Hand Dermatitis

Hand dermatitis, "eczema", is a common skin complaint. It is simply defined as inflammation of the skin of the hand. In a given year, approximately 10 % of the general population will suffer from hand dermatitis.

We use our hands to explore our environment; subsequently, our hands are in frequent contact with potential allergens and irritants. Approaching the diagnosis and treatment of hand dermatitis can be challenging, as both internal and external factors may contribute. The differential diagnosis of hand dermatitis is broad and the cause often multifactorial.

Common hand dermatitis allergens

Adhesives
Rubber compounds, p-tertiary-butylphenol formaldehyde resin, formaldehyde, epoxy resin

Antimicrobials/preservatives
Formaldehyde-releasers, formaldehyde

Finishing (waxes, polishes)
Colophony

Fragrances
Balsam of Peru, cinnamic aldehyde

Hair dye
Paraphenylenediamine

Metals
Nickel sulfate, cobalt chloride, potassium dichromatea (Also in cement and leather)

Rubber compounds
Black rubber mix, merceptobenzothiazole, carbamates, thiuram, dialkyl thioureas

Topical medications
Benzocaine, ethylenediamine dihydrochloride, lanolin, neomycin

There are multiple causes of hand dermatitis and numerous treatment options exist.

Topical glucocorticoids

Topical glucocorticoids are first-line treatment. Higher-potency topical steroids are required for treatment of the palms due to the thick stratum corneum.

A prospective, open, randomized trial with 120 patients with chronic hand dermatitis treated with mometasone furoate fatty cream showed that 42 % of patients improved with 3 weeks of therapy, 63 % improved with 6 weeks of therapy, and 86 % were controlled with 9 weeks of therapy.

 90 % of 61 patients had clearance of their dermatitis after 1–3 weeks of daily clobetasol propionate 0.05 % cream.

However, continuous use of potent topical steroids can cause local skin atrophy and paradoxically may ultimately decrease the skin’s protective barrier if used in the long term. Therefore, only brief courses of potent topical steroids are recommended, with prompt transition to lower-potency steroids or other non-steroidal topicals.

Topical calcineurin inhibitors

Topical calcineurin inhibitors have been successful in the treatment of contact dermatitis. Hand eczema patients treated with tacrolimus 0.1 % ointment twice daily for 4 weeks followed by an optional 2-month treatment period, demonstrated complete clearance in 44 % of subjects. Tacrolimus is a viable alternative to topical steroids in the treatment of allergic contact dermatitis.

Systemic Treatments

Severe cases of acute hand dermatitis may require a short course of systemic steroids administered via the oral or intramuscular route. One example that is often recommended is a 2-week course of prednisone by mouth starting at a dose of 60 mg and tapering by increments of 10 mg.

Other systemic treatments include methotrexate, cyclosporine, dapsone.

Topical psoralen combined with ultraviolet A radiation (PUVA) and UVB have been tried. New and experimental therapies are also available and are listed in the reference section below.

References

Hand Dermatitis: an Allergist’s Nightmare - Springer http://buff.ly/1wdv79Y



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