Dry, scaly, and painful hands could be hand eczema

Is the skin on your hands dry, thick, and scaly? Do you have deep, painful cracks on your hands that bleed? You may have more than dry skin. Hand eczema could be the culprit.

Hand eczema can cause the following:

• Dry, chapped skin (often the first sign)

• Patches of red (or dark brown) irritated skin

• Scaly and inflamed skin that may itch

• Burning sensation

• Itchy blisters

• Deep, painful cracks

• Bleeding or weeping skin

• Crusts, pus, and pain

Because it often looks like dry skin, hand eczema can easily be mistaken for dry skin. Unlike dry skin, you need more than a good moisturizer to get rid of hand eczema.

Relief requires finding the cause

Effective treatment begins with finding the cause. Anything that irritates your skin can cause hand eczema. Even something as harmless as water can irritate your skin if you often have wet hands. Many people who frequently have wet hands throughout the day, such as nurses, hair stylists, and plumbers get hand eczema.

Working with chemicals like solvents, detergents, or cement also increases the risk. Hand eczema is common among construction workers and machinists.

Chef with hand eczema

Anything that irritates your skin can cause hand eczema. For example, whenever this chef handles garlic, hand eczema develops.

Hand eczema can also be caused by an allergic reaction. Some health care workers get hand eczema from wearing latex gloves. 

You also have a higher risk of developing hand eczema if you had atopic dermatitis (often called eczema) as a child.

Because so many things can cause hand eczema, finding the cause can be tricky. Until you find the cause and avoid it, hand eczema can worsen.

That’s why it can help to see a dermatologist. These doctors have the expertise needed to track down the cause, as Mark’s* story illustrates.

Dermatologist solves the case of the printing press operator’s hand rash

When he was 42 years old, the skin on Mark’s hand became extremely painful and slightly itchy. A rash covered the back of his hands and some of his forearms. The only time Mark felt some relief was when he was away from work for a week.

By talking with Mark, his dermatologist learned that Mark worked as a printing press operator. On the job, Mark was exposed to many chemicals, but he wore gloves to protect his hands.

Because Mark was exposed to many chemicals, his dermatologist started by testing him for allergies. The results showed that Mark wasn’t allergic to anything tested.

Hand dermatitis

A solvent caused this rash on this man's hands and forearms.

So his dermatologist asked Mark about all the tasks he performed at work. One task stood out. Mark was responsible for cleaning the press between print jobs. While cleaning the press, Mark wore gloves to protect his hands from the solvent. Despite wearing gloves, Mark said that his hands often felt wet. When he would remove the gloves, however, he said there was no trace of solvent on his hands.

At this point, any number of things could be irritating Marks’ skin. His dermatologist focused on the gloves. 

By doing some research, Mark’s dermatologist discovered that the gloves stopped protecting Mark’s skin from the solvent after 4 hours.

The next step was to ask Mark how he used the gloves and how often he changed his gloves. From Mark’s answers, it seemed likely that the gloves were part of the problem.

During an appointment, Mark’s dermatologist showed him how to put on and remove the gloves to prevent solvent from getting inside. His dermatologist also recommended that Mark get a new pair of gloves every day rather than once every 4 to 8 weeks.

After making these minor changes, Mark said his skin improved dramatically. In a month, his rash was almost gone.

Treatment includes avoiding the cause

As you can see from Mark’s story, finding the cause often takes time, detective work, and expertise. 

But finding the cause is essential to get relief. Once you know what’s causing the hand eczema, treatment can bring relief. Treatment includes avoid what’s causing the hand eczema. To help your hands heal, your dermatologist may also include a moisturizer, barrier repair cream, or cortisone cream in your treatment plan. 

A dermatologist can also tell you how to avoid what’s causing your hand eczema.

Even if it seems unlikely that you’ll be able to avoid certain tasks like immersing your hands in water throughout the day or putting on a pair of latex gloves, a dermatologist can help. Dermatologists have developed strategies to help their patients continue to work while avoiding what’s causing their hand eczema.

Sometimes, a few days off of work can be helpful. If you have severe hand eczema, more time off of work may be necessary.

With preventive measures and treatment, however, most people with hand dermatitis recover completely. 

When to see a dermatologist

If you have extremely dry, painful hands and using moisturizer throughout the day fails to bring relief, you may have hand eczema. Without treatment and preventive measures, hand eczema tends to worsen. 

Seeing a dermatologist can relieve hand eczema before it worsens.

* This patient’s story appeared in the Journal of the American Academy of Dermatology. For this article, the patient was given a fictitious name.

Images
Image 1: Image used with permission of the American Academy of Dermatology’s National Library of Dermatologic Teaching Slides.

Image 2: Image used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2006; 55:891-6.)

References
Fowler JF, Ghosh A, et al. “Impact of chronic hand dermatitis on quality of life, work productivity, activity impairment, and medical costs.” J Am Acad Dermatol 2006 Mar; 54:448-57.

James WD, Berger TG, et al. “Atopic dermatitis, eczema, and noninfectious immunodeficiency disorders.” In: James WD, et al. Andrews’ Diseases of the Skin: Clinical Dermatology. (10th edition). Elsevier, Inc. Canada, 2006:78-80. 

Hapern AV and Heymann WR. ““Bacterial diseases.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1084.

Kohli N and Nedorost S. “Inflamed skin predisposes to sensitization to less potent allergens.” J Am Acad Dermatol 2016 Aug; 75:312-7.

Kwon S, Campbell LS, et al. “Role of protective gloves in the causation and treatment of occupational irritant contact dermatitis.” J Am Acad Dermatol 2006 Nov; 55:891-6.

Warshaw EM, Ahmed RL, et. al. “Contact dermatitis of the hands: Cross-sectional analyses of North American Contact Dermatitis Group Data, 1994-2004.” J Am Acad Dermatol 2007 Aug; 57:301-14.