So your doctor has told you that you have hand eczema or dermatitis. Don't panic. The National Eczema Association (NEA) wants to help you discover your own personal prescription for controlling this bothersome condition. You'll need time and patience—but you can do it!

Hand eczema may cause itchy, scaly patches of skin that flake constantly. Or your hands may become red, cracked, and painful. In some cases, the rash worsens into weepy bumps. These problems can happen to anyone at any time of life, but they are more likely to occur if any of the following hold true for you:

• You had similar skin problems, hay fever, or other allergies as a child. (Doctors call this set of symptoms "the atopy triangle.")
• Your hands get wet a lot, whether at home, work, or play.
• Your job exposes your hands to irritating chemicals.

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.

If at all possible, see a dermatologist who is certified by the American Board of Dermatology; these specialists are most likely to have the latest information on treatment options and they can offer tips for changing your work and home environment to help your hands heal faster and to lessen future flare-ups. It is also helpful to choose a dermatologist who sees a lot of patients with work-related skin problems and is consequently more familiar with the environmental factors that may trigger flares.

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 (marketed as Protopic) or pimecrolimus (marketed as Elidel). These newer 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, too. You'll probably also receive suggestions for hand cleansers or moisturizers free of ingredients that could worsen your eczema. (This brochure includes some suggestions too.)

Beyond that, clearing up your hand eczema depends largely on how you change your day-to-day habits. These changes may be difficult. That's why we've gathered together this collection of tips for living with hand eczema to make the process easier for you.

That old devil, dishpan hands, is actually a form of hand eczema. You don't have to be a homemaker to get it, though. 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.

So, if you already have hand eczema or are recovering from an episode, you need to avoid wetting your hands whenever possible. Here are some tips to help you do this:

• When you need to sanitize your hands (after using the toilet, for example), wash your hands with lukewarm water and with a perfume-free liquid cleanser (like those from Cetaphil or Aquanil), then blot your hands dry gently and immediately apply a moisturizer. The best moisturizer is petroleum jelly, but creams in a jar or tube (such as Cetaphil, DML, or Vanicream Skin Cream) are also effective. Avoid lotions in a pump bottle. You should keep a good moisturizer next to every sink in your house. (Does it feel tacky on your hands? Wipe off the excess with a tissue. You only need a very thin layer.)
• When making your hands sanitary isn't an issue, try waterless hand washing. Use the same liquid cleanser you normally use (like Cetaphil or Aquanil)—but without any water. Blot it off gently. Avoid the waterless or antibacterial cleansers on the market if you are in the midst of a flare-up; they contain solvents and other ingredients that may make your problem worse. But 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 reusable gloves inside and 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.

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, sometimes labeling them as "beauty gloves." 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.

Many people write NEA to tell us of little tricks they have discovered to help make their hand eczema symptoms more bearable. For each person, life lived with hands that don't work is a difficult journey, but the journey is easier if we have supportive friends to share it with us. We encourage all of you to continue sending your suggestions on effective hand care to NEA at . You may find your advice published in our next newsletter!

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.

Ironically, the more water there is in a lotion or moisturizer, the more likely it is to worsen your hand eczema. So-called "cream" moisturizers usually contain more water than oil, and when the water evaporates they have a net drying effect on the skin. (They are called cream moisturizers because they are white in color.)

The very best moisturizer for hand eczema is a greasy one. It has very few ingredients, it holds the skin's natural moisture in, and it provides a protective barrier to keep irritants out. This turns out to be petroleum jelly, also known as petrolatum (Vaseline is one brand, and there are others as well). You should apply it to your hands immediately after you bathe, and each time you wash your hands. Carry a small tube with you and reapply it throughout the day. 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 (they can be found in products like Uremol, Lac-Hydrin, and AmLactin). You need to read all labels carefully to make sure that products don't contain any ingredients that should be avoided (see the last page in this brochure). Eventually you'll be a skilled reader of labels for lotions, shampoos, and other cosmetics.

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.

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. But the efficacy of most of these treatments remains unproven.

A few years ago, for example, primrose oil was touted as a topical therapy for hand eczema, but it later was shown not to work. In November 1998, the American Medical Association Journal, Archives of Dermatology, listed several other plant extracts that have been used to treat skin conditions similar to eczema: calendula officinalis (marigold), chamomile, witch hazel, licorice root, and aloe vera gel. Unfortunately, a history of use doesn't necessarily translate into a history of effectiveness; indeed some of these substances (or the gel/lotion used to deliver them) may worsen your condition. 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.

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, but studies in the United States have not yet begun.

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 babying your hands for as long as a year even though they appear eczema free. But we at NEA hope these tips will help make the process easier for you.

This information sets forth current opinions from recognized authorities, but it does not dictate an exclusive course of treatment. Persons with questions about a medical condition should consult a physician who is knowledgeable about that condition.

If you have never been patch tested, you may wish to avoid some of the more common allergens found in moisturizers and cosmetics:

• methyldibromoglutaronitrile/phenoxyethanol
• methylchloroisothiazolinone/methylisothiazolinone
• fragrances (these can cause allergic reactions even if they are natural)
• formaldehyde releasers, including:
• formaldehyde (Formol, Methanal, Veracur, et cetera)
• quaternium-15
• pRopane, aka Bronopol
• diazolidinyl urea
• imidazolidinyl urea
• DMDM Hydantoin

Thanks to Frances Storrs, M.D., and Susan Nedorost, M.D., for their editorial contributions to this brochure.