3-part series on Hand Eczema with Dr Lynn Chiam
Dr Lynn Chiam
Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Children & Adult Skin Hair Laser Clinic, Singapore. Apart from paediatric dermatology, her other sub-specialty interests include adult pigmentary conditions and laser dermatology.
Is it really Hand Eczema?
Rashes on your hand may not be eczema although hand eczema/ hand dermatitis is the most common type of hand rash. Various other rashes can be:
Psoriasis
Psoriasis is a chronic skin condition characterized by clearly defined white, silvery or reddish thick patches. Apart from the palms, look for other typical signs of psoriasis such as scalp involvement and nail deformities.
Tinea Manuum
This refers to fungal infection of the hands which can look similar to hand eczema. Fungal infection needs to be excluded if only one hand is affected. A fungal scrape (skin test) will be positive in tinea manuum.
MarcieMom: Dr Lynn, how frequent are the above in causing hand rashes? Are there other common differential diagnosis from hand dermatitis?
Dr Lynn: Hand eczema has been identified as one of the most common frequent dermatological disorder encountered in clinical practice. It is caused by a combination of internal (genetics, individual predisposition) and external factors (exposure to irritants and allergens). It is estimated that about 10% of the general population suffer from hand eczema. It is reported to be more common in women and in certain occupations like hairdressers, healthcare workers and domestic workers.
Other conditions that can mimic hand eczema include psoriasis (which affects about 1% of the local population) and tinea manuum, a fungal infection of the hands which is uncommon.
Different types of Hand Eczema/ Dermatitis
Hand eczema results in inflammation of the skin which can present with dryness, scaling, redness, vesicles( bubbles), fissures, thickening, pain and itch. Even within hand eczema, there are various forms of dermatitis:
Irritant Contact Dermatitis
This is the most common form of dermatitis, caused by repeated exposure to irritants like water (from repeated hand washing), soaps, detergents, food products or chemicals frequently exposed to in a job, such as solvents, lubricants, oils and coolants. Friction and repetitive rubbing of the skin also increases the likelihood of irritant contact dermatitis. The rash is typically found on the knuckle surface of the hands. Avoidance of the irritant material can bring about a significant improvement.
Allergic Contact Dermatitis
Allergic contact dermatitis only happens to a small number of people who are sensitized to a certain material. This means that in the past, they may have been in contact with the offending material and even though on the first contact, there may have been only a little or mild reaction, the skin “remembers” the material as an allergen. On the repeated contact with the same material, a worse rash will result. Common allergens include nickel, fragrances, preservatives and rubber. A patch test can confirm the allergy.
Atopic Dermatitis
Patients who have atopic eczema when young are more likely to develop atopic dermatitis on the hands as an adult. Look for involvement of the other areas on the body.
Pompholyx
Pompholyx has a distinctive appearance of itchy small blisters on the palms of the hands. It is also more closely associated with excessive sweating and can be found on the soles and toes.
Nummular Hand Dermatitis
This shows up as circular areas of redness, scaling on the backs of the hands and can appear oozy.
Symptoms of Hand Eczema
Symptoms include redness (erythema), itch (pruritus), pain, dry, peeling/ flaking skin, blisters (vesicles) and cracks (fissures), weeping (exudation) and swelling (oedema).
MarcieMom: Dr Lynn, there are quite a few types of dermatitis – do they have similar symptoms or can it be difficult to diagnose which type of dermatitis one suffers from? Does age, gender or occupation affect which type of dermatitis one suffers from?
Dr Lynn:Yes, the different types of hand eczema can have similar symptoms. However, there are certain clues to look out for. From the history of the onset of the rash, contact with certain materials, improvement with avoidance, one may be able to distinguish between irritant and allergic contact dermatitis. A positive or family history of atopy (allergic tendencies) and involvement of the feet points to atopic hand eczema.
More women are affected by hand eczema than men. The prevalence of hand eczema is also higher in certain occupations like healthcare workers, hairdressers and domestic workers. This is due to prolonged and repeated contact with certain harsh materials resulting in irritant contact dermatitis. In irritant contact dermatitis, the knuckles, finger tips and web-spaces are commonly affected. Improvement is noted with avoidance of the material.
In allergic contact dermatitis, the rash may persist even with further avoidance of the allergen. Patch testing can help determine the allergen.
In adults with atopic eczema affecting the hands, other areas of the body can also be affected. In the acute stage, red spots, oozing and excoriations can be seen. In the later stages, the skin becomes dry, cracked and thick. Secondary infections can also set in.
Triggers of Hand Eczema
Triggers of hand eczema are typically water, sweat, soaps, detergents, food products, solvents, lubricants, oils and coolants.
MarcieMom: Dr Lynn, regardless of whether it is irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis, are the triggers similar? If yes, will avoiding these triggers be actions a hand eczema sufferer should take?
What are the factors that affect what form of dermatitis one get?
Dr Lynn: Yes, there are certain common triggers that will adversely affect the hands. Over-washing (even with just plain water), harsh soap, detergents and lubricants should generally be avoided by people with hand eczema. Wearing of gloves to reduce the contact of water and soaps with the skin is recommended if prolonged wet work is necessary.
Regular use of moisturizer can help prevent flares in people with hand eczema. Gentle soap in small amounts is recommended.
Keeping fingernails short prevent further damage of the skin while scratching. It is advisable to remove rings and bangles before hand-washing and wet work as they can trap moisturizer, dirt and bacteria.
MarcieMom: Thank you Dr Lynn for helping us to understand the different types of hand rash, hand eczema and its common triggers. Next week, we will look forward to learning about treatment of hand eczema.
