Lifestyle modification and self care are the first lines of defence. This includes:
Moisturizing and Gentle Cleansing
Use hand cleansers and moisturizers that are free of irritating ingredients and fragrances (see our Seal of Acceptance products). Moisturizing regularly will help to replenish skin moisture, and will help you to keep your eczema under control.
Petrolatum is often the preferred moisturizer for hand eczema as it has few ingredients, and doesn’t sting or irritate open areas. Petrolatum also holds in the skin’s natural moisture and provides a protective barrier to keep irritants out.
Apply a rich moisturizer immediately after bathing, hand washing, and anytime in between. If your eczema has cleared up, and you are no longer using your prescription treatments, continue with a diligent moisturizing routine, which may help to prolong the period between flares.
- Where possible, avoid or minimize wet-work.
- Avoid excessive sweating and dry conditions which are sometimes triggers.
- Avoid scratching which worsens the condition and may cause cracks allowing bacteria to enter leading to infection. Sometimes applying cold compress to area reduces itch. Keep fingernails short.
- Avoid the substance(s) causing the irritation or allergy. Avoiding all substances can be very difficult-if not impossible-especially if these substances are encountered at work. Using barrier cream, wearing gloves, and practicing glove hygiene is often helpful.
- Minimize contact with fruit juices, fruits, vegetables, raw meat while preparing food, or wear gloves.
- Protect hands by using cotton gloves as liner under vinyl gloves.
- Shampoo and style hair while wearing vinyl gloves, if possible.
- Take off rings before wet-work or hand washing.
- Use emollients frequently to help restore normal skin barrier function. A thin smear of a thick barrier cream should be applied to all affected areas before work, and reapplied after washing and whenever the skin dries out.
- Stress management-stress triggers flare-ups in many people so reducing stress may be beneficial.
To treat inflammation, topical corticosteroids are commonly used. Use only as needed — that is, when your eczema is actively flaring. Prolonged use can cause thinning of the skin. Fearing side effects, patients more commonly use too little rather than too much.
If your response is unexpectedly slow, discuss the possibility of corticosteroid allergy with your doctor. Pimecrolimus (Elidel®) and tacrolimus (Protopic®) may be helpful as an alternative to topical corticosteroids.
Narrow-band UVB light and PUVA are helpful for their local immunomodulatory effect. Speak to your doctor about the possibility of Phototherapy as a treatment option. There are specific Phototherapy units that are used to treat the hands.
Antibiotics are sometimes needed if infection develops, and most infections are caused by staph.
Oral corticosteroids may be effective in a short course for recurrent pomphylx and dyshidrotic hand dermatitis, however should be avoided. Warning about serious side effects of prednisone must always be considered.
Toctino® (alitretinoin) is an oral retinoid. A once daily treatment, it is available for patients suffering from severe symptoms that never go away completely or keep coming back even after using potent topical steroids. Research has demonstrated significant clinical improvement in patients with chronic hand eczema, especially for the variant known as hyperkeratotic dermatitis. Side-effects include headache and flushing. Some patients are not suitable candidates for alitretinoin. Speak with your doctor about this treatment.
IMPORTANT NOTE: Strict pregnancy prevention is required 1 month before, during, and for 1 month after treatment with alitretinoin for women of child bearing potential due to the teratogenicity of the product (the product can cause birth defects). Never share your prescription of Toctino® and speak with your doctor about whether this treatment is right for you.