique

• Use lukewarm (not hot) water
• Choose fragrance-free, mild cleansers
• Remove rings and jewelry before washing
• Gently pat hands dry rather than rubbing
• Apply moisturizer immediately after drying

Protection

• Wear appropriate gloves when handling irritants or doing wet work
• Use cotton glove liners under rubber or vinyl gloves to absorb sweat
• Avoid known allergens identified through patch testing
• Keep gloves clean and dry inside

Lifestyle adjustments

• Keep fingernails short to reduce damage from scratching
• Avoid touching your face with your hands
• Use fragrance-free products
• Keep a tube of moisturizer near every sink
• Consider using hand sanitizer instead of soap and water when hands are not visibly dirty, to reduce wet-to-dry cycles

Outlook

The outlook for hand dermatitis varies from person to person. Some people experience short episodes that clear up completely with treatment, while others develop chronic symptoms that require ongoing management^[1].

Hand dermatitis can have a significant impact on quality of life, affecting your ability to work, perform daily tasks, and engage in social activities. However, with proper identification of triggers, consistent use of moisturizers, and appropriate medical treatment, most people can successfully manage their symptoms^[2][8].

It’s important to work closely with your healthcare provider to find the treatment approach that works best for you. In cases where symptoms don’t improve with standard treatments, referral to a dermatologist or allergist may be necessary for specialized care, including patch testing or more advanced therapies^[4].