What is Hand Eczema and Why Does It Occur?
Hand eczema, also known as hand dermatitis, is a chronic inflammatory skin condition affecting the hands and wrists. It is estimated to affect up to 14.5% of the general population, making it a very common problem [1]. This condition not only causes physical discomfort but also has a serious negative impact on quality of life, leading to missed work or school days, reduced productivity, and impaired work ability [1, 8].
The causes of hand eczema are often multifactorial [7]. It can be triggered by internal (endogenous) factors, such as dyshidrosis or atopy, as well as external (exogenous) exposures, including irritant or allergic contact dermatitis [6]. The chronic nature of the disease and its diverse forms make the treatment of hand eczema a challenging task, often causing patient dissatisfaction with available therapy options [3, 4].
Diagnosis and Identification of Hand Dermatitis Causes
Effective treatment of hand dermatitis begins with a thorough diagnosis. It is important to gather a detailed medical history, including information about potential contact with irritants and allergens [3, 5, 7]. Physical examination also plays a key role in determining the type and severity of the condition [5].
One of the standard diagnostic methods is patch testing, which helps identify allergic reactions to specific substances [3, 5]. The dermatologist must also rule out other conditions with similar symptoms, such as psoriasis or fungal infections [6]. In some cases, particularly in healthcare workers, evaluation for a potential latex allergy may be required [6]. Understanding the root cause of eczema is crucial for developing a personalized and effective treatment plan.
A Comprehensive Approach to Treatment: From Basics to Modern Methods
Managing chronic hand eczema requires a comprehensive approach that goes beyond pharmacological treatment alone [3]. The primary goal of therapy is the restoration of hand function, while skin clearance is a secondary but also important objective [3].
Key treatment principles include:
- Elimination or avoidance of triggering factors: This may mean using impermeable gloves to protect hands from irritants or allergens [3, 7].
- Behavioral changes and social support: Patients may need lifestyle modification guidance and support to adapt to a chronic condition [3].
- Regular use of emollients and moisturizers: These products are the cornerstone of skin care, helping to restore barrier function and reduce dryness and cracks [1, 5, 7].
It is important to note that each new treatment, if necessary, should be considered as complementing or overlapping with previous therapy [3]. The intensity of treatment should be determined by the degree of severity and chronicity of the disease, requiring a step-by-step approach [4].
Modern Therapeutic Strategies
Hand eczema treatment is constantly evolving, offering new and more effective methods:
Topical Agents
- Topical corticosteroids: These are the standard of care and are widely used. For patients with moderate symptoms, potent or super-potent topical corticosteroids are often prescribed [1, 3, 5, 7].
- Topical calcineurin inhibitors: An alternative to corticosteroids, especially for long-term use or on sensitive skin areas [5].
- Crisaborole: Another topical medication used for eczema [5].
- Dexyane Med: Shown in a study to provide significant improvement when combined with topical mometasone in patients with chronic hand eczema and contact eczema [2].
- Topical Janus kinase inhibitors (JAK inhibitors): Represent a promising new direction in the treatment of eczema, including hand eczema [4].
- Delgocitinib cream: In the Phase 3 DELTA FORCE clinical trials, delgocitinib cream demonstrated efficacy and safety compared to oral alitretinoin in adults with severe chronic hand eczema [8].
Systemic Therapy
In cases of severe and chronic hand eczema where topical treatments prove insufficient, systemic treatment may be required:
- Alitretinoin: Currently the only approved systemic drug for the treatment of severe chronic hand eczema [8].
- Biologics: Used to treat atopic eczema and may hold promise for hand eczema [4, 5].
- Phototherapy: The use of ultraviolet light can be an effective treatment method [5].
- Other systemic agents: The choice of systemic drugs depends on the type and severity of the eczema [1, 6].
Prospects and New Horizons in Treatment
Medical science is constantly searching for new therapeutic targets for hand eczema [1]. Thanks to ongoing research and development, new opportunities are emerging to manage this condition by targeting its underlying mechanisms [1]. In the near future, patients with hand eczema may benefit from novel therapeutic principles, such as biologics for atopic eczema and topical Janus kinase inhibitors [4]. The development of products like delgocitinib cream demonstrates significant progress in combating severe chronic hand eczema [8].
Living with Hand Eczema: Tips and Recommendations
In addition to medical treatment, daily habits play a vital role in managing hand eczema. Regular and generous skin moisturization is a key element of care, helping to maintain the skin barrier and prevent the appearance of cracks. Avoiding known irritants such as harsh detergents, solvents, or prolonged contact with water can significantly reduce flare-ups. Wearing protective gloves when performing household chores or work involving contact with potential irritants is also an effective preventive measure [3, 7].
It is important to remember that hand eczema is a chronic condition requiring ongoing attention and a personalized approach. Close collaboration with a dermatologist will help develop an optimal treatment and care plan tailored to your needs and significantly improve your quality of life.
References
- 1. A Review of Existing and New Treatments for the Management of Hand Eczema. https://pubmed.ncbi.nlm.nih.gov/37496489/
- 2. What's new in the treatment of eczemas. https://pubmed.ncbi.nlm.nih.gov/29050445/
- 3. Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. https://pubmed.ncbi.nlm.nih.gov/32776537/
- 4. Hand eczema: treatment. https://pubmed.ncbi.nlm.nih.gov/31860736/
- 5. Diagnosis and Management of Dermatitis, Including Atopic, Contact, and Hand Eczemas. https://pubmed.ncbi.nlm.nih.gov/34059241/
- 6. Hand eczema. https://pubmed.ncbi.nlm.nih.gov/9782961/
- 7. Hand eczema. https://pubmed.ncbi.nlm.nih.gov/23134383/
- 8. Efficacy and safety of topical delgocitinib cream versus oral alitretinoin capsules in adults with severe chronic hand eczema (DELTA FORCE): a 24-week, randomised, head-to-head, phase 3 trial. https://pubmed.ncbi.nlm.nih.gov/40252681/
The information presented in this article is for informational purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.