During the COVID pandemic, with all the hand washing and hand sanitizing, there was an uptick of hand rashes.
Hand rashes can be super annoying as you use your hands for everything! The moment the rashes show up, it seems to get worse with anything you do. Putting lotions or creams on the hands is also very annoying as it is slippery, making it hard to type on your keyboard and use your phones.
Why causes hand eczema?
No one knows for sure. It is a combination of genetic factors. In those with intrinsic eczema, many have a filaggrin mutation which causes problems with the skin barrier, allowing for irritants and allergens to penetrate the skin. Thus, eczema patients are at higher risk for getting hand eczema.
Injury to the skin caused by chronic exposures to certain caustic ingredients (irritant contact dermatitis) may also cause hand eczema. For example, if you wash your hands in bleach everyday. These irritants can damage the top layer of the skin called the stratum corneum destroying the protective lipids on the skin resulting in water loss and skin inflammation.
Development of new skin allergies from certain chemicals or allergens in the environment (allergic contact dermatitis) may also cause hand eczema. For example, if there is a fragrance in your hand sanitizer and you are allergic to fragrance.
What are some clinical features of hand eczema?
Hand eczema can present as burning or itching symptoms. Patients can have cracks or fissures in their skin. One can have areas of dry, scaly, red skin. There may be tiny blisters or vesicles on the skin (dyshidrotic eczema). Skin may be swollen due to super-infection from bacteria. Over time, the skin may get rough and thick as your body is doing everything it can to protect itself.
How do I treat my hand eczema?
The most important thing to do to treat your hand eczema is identifying the main cause. If you are a nurse and you are washing your hands or using hand sanitizer constantly, it is difficult to improve this situation. There are topical medications that may be recommended, but if the environment does not change, it is difficult to cure the hand eczema completely.
However, if your hand eczema is due to a skin allergy to an environmental trigger, avoiding these triggers will eventually resolve your hand eczema, possibly providing a cure. If you are allergic to fragrance, using a fragrance-free soap and avoiding other fragrances in anything you touch will likely resolve the rash after a few months. Sometimes, it can take up to 3 months of avoiding an allergen for rash to completely resolve. There are skin allergy tests that can be done to identify these allergens to help you avoid them.
Nevertheless, there is a few things that your dermatologist may prescribe you to help the condition immediately:
- Class I topical steroids – ointment or cream – betamethasone, clobetasol, or halobetasol use twice daily x 2-4 weeks under occlusion with cotton or nitrile gloves.
- Topical calcineurin inhibitors – tacrolimus ointment or pimecrolimus cream.
- Superglue to treat cracks/fissures in skin.
- Treatment of any co-infections such as bacteria or fungus with antibiotics or antifungals.
- Hand lotions/creams/ointments – ie. Vaseline or Aquaphor, use this after each hand washing.
- Gentle fragrance-free hand soap – ie. Cetaphil cleanser or Vanicream cleanser.
- Use gloves to perform activities that require hands to be in water (ie. washing dishes).
- Consider keeping a log or journal to identify any possible triggers for 3 months.
- If all of the above is not helpful after a few months, then your doctor may recommend phototherapy or systemic medications. Oral medications may include methotrexate, azathioprine, mycophenolate mofetil, cyclosporine, apremilast (Otezla), and injectable medications may include Dupilumab (Dupixent).
What other conditions can look like hand eczema?
The more common conditions that can look like hand eczema may be palmoplantar psoriasis or tinea manuum (fungus). Both can be mistaken for hand eczema. If initial treatments above are not improving hand eczema, your dermatologist may recommend a skin scraping (potassium hydroxide test) to check for fungus or a skin biopsy to help make a definitive diagnosis.
The overall prognosis of hand eczema is good because it is often very treatable and there is no systemic issue with having hand eczema. However, it surely can be annoying and uncomfortable, often even painful in severe cases. See your dermatologist if you have hand eczema as we can definitely help make it better with the right treatments.
I am a board certified dermatologist at Cedars-Sinai in Los Angeles. I am a comprehensive dermatologist caring for families. I love seeing children and adults. My youngest patient was 0 days old and my oldest was 110 years old. I have had psoriasis since the age of 8 and considered an expert in psoriasis and psoriasis treatments. I have lectured locally and nationally and published numerous papers on other topics such as skin manifestations of eczema, hidradenitis suppurativa, systemic lupus erythematous, granuloma annulare, microbiome, skin cancers, and more. My expertise includes knowledge in managing complex skin diseases. I am experienced with surgical treatment of skin cancers, as well as non-surgical methods to treat skin cancer and precancerous lesions. I run a full medical, cosmetic, and surgical dermatology practice. I am experienced with the use of complex dermatologic therapy, including biologic therapy, immunosuppressive medications, and phototherapy. I also treats fine lines and wrinkles non-surgically with combinations of botox, fillers, chemical peels, lasers, and radiofrequency. I perform minor surgeries such as excisions for cysts, lipomas, basal cell skin cancer, squamous cell skin cancers, and early stage melanoma. I am physician expert for Kopa for Psoriasis, part of Happify. I have been featured on podcasts and quoted in numerous online and print publications. I am honored to be named “Top Doctor” in Los Angeles magazine. In my free time, I volunteer for community events such as skin cancer screenings and at the local free clinics. I also teach internal medicine and dermatology residents at several academic centers. I try to do yoga every day and every year, I run a half-marathon at the Golden Gate Bridge.