Hand eczema

Disease Description (Causes and Symptoms)

• Definition: Hand eczema is eczema (a superficial inflammatory skin disease) that occurs on the hands and is characterized by spongiosis of the epidermis and perivascular inflammation of the dermis.
• Main causes: Frequent contact with water or detergents (work-related or household labor), irritant contact, allergic contact (e.g., nickel, latex, preservatives), atopic constitution, and dry environments (low humidity).
• Pathophysiology: When damage to the stratum corneum disrupts the skin barrier, external irritants and antigens can easily penetrate, causing inflammation and epidermal changes (vesicles, scaling, fissures, hyperkeratosis, etc.). Repeated exposure can lead to chronic disease, causing the skin to thicken and potentially leaving hyperpigmentation, fissures, and scars.
• Main symptoms: Itching, erythema, vesicles (blisters) or papules, edema, scaling, skin thickening (lichenification), fissures and bleeding, and hyperpigmentation. If infection occurs, purulent discharge and pain may accompany the symptoms.

Treatment Methods

• Basic principles: Avoiding triggers (water, detergents, allergens) and restoring the skin barrier (moisturization) are key to treatment.
• Topical treatment
  • Moisturizers (emollients): Apply frequently, especially after washing the hands and before bedtime. Fragrance-free, non-irritating formulations are recommended.
  • Topical corticosteroids: When symptoms worsen (erythema, itching, vesicles), use topical corticosteroids of an appropriate potency for a short period. Be aware of side effects such as skin atrophy and acneiform eruptions with long-term or extensive use.
  • Topical immunomodulators (tacrolimus, pimecrolimus): May be used as alternatives in some cases, such as on the face or in skin folds, or when there are concerns about steroid side effects.
• Systemic/specialized treatment (recurrent, severe, or chronic forms)
  • Alitretinoin: An oral treatment used for severe, chronic hand eczema that does not respond to topical treatment (women face a serious risk of teratogenicity — strict contraception and monitoring are required).
  • Phototherapy: PUVA or narrowband UVB, etc., performed under a specialist's judgment.
  • Systemic immunosuppressants (methotrexate, cyclosporine, etc.) or biologic agents (e.g., biologic agents may be considered when atopic features are also present) — consultation with a specialist is required, and indications are limited.
• Infection treatment: Antibiotics may be prescribed for secondary bacterial infection (accompanied by erythema, pus, and pain).
• Lifestyle management and protective measures
  • If you need to wash your hands frequently with water, moisturize frequently and use protective gloves while working, using a material appropriate for your needs instead of vinyl or latex. When wearing gloves, cotton liners are recommended to reduce irritation caused by sweat.
  • Minimize exposure to irritating detergents, solvents, and chemicals; if a work-related cause is suspected, consider improving the work environment or adjusting work duties.
• Precautions
  • Long-term or excessive use of topical steroids may cause skin atrophy, telangiectasia, and pigment changes. Follow the directions and dosage.
  • Alitretinoin is contraindicated during pregnancy and breastfeeding; both men and women need counseling before taking it.
  • If the condition is caused by allergens such as metals or preservatives, identify them with a patch test and avoid the relevant substances.
• Complications: Secondary infection due to persistent fissures, pain and functional impairment, occupational loss, scarring, and hyperpigmentation.

Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)

• Items to bring
  • A list of currently taken medications (including prescription drugs, over-the-counter drugs, herbal medicines, and supplements)
  • Previous dermatology medical records, medications used for treatment (especially steroids and oral treatments), and test results (such as patch tests, skin biopsies, and blood tests)
  • Photos showing when the symptoms began and how they progressed (early onset, progression, and most recent condition)
  • A record of substances that come into contact with your hands at work and in daily life (detergents, types of gloves, and work environment), as well as the frequency and habits of handwashing
  • Possibility of pregnancy (women), breastfeeding status, and recent vaccinations or infections
• Information useful to record for the visit
  • Factors that worsen or improve the symptoms (which activities or substances make them worse), whether they interfere with sleep at night, and the presence or absence of pain or bleeding
  • Effects of previous treatments (whether they helped, whether there were side effects, and how long they were used)
• Tests that may be performed as an outpatient (anticipated)
  • Clinical examination (visual assessment), patch testing if needed (to determine whether allergic contact is involved), bacterial culture (if infection is suspected), skin biopsy (if the diagnosis is unclear), and blood tests (safety assessment before systemic treatment).

Examples of General Questions to Ask the Doctor

• "What are the possible causes of this condition? How can we distinguish whether it is allergic or irritant?"
• "What are the expected effects and possible side effects of the treatment you recommend?"
• "What daily-life and occupational precautions should I take to prevent the symptoms from worsening?"
• "How likely is the condition to recur after treatment, and what should I do if it recurs?"

Examples of Condition-Specific Questions

• "Should I have a patch test? Which allergens should be tested, including work-related exposures?"
• "If there is no improvement with topical treatment (after several weeks or more), when should the next steps—such as alitretinoin, phototherapy, or systemic treatment—be considered? What alternatives are available if I am planning a pregnancy?"