What is Hand Eczema?
Hand eczema (also known as hand dermatitis) is a common condition affecting up to 10% of the population. It results from a combination of factors, both internal (e.g. your genetic make-up), and external (e.g. contact with irritants and allergens such as chemicals). The irritant nature of some chemicals means that hand eczema is particularly common in people with jobs involving cleaning, catering, hairdressing, healthcare and mechanical work. It is an inflammatory condition and is not contagious, but it can still have a major effect on people’s work, social lives and self-esteem.
The main symptoms of hand eczema include one or more of the following:
Download this brochure as a PDF 2MB
There is also a specific type of hand eczema called pompholyx (pronounced Pom-foe-licks, from the Greek word for bubble). The cause of pompholyx is unknown and it tends to occur more commonly in women. Each outbreak consists of the appearance of itchy small blisters on the palms of the hands. The condition may come and go over the course of many years, and is notoriously difficult to treat effectively.
What happens at the doctor’s office? It’s only a starting point…
If your hand eczema symptoms have been present for more than a few weeks and do not seem to be getting any better, you should seek treatment from your doctor. Because your hands are in constant use, it is much more difficult to treat hand eczema after it has been present for a while. Your skin will begin to thicken and harden in response to constant rubbing and scratching in much the same way that a callus forms on the bottom or side of a heel. This will make it more difficult for any medication to penetrate deeply enough to have a satisfactory effect. The likelihood of suffering from persistent and chronic hand eczema increases the longer the condition goes undiagnosed and untreated.
Your doctor will ask you about the kinds of activities you engage in at home and at work. It’s very important to be as thorough as you can with your answers, so your doctor can help determine what might be causing the problem. If your hand eczema has persisted for a long time or is unusually severe, the doctor may suggest that you be patch tested to determine if you are allergic to any of the chemicals and allergens you are exposed to on a daily basis at home or at work. Patch testing involves putting different substances on your skin to see how it reacts.
You may receive a prescription for a corticosteroid medication to put on your eczema. (Hint: It will soothe your itching better if you keep it in the refrigerator.) Use topical corticosteroids only as needed—that is, when your hand eczema is actively flaring. Prolonged use of these drugs can cause thinning of the skin, and there are other side effects to consider as well. Perhaps your doctor will recommend a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel). These agents are approved for use by adults and children two years of age or older, and they do avoid many of the side effects of corticosteroids. They should not be used long-term on sun-exposed portions of skin, like the backs of the hands; sunscreen must always be used. Sometimes oral antihistamine pills can help eczema too. You’ll probably also receive suggestions for hand cleansers or moisturizers free of ingredients that could worsen your eczema.
Beyond that, clearing up your hand eczema depends largely on how you change your day-to-day habits. These changes may be difficult.
Following is a collection of tips for living with hand eczema.
What can I do to protect my hands at home?
- “Dishpan hands” are actually a form of hand eczema. It occurs because constant wetting and drying breaks down the skin’s protective outer barrier. Perfumes and preservatives in soaps and irritants in household cleansers can make things worse. If you already have hand eczema or are recovering from an episode, you need to avoid wetting your hands whenever possible.
- When you need to sanitize your hands, wash your hands with lukewarm water and a perfume-free mild cleanser, then blot your hands dry gently and immediately apply a moisturizer. The best moisturizer is petroleum jelly, but creams in a jar or tube are also effective. You should keep a good moisturizer next to every sink in your house. If it feels tacky on your hands, wipe off the excess. You only need a very thin layer.
- When making your hands sanitary isn’t an issue, try waterless hand washing. Use the same gentle cleanser you normally use — but without any water. Blot it off gently. Avoid waterless or antibacterial sanitizers if you are in the midst of a flare-up; they generally contain solvents and other ingredients that may make your problem worse. If your hands are clear, the latter products may actually help prevent hand eczema.
- Keep several pairs of cotton gloves around the house to protect your hands while doing chores. Even folding laundry can irritate tender skin. When these gloves get dirty, wash them in a perfume-free and dye-free soap. If your fingertips aren’t affected by hand eczema, you can cut the glove tips off to stay cooler in hot weather. For wet work, put on your cotton gloves and then cover them with unlined powder-free vinyl or neoprene gloves. (The latex in rubber gloves can cause allergies.) Afterward, wash eczema reusable gloves inside-out and let them air dry thoroughly. If a reusable vinyl glove gets a hole in it, throw it away. Wearing a glove with a hole in it is worse than wearing no glove at all. If water gets in your glove, take it off immediately; blot your hand dry, and use a new glove.
- Wear gloves when peeling potatoes and when working with meat, onions, peppers, or acidic fruit, like citrus and tomatoes. We recommend disposable vinyl gloves. When you finish preparing these foods, just throw the gloves away.
- Never wear a waterproof glove for more than 15 or 20 minutes at a time.
- Ask someone else to shampoo your hair for you. Or wash your hair wearing your waterproof/cotton liner glove combination. Use rubber bands on your forearms to keep water out.
- Rings can trap irritants underneath them. Remove them when doing housework and before washing and drying your hands. Also, clean your rings regularly by soaking them overnight in one tablespoon of ammonia in a pint of water.
- Use the washing machine and the dishwasher, not your hands, to do laundry and dishes. If you must wash dishes by hand, do it under running water. Use a long-handled scrubber to minimize hand damage from hot water.
- For outdoor work, wear unlined leather or thick fabric gloves to protect your hands. Leather gloves also will protect your hands in dry, windy, or cool weather. Avoid wool because it may be prickly and irritating
What tools will help?
You can find 100-percent cotton “T-shirt knit” gloves at many hobby and craft stores and at professional camera supply stores. Many drug stores and beauty salons also carry them. These are lifesavers for your hands, either worn alone or as liners beneath vinyl or other waterproof gloves. Many people are reluctant to wear “household gloves” because they can cause sweating, which leads in turn to itching and burning. But wearing a pair of cotton gloves will absorb most of the sweat, and will ensure that your medication or moisturizer stays in contact with your skin. If possible, buy your outer waterproof gloves in a larger size to accommodate the use of liners. Many people go to pharmacy/medical supply stores to purchase boxes of vinyl exam gloves, which come in a variety of sizes, including extra small sizes that will work for older children.
How can I protect my hands at work?
If your job is causing your hand eczema, your doctor will help you determine what irritating chemicals or work practices are contributing to your condition. In addition to modifying those risks, many of the same hand-protective strategies you use at home can help you at work. Here are some ideas:
- Use heavy-duty vinyl or neoprene gloves in tandem with cotton glove liners when doing wet work. Wash the cotton gloves regularly, as well as the vinyl gloves if they aren’t disposable.
- Wear leather or clean, heavy-duty fabric gloves for dry work.
- Avoid using industrial hand cleansers or waterless or antibacterial cleansers that contain irritating ingredients such as alcohol and solvents, especially when your hand eczema is flaring.
- Carry your own hand cleanser, moisturizer, and prescription medication to work, and use them to prevent problems.
- Keep your work clothes, protective clothing, tools, and work surfaces clean; irritant residues on them can aggravate your problem.
- Treat all minor wounds on your hands, and bandage them, in order to avoid giving irritants and allergens an easy route into your skin.
What about moisturizers?
Once your eczema has cleared and you are no longer using a prescription ointment, your doctor may also suggest using petroleum jelly or a prescription medication on an ongoing basis at night with cotton gloves. In this case, wear the same gloves over and over to help contain the medication. If you dislike petroleum jelly, the next best alternatives are, in order, lubricants, hydrating gels, and creams (like Cetaphil, Neutrogena, and Curél). Urea and lactic acid are helpful ingredients because they help the skin absorb moisture. You need to read all labels carefully to make sure that products don’t contain any ingredients that should be avoided. NEA has more information about these ingredients.
Eventually you’ll be a skilled reader of labels for lotions, shampoos, and other cosmetics.
What ingredients should I avoid?
Patch testing can help to determine if you are allergic to specific components of personal care products; after you have been patch tested; your dermatologist will assist you with finding appropriate products. If your doctor has told you that you are sensitive or allergic to a specific substance, avoid products that contain that too. There are a wide variety of additional ingredients, usually preservatives, which can cause skin irritation or allergy, and it’s best to avoid them if you already have hand eczema. When in doubt, use plain petrolatum. It only has one ingredient.
What about “alternative” therapies?
Once you have an episode of hand eczema, your risk of having another one increases greatly. For some people, hand eczema becomes chronic. The lack of an easy fix from conventional medicine has led some hand eczema patients to seek alternative treatments. The efficacy of most of these treatments remains unproven. If you do find an alternative that works for you, please share it with the National Eczema Association to help others. If you do decide to try an alternative therapy for your hand eczema, be sure to tell your doctor about it. This is important for coordination of your care.
What about future therapies?
The results of some early studies on the use of oral alitretinoin in patients with chronic hand dermatitis resistant to topical corticosteroid therapy have already been published and studies in the United States are on-going. NEA will keep you apprised of all research and new treatments.
What is the bottom line?
Unfortunately, there is no quick and easy solution to hand eczema. Clearing up an episode of the condition can take several months, and you will need to continue caring for your hands for as long as a year, even though they appear eczema free.
Be creative with your hand care and tell us what works!
Many people write to NEA to communicate tips, products, and treatments they have discovered to help their hand eczema. Please stay connected with us to learn more and share what works for you!
For a complimentary copy of the NEA
print newsletter, The Advocate, and an eczema information package, please contact us.
We are always here to help!
This information sets forth current opinions from recognized authorities, but it does not dictate an exclusive treatment course. Persons with questions about a medical condition should consult a physician who is knowledgeable about that condition.
The National Eczema Association (NEA) improves the health and quality of life for individuals with eczema through research, support, and education. NEA is entirely supported through individual and corporate contributions and is a 501(c)(3) tax-exempt organization. NEA is the only organization in the United States advocating solely for eczema patients.
Acknowledgments: The National Eczema Association (NEA) acknowledges Frances Storrs, MD and Susan Nedorost, MD, for their editorial contributions to this brochure.
Copyright © 2012 National Eczema Association