Hand & Foot Eczema: How to Cope
Matthew J. Zirwas, MD
Assistant Professor of Dermatology and Director of The Ohio State University Contact Dermatitis Center
Although atopic dermatitis (AD) usually improves with age, adults with a history of childhood AD often have persistent eczema on their hands and feet. Some children are also plagued by hand and foot eczema. Eczema affecting these sites can interfere with daily activities like playing, writing and walking.
While lots of people with eczema on their hands and/or feet have come up with their own tricks for keeping it under control, below are a few suggestions that can help.
Why Do So Many People with AD Get Eczema on their Hands and Feet?
Skin affected by AD is special in two major ways: 1. It doesn’t trap moisture as well as it should, so it can’t provide optimal protection against the outside world; and 2. The immune proteins in AD skin are altered and do not react normally to germs and other materials. Both of these factors predispose hands and feet in particular to eczema because these sites are more often in contact with more risky stuff than the skin on any other part of the body. The most common culprits are soap, water, sweat, germs, extreme temperatures, rough surfaces, and dirt.
What Can People with AD Do to Prevent or Treat Eczema on the Hands?
Avoid excessive exposure to soap and water by following the suggestions below:
1. Ideally, avoid occupations that require frequent exposure to wet conditions or lots of hand washing. Examples include cook, hair stylist, surgeon, dental hygienist, bricklayer, gardener. If you have already chosen one of these high-risk jobs, you will need to take extra precautions to protect your hands.
Use hand sanitizer more often than soap and water to cleanse your hands. Although hand sanitizer often stings, while soap and water don’t, this does not mean that washing is less damaging. In fact, lathering with soap dissolves the natural skin oils and further dries out fragile skin affected by eczema. Some ingredients in hand sanitizers can irritate nerve endings (causing the stinging sensation), but do not remove the oils or damage the skin as much as soap. Studies have confirmed that hand sanitizer is less risky than frequent, vigorous washing. However, some people can develop allergies to some hand sanitizer ingredients, such as fragrance and preservatives. It is safest to choose a hand sanitizer that is free of fragrance and alcohols.
2. Avoid dish soap that claims to “cut grease.” Grease-cutting dish soaps are among the most common damaging products that people ever use.
3. To protect your hands from dish soap, cleaning agents, and frequent wetting, wear gloves made of vinyl rather than rubber, which can cause allergic reactions in some people. But be aware that vinyl gloves hold in sweat, which can irritate the skin and can make eczema worse. Tips to overcome this problem: 1. Wear gloves that are a little loose; 2. Wear white cotton gloves under the vinyl gloves to wick away moisture; and 3. Take the gloves off frequently to let your skin breathe and apply a bland moisturizer. Tubifast is a brand of gloves that wicks away moisture and fits well.
4. When using soap and water, apply only a small amount of soap to the palms, but try to avoid soaping and wetting the tops of your hands. Palm skin is thicker and less likely to become irritated. Choose a mild soap that doesn’t contain fragrances or preservatives. Products that do not lather are safest. Good choices include: Cetaphil Gentle Skin Cleanser, Aquanil Cleanser, and CeraVe Hydrating Cleanser. If your hands are really dirty and you need a something that lathers, then a good choice is Dove Sensitive Skin Unscented Bar. Carry one of these products with you during the day and at work so you can avoid the very harsh soaps in the dispensers in public restrooms.
5. Apply a bland moisturizer to your hands as often as possible. Immediately after you wash your hands, at the very least, but 20 times a day is not too often. A thick moisturizing cream or ointment works better than a lotion that can be poured from a bottle. When choosing a product, read the ingredients on the label. Pick one that doesn’t have a long list of ingredients, and doesn’t contain fragrance or lots of preservatives. Good choices are: plain petroleum jelly, Albolene Moisturizing Cleanser, Vanicream Moisturizing Skin Cream, Cetaphil Moisturizing Cream, CeraVe Moisturizing Cream, Neutrogena Norwegian Formula Fragrance Free Hand Cream, Aveeno Intense Relief Hand Cream, or Eucerin Plus Intensive Repair Hand Creme. However, how frequently you apply it is much more important than the product you use. Be aware that some people can become allergic to some of the ingredients in moisturizers, so if your eczema is getting worse, switch to plain petroleum jelly or mineral oil. For severe hand or foot eczema try using an additional barrier on top of moisturizer like Vaniply Ointment or plain zinc oxide ointment. Cavilon No Sting Skin Barrier Film, which forms a breathable, transparent coating on the skin, can also be applied directly to skin as an added barrier.
6. Avoid using topical steroids more than twice a day or for more than a few days in a row. While these medications are soothing, frequent and prolonged use can weaken the skin and make it more susceptible to damage, creating a vicious cycle of worsening when the medication is stopped. Protopic and Elidel don’t cause this problem and can be used for longer periods of time.
7. If your hands are cracked and bleeding or uncomfortable enough to interfere with sleep, use a soak-n-smear technique before bed. There are many variations of this technique. My favorite is: soak your hands in a basin with a gallon of lukewarm water and a teaspoon of added bleach for 5 to 10 minutes. Then pat your hands dry, and immediately put on a heavy layer of plain petroleum jelly (read the label and avoid products with names like “Baby”, “Lavendar,” or “Shea Butter” petroleum jelly). Then put on water-dampened white cotton or Tubifast gloves followed by dry vinyl gloves and wear them overnight to keep the petroleum jelly in place. In the morning, remove the gloves and immediately reapply the plain petroleum jelly. You may want to put on a pair of dry white cotton or brown jersey gloves to allow you to begin your daily chores without making a greasy mess.
8. If your hands suddenly become painful, blistered or weepy, see your doctor. A culture for bacteria or herpes virus can help sort out the cause and direct the most appropriate treatment.
9. Keep in mind that it is possible to become allergic to ingredients in soaps, moisturizers, topical medications, and gloves, even if you’ve been using the same products without problems for years! Suspect a contact allergy to one or more of these products if your hands are getting worse and you can’t get them better. See your dermatologist and ask about patch testing and allergen avoidance.
What Can People with AD Do to Prevent or Treat Eczema on the Feet?
Irritation from sweat, from socks, and friction is a major cause for foot eczema in people with AD. A moist environment can also predispose feet to infections with bacteria or fungus. Below are suggestions to restore and maintain healthy skin that you may find useful:
1. Choose comfortable shoes that are not too tight and are made from materials that allow air flow. Take your shoes off as much as possible. If they have laces, don’t tie them tightly, and untie them when you are not walking.
2. Socks lined with roughly woven or seamed fabric can be hard on your skin. If you need to wear thick socks for protection under athletic shoes or work boots, wear a thin, smooth sock or sock liner under them. Liners made of polypropylene, Merino wool, silk, or nylon work well. You can find a place to buy thin socks by using the Internet search term “sock liner.” An absorbent outer sock can help wick sweat away from your feet.
3. If your feet sweat enough to keep your socks damp even when you’re not exercising or doing manual work, you may benefit from a treatment to reduce sweating. Some options are prescription strength antiperspirant, tap water iontophoresis (check www.drionic.com), oral glycopyrrolate pills, and Botox injections. Ask your doctor about the risks and costs of each of these treatments in order to choose the best one for you.
4. Avoid complex topical products such as antibacterials, antifungals, anti-itch creams or hydrocortisone. You can easily become allergic to ingredients in any or all of these. Furthermore, these products can adhere to the inside of your shoes so that the allergic contact reaction continues even after you stop using them. The safest topical products are those prescribed by your doctor, plain petroleum jelly, or mineral oil.
5. Avoid using topical steroids more than twice a day or for more than a few days in a row. While these medications are soothing, frequent and prolonged use can weaken the skin and make it more susceptible to damage, creating a vicious cycle of worsening when the medication is stopped. Protopic and Elidel don’t cause this problem and can be used for longer periods of time.
6. If your feet are cracked and bleeding, follow the instructions in #’s 7, 8, and 9 above, using socks and vinyl wrap instead of gloves. Tubifast socks are also available.