Hand Eczema: Causes, Symptoms, and Modern Treatment Methods

Hand eczema (HE) is a common skin condition that affects the hands and wrists, and sometimes the feet [1]. It is estimated to affect about 14.5% of the population, having a significant impact on quality of life, including missed work or school and reduced productivity [4]. It is a heterogeneous condition, meaning it can manifest in different ways and have multiple causes [1].

Hand eczema can be acute or chronic, with varying degrees of severity ranging from mild to moderate and severe. Flare-ups can be frequent or rare [1]. Eczema is considered chronic if it persists for more than three months or has a minimum of two relapses per year after initial presentation with complete resolution of symptoms [7]. The variety of causes and clinical manifestations makes the diagnosis and management of HE a challenging task even for experienced dermatologists [1, 3].

What is Hand Eczema and Why Does it Occur?

Hand eczema is an inflammatory skin disease, often with a multifactorial nature [5]. The causes of its occurrence are diverse and can be both internal (endogenous) and external (exogenous) [1, 2].

• Endogenous factors include atopic predisposition (tendency toward allergic reactions) and dyshidrosis (appearance of blisters, often on the palms and soles) [2].
• Exogenous factors are associated with exposure to irritants or allergens. This can be irritant contact dermatitis (e.g., from frequent hand washing, contact with chemicals) or allergic contact dermatitis (a reaction to specific substances such as latex, metals, preservatives) [2, 5].

Hand eczema is particularly common among healthcare workers and individuals in other professions that require frequent contact with water, chemicals, or wearing gloves [2, 7]. An important step in managing the disease is identifying and avoiding triggering factors [5, 7].

Symptoms of Hand Eczema: How to Recognize It?

Symptoms of hand eczema can vary greatly, but typically include [1]:

• Redness and inflammation of the skin.
• Intense itching (pruritus) [6].
• Dryness, peeling, and skin cracks that can be painful [6].
• Formation of blisters (vesicles), especially in the dyshidrotic form.
• Skin thickening (lichenification) in chronic courses.
• In some cases, weeping and crusting.

The severity of symptoms can range from mild discomfort to severe pain and significant impairment of hand function [1]. It is important to note that similar symptoms can be observed in other conditions, such as psoriasis or fungal infections, requiring careful diagnosis [2].

Diagnosis and Differential Diagnosis

Diagnosis of hand eczema begins with a thorough medical history and physical examination. The dermatologist evaluates the nature of the rashes, their location, and the history of the disease development [1]. Since hand eczema can be triggered by multiple factors, it is important to determine the specific etiology in each case [7].

Key aspects of diagnosis include:

• Identification of triggering factors: Detailed questioning about contact with irritants or allergens at work and at home [7, 8].
• Patch testing: This is the standard investigation to rule out allergic contact dermatitis, especially if the eczema persists [7, 8]. Testing helps identify specific substances to which the skin is having an allergic reaction.
• Differential diagnosis: Distinguishing eczema from other diseases with similar manifestations, such as psoriasis, fungal infections, scabies, or other forms of dermatitis [2].

Proper diagnosis is the basis for developing an effective treatment plan [1].

Modern Approaches to Hand Eczema Treatment

Treating hand eczema, especially in severe and chronic cases, is a complex task requiring a comprehensive approach [3, 8]. The goal of therapy is not only to clear the skin, but also to restore its function and improve the patient's quality of life [8]. Treatment should be step-by-step, taking into account the severity and chronicity of the disease [3].

Main Treatment Methods:

• Avoiding triggering factors: The primary measure. Includes the use of impermeable gloves when in contact with water or chemicals, as well as eliminating contact with identified allergens [5, 7].
• Moisturizers (emollients): Regular application of moisturizing creams and ointments is the cornerstone of therapy. They help restore the skin barrier function and reduce dryness [2, 4, 5].
• Topical corticosteroids: Potent topical glucocorticoids are the standard treatment for reducing inflammation and itching [2, 4, 5, 8]. They are prescribed depending on the severity of the condition.
• Antibacterial agents: Used when a secondary bacterial infection develops [2].
• Systemic therapy: In cases of severe and chronic eczema where topical treatment is ineffective, systemic medications may be prescribed. These can be oral corticosteroids, immunosuppressants, or other drugs acting on the immune system [2, 3, 4, 8].
• Phototherapy: Ultraviolet (UV) irradiation can be an effective treatment method for chronic eczema [7].

New Directions in Treatment:

Medicine is constantly evolving, and new therapeutic options are emerging [4]. In the near future, patients with hand eczema may benefit from:

• Biologics: Especially for the treatment of atopic eczema, they target specific pathways of the immune response [3].
• Topical Janus kinase inhibitors (JAK inhibitors): These novel topical medications show promising results in reducing inflammation [3].
• Combination approaches: Studies show the effectiveness of combining existing methods. For example, in one study, the combination of Dexyane Med with topical corticosteroids showed significant improvement in patients with chronic and contact eczema [6].

It is important to remember that each new treatment method, if necessary, should be considered as complementing or overlapping previous therapy [8]. Sustainable eczema management requires not only medical treatment, but also the elimination or avoidance of causal factors, behavioral changes, and social support [8].

Prevention and Hand Skin Care

Prevention and proper care play a key role in managing hand eczema and preventing its flare-ups. The main recommendations include:

• Hand protection: Avoid direct contact with irritants such as detergents, solvents, harsh chemicals. Use protective gloves (cotton under vinyl or nitrile) when doing household chores, gardening, or working industrially [5].
• Gentle hand washing: Use mild, soap-free cleansers. Avoid hot water. After washing, gently pat hands dry and immediately apply a moisturizer [5].
• Regular moisturization: Apply emollients several times a day, especially after every hand wash. This helps restore the skin barrier and prevent dryness [2, 4].
• Identification and avoidance of allergens: If specific allergens are identified (e.g., using patch tests), strictly avoid contact with them [7].
• Patient education: Understanding the disease, its causes, and management methods is an important part of successful treatment and prevention [1].

Sources

1. Hand eczema: epidemiology, prognosis and prevention. (Journal of the European Academy of Dermatology and Venereology, 2020) https://pubmed.ncbi.nlm.nih.gov/31860734/
2. Hand eczema. (Ostomy/Wound Management, 1998) https://pubmed.ncbi.nlm.nih.gov/9782961/
3. Hand eczema: treatment. (Journal of the European Academy of Dermatology and Venereology, 2020) https://pubmed.ncbi.nlm.nih.gov/31860736/
4. A Review of Existing and New Treatments for the Management of Hand Eczema. (Journal of Cutaneous Medicine and Surgery, 2023) https://pubmed.ncbi.nlm.nih.gov/37496489/
5. Hand eczema. (New England Journal of Medicine, 2012) https://pubmed.ncbi.nlm.nih.gov/23134383/
6. What's new in the treatment of eczemas. (Italian Journal of Dermatology and Venereology, 2017) https://pubmed.ncbi.nlm.nih.gov/29050445/
7. Chronic Hand Eczema. (American Journal of Clinical Dermatology, 2024) https://pubmed.ncbi.nlm.nih.gov/39300011/
8. Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. (Australasian Journal of Dermatology, 2021) https://pubmed.ncbi.nlm.nih.gov/32776537/

Disclaimer: The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified physician for diagnosis and prescription of adequate therapy.