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Hand Dermatitis (eczema)

May 23, 2017

Hand dermatitis (eczema) is associated with irritants or allergies and can be triggered or aggravated at work (occupational dermatitis). Many patients are employed as healthcare workers/nurses, hair stylists, restaurant servers/staff, bakers, or printers.

There are 3 types of hand dermatitis: irritant, allergic, and atopic.

Chronic hand dermatitis lasts at least three months or incurs two relapses in a calendar year. Alitretinoin, cyclosporine, high potency topical corticosteroids, and phototherapy are indicated in Canada for the treatment of chronic hand dermatitis. (Acitretin, azathioprine, methotrexate even soriatane are sometimes used.)

Itchiness is a symptom of both allergic and atopic hand dermatitis. Irritant hand dermatitis often has little or no itchiness.

Common irritants include friction, dryness, moisture, and chemicals (e.g., hand disinfectants, germicides, detergents, ink, dyes, solvents, etc.). When these offending exposures are in the working environment, symptoms develop gradually, show little improvement on weekends, but marked recovery with extended periods away from work.

Allergens like latex, animal fur/dander, perfumes, and food are also be implicated. This is often characterized by redness, blistering, and severe itchiness. Work exposure usually improves on weekends, symptoms disappear on vacation, but recur soon after returning to work. A patch test can confirm the diagnosis.

Atopic dermatitis is frequently unrelated to occupation and a family history of allergy is common. It can involve the flexor surfaces of the wrists, the nails, and the “snuff box”. Blisters are often seen and the skin can turn thick and leathery (lichenification).

The mainstay of hand dermatitis treatment is topical corticosteroids.

Moderate potency corticosteroids are sometimes used for 4-8 weeks (2 weeks if dorsal location) to manage mild-to-moderate chronic hand dermatitis. Severe chronic hand dermatitis uses a potent topical corticosteroid for 4 to 8 weeks (2 weeks if dorsal location) or super-potent topical corticosteroid for 2 weeks.

When moderate chronic hand dermatitis is not improved by prevention strategies, emollient therapy, and a high potency topical corticosteroid of 2-week duration, it is treated as severe and phototherapy/oral treatment is considered. An oral treatment is alitretinoin but pregnancy must be avoided (pregnancy prevention program).

Treatment should be combined with moisturizing therapy and hand protection (eg, gloves), which should continue after discontinuation of corticosteroids.

In hyperkeratotic dermatitis, salicylic acid 20% or urea 5–10% is sometimes prescribed to smooth the skin and help with treatment penetration.

Topical steroids— Potency

Low

  • Desonide 0.05%
  • Hydrocortisone 0.5%, 1%, 2.5%
  • Hydrocortisone acetate 0.5%, 1%, 2%

Medium

  • Betamethasone valerate 0.05%, 0.1%
  • Clobetasone butyrate 0.05%
  • Diflucortolone valerate 0.1%
  • Fluocinolone acetonide 0.01%, 0.025%
  • Hydrocortisone valerate 0.2%
  • Mometasone furoate 0.1%
  • Triamcinolone acetonide 0.025%, 0.1%, 0.5%
  • Prednicarbate 0.1%

High

  • Amcinonide 0.1%
  • Betamethasone dipropionate 0.05%
  • Fluocinonide 0.05%
  • Halcinonide 0.1%
  • Desoximetasone 0.05%, 0.25% •

Ultra-high

  • Beclomethasone dipropionate 0.05% in base containing propylene glycol
  • Clobetasol propionate 0.05%
  • Halobetasol propionate 0.05%

RESOURCES

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