Diagnosis and treatments of hand eczema
Is hand eczema the same as the eczema that appears on other parts of the body? Should it be cared for differently? Eczema Society of Canada invited dermatologist Neil Shear, MD, FRCPC to share his insights about hand eczema and how dermatologists help to manage this frustrating and painful condition.
What is hand eczema?
Hand eczema (or hand dermatitis) describes any type of eczema that develops on the hands. It is commonly job-related and can be made worse by factors including frequent hand washing and exposure to chemicals. People who wash their hands frequently, work with chemicals or in wet work, or those who had eczema as children are more likely to get hand eczema, however, in some cases, some individuals may never identify the cause.
What does hand eczema look like?
Hand eczema typically causes itchy, dry, scaly patches of skin that crack and flake. It can occur acutely but may also be a condition referred to as chronic hand eczema (CHE) or chronic hand dermatitis (CHD).
How is hand eczema diagnosed?
A thorough history and physical examination is essential in helping to determine the cause(s) of hand eczema. Medical, occupational and social history are important, as well as patch testing, as it can be challenging to distinguish different types of eczema, such as irritant contact dermatitis from allergic contact dermatitis.
How is hand eczema treated?
Lifestyle modification and self care
Hand washing and frequent exposure to water are destructive to the skin barrier and should always be followed by applying moisturizer. Wearing gloves when doing wet work or working with potential irritants can also be helpful.
Topical therapies
To treat inflammation, topical therapies, such as topical corticosteroids, are commonly used when the eczema is actively flaring. These medications are typically applied to the skin in a cream or ointment. If your response is unexpectedly slow, see your doctor or dermatologist. Another class of medications is topical calcineurin inhibitors, which may be helpful as an alternative to topical corticosteroids.
Phototherapy
Phototherapy (also known as light therapy) may be helpful for the local immunomodulatory effect. Speak to your doctor about the possibility of Phototherapy as a treatment option.
Systemic medication (i.e. taken by mouth or by injection)
For some patients the severe symptoms never go away or keep returning even after using increasingly potent topical medications. There is a once-a-day oral (i.e. taken by mouth) medication specifically targeted to hand eczema. This medication is called alitretinoin and is a retinoid (a vitamin A based medicine). Further, some biologics may be appropriate for some individuals, and newer therapies are also expected become available down the road. If patients are struggling to manage their hand eczema, a dermatologist can help.
Eczema Society of Canada thanks Neil Shear, MD, FRCPC for his volunteer contribution to this educational content.
Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool. The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific health care needs with a qualified health care professional.
August 2021
