Chronic hand eczema is an inflammation of the skin on the hands that is not contagious. Eczema can exist for a period of months or years or follow an episodic course. It is estimated that five to ten per cent of the total population are affected, women more commonly than men. When eczema is present, the natural protective function of the skin is weakened. It can be caused by substances that are irritating or harmful to the skin, allergy-causing substances but also hereditary factors. This summary concerning chronic hand eczema is based on the booklet "Chronisches Handekzema" (Chronic Hand Eczema) which was compiled at the Occupational Allergology Department of the Dermatology University Clinic, Zurich, and can be downloaded.

Causes and forms of hand eczema

The more frequently the skin comes into contact with irritant, harmful or allergy-causing substances and the shorter the regeneration phases between periods of contact, the more likely it is that the natural protective barriers of the skin will be exhausted.

Irritant contact hand eczema

This form of eczema is caused by external factors that irritate the skin. Constantly working in wet conditions, frequent hand washing, working with food or disinfectants, contact with oils or chemicals are the most common causal factors.

Allergic contact hand eczema

This form occurs as a result of contact with allergy-causing substances, e.g. nickel, epoxy substances, chromate, Peru balsam, fragrances.

Atopic hand eczema

A genetic predisposition to neurodermatitis, hay fever or allergic asthma is known as atopy. People with this atopic predisposition have three times as high a risk of developing hand eczema as the average for the population because the protective barrier of their skin is often disrupted.

Symptoms

The symptoms can vary widely and also differ in terms of severity:

  • Dry, scaling skin
  • Itching
  • Redness
  • Cracks in the skin
  • Inflammation of the finger pads
  • Blistering
  • Disturbed cornification of the skin

Occupational disease "chronic hand eczema"

About 90 per cent of recognized occupational skin diseases are forms of contact eczema. Occupations involving activities that are stressful to the skin (e.g. hairdresser, cleaner, nursing professional or jobs in the metal or building industry) are particularly at risk. Proper care of the skin and wearing suitable gloves are important preventive measures.

If hand eczema is already present, we recommend consulting a dermatologist. If the eczema is due to a person’s occupation, in conjunction with the employer a notification of occupational disease should be submitted to SUVA (Swiss National Accident Insurance Fund) or to the private accident insurer.

Useful examinations in case of hand eczema

The following questions may help to discover the cause of a person’s hand eczema:

  • During which activities or during contact  with which substances does the eczema improve or get worse?
  • Does the condition improve during holidays?
  • Did I have eczema, hay fever or asthma as a child?

If allergic contact eczema is suspected, allergy tests by the doctor may provide information about the trigger factors.

What can I do myself?

  • Do not wash your hands too often and wash them under lukewarm water. Instead of soap, preferably use fragrance-free syndets (synthetic soap-free detergents) or hand-washing oils.
  • Avoid cleaning with hand-washing pastes or brushes.
  • After washing, nourish your hands with moisturizing creams at night and after work.
  • In winter intensively moisturize your hands and wear gloves to protect against the cold.
  • Avoid direct contact with cleaning agents or solvents.
  • Before and during work, protect your hands against harmful substances with special skin protection creams.
  • Protect hands with gloves when working with substances that irritate the skin. You may also wear additional cotton gloves under your work gloves.

Treatment options

There are various therapies for the treatment of hand eczema, which are used as single therapy or in combination depending on the nature and severity of the eczema:

  • Cortisone preparations in the form of creams for topical application or as tablets
  • Anti-pruritic medications
  • Light therapy or phototherapy
  • Anti-inflammatory and immunomodulatory drugs for severe and chronic eczema (e.g. vitamin A acid)

Living with chronic hand eczema

The hand is an important organ of communication. Eczema sufferers can no longer take for granted entirely normal things such as "shaking hands" or simple interpersonal contact. A handshake can be painful and other people’s reactions to visible and tangible skin symptoms can be upsetting. This is why eczema of the hands can be emotionally stressful, reduce self-esteem, make people anxious and withdrawn. Communicating with other sufferers can make it easy to cope with eczema.

PDF Broschüre Handekzem (Hand Eczema booklet – only available in German) from the Dermatology Clinic of Zurich University Hospital.
You can find out more at the website of Dermatology Clinic of Zurich University Hospital.


Author: Professor Barbara Ballmer-Weber, Senior Physician, Dermatology Clinic, Zurich University Hospital.
Editors: aha! Swiss Allergy Centre in co-operation with the Scientific Advisory Board.

 

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