What is hand eczema?
So your doctor has told you that you have hand
eczema or dermatitis. Don't panic. The National
Eczema Association (NEA) wants to help
you discover your own personal prescription for
controlling this bothersome condition. You'll need
time and patience—but you can do it!
Hand eczema may cause itchy, scaly patches
of skin that flake constantly. Or your hands
may become red, cracked, and painful. In some
cases, the rash worsens into weepy bumps.
These problems can happen to anyone at any
time of life, but they are more likely to occur if any
of the following hold true for you:
- You had similar skin problems, hay fever, or other allergies as a child. (Doctors call this set of symptoms "the atopy triangle.")
- Your hands get wet a lot, whether at home, work, or play.
- Your job exposes your hands to irritating chemicals.
What happens at the doctor's office?
(It's only a starting point)
If your hand eczema symptoms have been
present for more than a few weeks and do
not seem to be getting any better, you should
seek treatment from your doctor. Because
your hands are in constant use, it is much
more difficult to treat hand eczema after it
has been present for a while. Your skin will
begin to thicken and harden in response to
constant rubbing and scratching in much the
same way that a callus forms on the bottom or
side of a heel. This will make it more difficult
for any medication to penetrate deeply enough
to have a satisfactory effect. The likelihood of
suffering from persistent and chronic hand
eczema increases the longer the condition
goes undiagnosed and untreated.
If at all possible, see a dermatologist who is
certified by the American Board of Dermatology;
these specialists are most likely to have the
latest information on treatment options and they
can offer tips for changing your work and home
environment to help your hands heal faster and to
lessen future flare-ups. It is also helpful to choose
a dermatologist who sees a lot of patients with
work-related skin problems and is consequently
more familiar with the environmental factors that
may trigger flares.
Your doctor will ask you about the kinds of
activities you engage in at home and at work. It's
very important to be as thorough as you can with
your answers, so your doctor can help determine
what might be causing the problem.
If your hand eczema has persisted for a long time
or is unusually severe, the doctor may suggest
that you be patch tested to determine if you are
allergic to any of the chemicals and allergens
you are exposed to on a daily basis at home or
at work. Patch testing involves putting different
substances on your skin to see how it reacts.
You may receive a prescription for a corticosteroid
medication to put on your eczema. (Hint: It will
soothe your itching better if you keep it in the
refrigerator.) Use topical corticosteroids only
as needed—that is, when your hand eczema
is actively flaring. Prolonged use of these drugs
can cause thinning of the skin, and there are
other side effects to consider as well. Perhaps
your doctor will recommend a non-corticosteroid
topical medication such as tacrolimus (marketed
as Protopic) or pimecrolimus (marketed as
Elidel). These newer agents are approved for
use by adults and children two years of age or
older, and they do avoid many of the side effects
of corticosteroids. They should not be used
long-term on sun-exposed portions of skin, like
the backs of the hands; sunscreen must always
be used. Sometimes oral antihistamine pills can
help, too. You'll probably also receive suggestions
for hand cleansers or moisturizers free of
ingredients that could worsen your eczema.
(This brochure includes some suggestions too.)
Beyond that, clearing up your hand eczema
depends largely on how you change your day-to-day habits. These changes may be difficult.
That's why we've gathered together this
collection of tips for living with hand eczema to
make the process easier for you.
What can I do to protect my hands at home?
That old devil, dishpan hands, is actually a
form of hand eczema. You don't have to be a
homemaker to get it, though. It occurs because
constant wetting and drying breaks down the
skin's protective outer barrier. Perfumes and
preservatives in soaps and irritants in household
cleansers can make things worse.
So, if you already have hand eczema or are
recovering from an episode, you need to avoid
wetting your hands whenever possible. Here are
some tips to help you do this:
- When you need to sanitize your hands (after
using the toilet, for example), wash your hands
with lukewarm water and with a perfume-free
liquid cleanser (like those from Cetaphil or
Aquanil), then blot your hands dry gently and
immediately apply a moisturizer. The best
moisturizer is petroleum jelly, but creams
in a jar or tube (such as Cetaphil, DML, or
Vanicream Skin Cream) are also effective.
Avoid lotions in a pump bottle. You should keep
a good moisturizer next to every sink in your
house. (Does it feel tacky on your hands? Wipe
off the excess with a tissue. You only need a
very thin layer.)
When making your hands sanitary isn't an
issue, try waterless hand washing. Use the
same liquid cleanser you normally use (like
Cetaphil or Aquanil)—but without any water. Blot
it off gently. Avoid the waterless or antibacterial
cleansers on the market if you are in the midst
of a flare-up; they contain solvents and other
ingredients that may make your problem worse.
But if your hands are clear the latter products
may actually help prevent hand eczema.
Keep several pairs of cotton gloves around
the house to protect your hands while doing
chores. Even folding laundry can irritate
tender skin. When these gloves get dirty,
wash them in a perfume-free and dye-free
soap. If your fingertips aren't affected by
hand eczema, you can cut the glove tips
off to stay cooler in hot weather. For wet
work, put on your cotton gloves and then
cover them with unlined powder-free vinyl
or neoprene gloves. (The latex in rubber
gloves can cause allergies.) Afterward, wash reusable gloves inside and out and let them
air dry thoroughly. If a reusable vinyl glove
gets a hole in it, throw it away. Wearing a
glove with a hole in it is worse than wearing
no glove at all. If water gets in your glove,
take it off immediately, blot your hand dry,
and use a new glove.
Wear gloves when peeling potatoes and
when working with meat, onions, peppers,
or acidic fruit, like citrus and tomatoes. We
recommend disposable vinyl gloves. When
you finish preparing these foods, just throw
the gloves away.
Never wear a waterproof glove for more than
15 or 20 minutes at a time.
Ask someone else to shampoo your hair for
you. Or wash your hair wearing your waterproof/
cotton liner glove combination. Use rubber
bands on your forearms to keep water out.
Rings can trap irritants underneath them.
Remove them when doing housework and
before washing and drying your hands. Also,
clean your rings regularly by soaking them
overnight in one tablespoon of ammonia in a
pint of water.
Use the washing machine and the dishwasher,
not your hands, to do laundry and dishes. If
you must wash dishes by hand, do it under
running water. Use a long-handled scrubber to
minimize hand damage from hot water.
For outdoor work, wear unlined leather or thick
fabric gloves to protect your hands. Leather
gloves also will protect your hands in dry,
windy, or cool weather. Avoid wool because
it may be prickly and irritating.
What tools will help?
You can find 100-percent cotton "T-shirt-knit"
gloves at many hobby and craft stores and at
professional camera supply stores. Many drug
stores and beauty salons also carry them,
sometimes labeling them as "beauty gloves."
These are lifesavers for your hands, either
worn alone or as liners beneath vinyl or other
waterproof gloves. Many people are reluctant
to wear "household gloves" because they can
cause sweating, which leads in turn to itching
and burning. But wearing a pair of cotton
gloves will absorb most of the sweat, and will
ensure that your medication or moisturizer
stays in contact with your skin. If possible, buy
your outer waterproof gloves in a larger size to
accommodate the use of liners. Many people go
to pharmacy/medical supply stores to purchase
boxes of vinyl exam gloves, which come in a
variety of sizes, including extra small sizes that
will work for older children.
Be creative with your hand care and tell us what works!
Many people write NEA to tell us of little tricks
they have discovered to help make their hand
eczema symptoms more bearable. For each
person, life lived with hands that don't work is
a difficult journey, but the journey is easier if we
have supportive friends to share it with us. We
encourage all of you to continue sending your
suggestions on effective hand care to NEA at
You may find your advice published in our next newsletter!
How can I protect my hands at work?
If your job is causing your hand eczema, your
doctor will help you determine what irritating
chemicals or work practices are contributing
to your condition. In addition to modifying
those risks, many of the same hand-protective
strategies you use at home can help you at work.
Here are some ideas:
- Use heavy-duty vinyl or neoprene gloves in
tandem with cotton glove liners when doing wet
work. Wash the cotton gloves regularly, as well
as the vinyl gloves if they aren't disposable.
Wear leather or clean, heavy-duty fabric gloves for dry work.
Avoid using industrial hand cleansers or
waterless or antibacterial cleansers that
contain irritating ingredients such as alcohol
and solvents, especially when your hand
eczema is flaring.
Carry your own hand cleanser, moisturizer,
and prescription medication to work, and use
them to prevent problems.
Keep your work clothes, protective clothing,
tools, and work surfaces clean; irritant residues
on them can aggravate your problem.
Treat all minor wounds on your hands, and
bandage them, in order to avoid giving irritants
and allergens an easy route into your skin.
What about moisturizers?
Ironically, the more water there is in a lotion or
moisturizer, the more likely it is to worsen your
hand eczema. So-called "cream" moisturizers
usually contain more water than oil, and when
the water evaporates they have a net drying
effect on the skin. (They are called cream
moisturizers because they are white in color.)
The very best moisturizer for hand eczema is a
greasy one. It has very few ingredients, it holds
the skin's natural moisture in, and it provides
a protective barrier to keep irritants out. This turns out to be petroleum jelly, also known as
petrolatum (Vaseline is one brand, and there are
others as well). You should apply it to your hands
immediately after you bathe, and each time you
wash your hands. Carry a small tube with you
and reapply it throughout the day. Once your
eczema has cleared and you are no longer using
a prescription ointment, your doctor may also
suggest using petroleum jelly or a prescription
medication on an ongoing basis at night with
cotton gloves. In this case, wear the same gloves
over and over to help contain the medication.
If you dislike petroleum jelly, the next best
alternatives are, in order, lubricants, hydrating
gels, and creams (like Cetaphil, Neutrogena,
and Curél). Urea and lactic acid are helpful
ingredients because they help the skin absorb
moisture (they can be found in products like
Uremol, Lac-Hydrin, and AmLactin). You need
to read all labels carefully to make sure that
products don't contain any ingredients that
should be avoided (see the last page in this
brochure). Eventually you'll be a skilled reader
of labels for lotions, shampoos, and other
What ingredients should I avoid?
Patch testing can help to determine if you are
allergic to specific components of personal care
products; after you have been patch tested, your dermatologist will assist you with finding
appropriate products. If your doctor has told you
that you are sensitive or allergic to a specific
substance, avoid products that contain that too.
There are a wide variety of additional ingredients,
usually preservatives, which can cause skin
irritation or allergy, and it's best to avoid them if
you already have hand eczema. When in doubt,
use plain petrolatum. It only has one ingredient.
What about "alternative" therapies?
Once you have an episode of hand eczema, your
risk of having another one increases greatly. For
some people hand eczema becomes chronic.
The lack of an easy fix from conventional
medicine has led some hand eczema patients to
seek alternative treatments. But the efficacy of
most of these treatments remains unproven.
A few years ago, for example, primrose oil was
touted as a topical therapy for hand eczema,
but it later was shown not to work. In November
1998, the American Medical Association Journal,
Archives of Dermatology, listed several other
plant extracts that have been used to treat
skin conditions similar to eczema: calendula
officinalis (marigold), chamomile, witch hazel,
licorice root, and aloe vera gel. Unfortunately, a
history of use doesn't necessarily translate into
a history of effectiveness; indeed some of these substances (or the gel/lotion used to deliver
them) may worsen your condition.
If you do decide to try an alternative therapy for
your hand eczema, be sure to tell your doctor about
it. This is important for coordination of your care.
What about future therapies?
The results of some early studies on the use
of oral alitretinoin in patients with chronic hand
dermatitis resistant to topical corticosteroid
therapy have already been published, but studies
in the United States have not yet begun.
What is the bottom line?
Unfortunately, there is no quick and easy solution
to hand eczema. Clearing up an episode of the
condition can take several months, and you will
need to continue babying your hands for as long
as a year even though they appear eczema free.
But we at NEA hope these tips will help make
the process easier for you.
This information sets forth current opinions from
recognized authorities, but it does not dictate
an exclusive course of treatment. Persons with
questions about a medical condition should
consult a physician who is knowledgeable about
If you have never been patch tested,
you may wish to avoid some of the
more common allergens found in
moisturizers and cosmetics:
- fragrances (these can cause allergic reactions even if they are natural)
- formaldehyde releasers, including:
- formaldehyde (Formol, Methanal, Veracur, et cetera)
- pRopane, aka Bronopol
- diazolidinyl urea
- imidazolidinyl urea
- DMDM Hydantoin
Thanks to Frances Storrs, M.D., and Susan Nedorost, M.D., for their editorial
contributions to this brochure.
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