Definition:

Hand dermatitis, also known as hand eczema, is a common inflammatory skin condition affecting the palms and backs of the hands.

It can be acute or chronic, often presenting with redness, thickened skin, scaling, swelling, and cracks. Chronic hand eczema (CHE) refers to cases lasting over three months or recurring frequently within a year.

Epidemiology:

Hand dermatitis accounts for 20–35% of all dermatitis cases, though it is particularly common in young adult females it can occur at any age. It is more prevalent in individuals with a history of atopic dermatitis.

Chronic hand eczema (CHE) affects an estimated 10–15% of the population, frequently observed in occupations involving wet work or chemical exposure.

Etiology:

Hand eczema results from a combination of genetic and environmental factors:

Genetic susceptibility (such as mutations in the filaggrin gene (FLG) impairs the skin barrier, leading to increased water loss and susceptibility to irritants and allergens.

Environmental factors like repeated exposure to water, detergents, and chemicals, especially through occupational tasks.
Additionally, allergic contact dermatitis can contribute to the condition.

Clinical features:

Hand eczema is typically bilateral, affecting both the palmar and dorsal surfaces of the hand. Common symptoms include burning, stinging, and itching. The condition can alternate between acute flare-ups, which cause redness, swelling, weeping, and the formation of vesicles, and a chronic phase that is marked by nail changes (such as cuticle loss, thickening of nail folds (chronic paronychia), and nail plate ridging), lichenification, dry, thickened skin, and fissures.

Diagnosis:

The diagnosis of hand eczema is primarily clinical and involves a comprehensive approach, starting with a detailed personal and occupational history to identify any personal or family history of atopy and potential exposure to irritants or allergens, A physical examination assesses the extent of hand involvement, along with a complete skin examination.

Patch testing is crucial for identifying allergens in patients with CHE unresponsive to treatment.
Additional tests, such as skin prick tests, KOH preparation, and bacterial cultures, may be used to rule out other conditions. Also, in some cases, a skin biopsy is necessary to exclude other causes.

Management:

The management of hand eczema focuses on educating patients about proper Hand care, avoiding irritants and allergens, using non-soap cleansers, and applying thick emollients frequently.

For mild to moderate cases, high-potency topical corticosteroids are recommended, alongside liberal use of emollients. Steroid-sparing options like topical Calcineurin inhibitors (e.g., Tacrolimus) can also be used as an alternative.
In severe or unresponsive cases, a short course of oral corticosteroids may be necessary. Alternative treatments include phototherapy, oral immunosuppressants (such as methotrexate, cyclosporin, or azathioprine), or alitretinoin.
Dupilumab is an option for atopic CHE, and systemic antibiotics are prescribed if secondary bacterial infections are present.

Written by:

Raneem Alahmadi, Medical Intern.

Revised by:

Naif Alshehri, Medical Intern

Resources:

Dermnet

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