Hand Dermatitis: A Review of Clinical Features, Prevention and Treatment

Abstract

Hand dermatitis is a socially significant health problem. This review provides a discussion on the clinical features and patterns as well as the differential diagnosis of hand dermatitis, because these are essential for proper diagnosis in clinical practice. The morphology, however, is poorly related to the etiology in chronic cases. In all cases of chronic hand dermatitis, a full diagnostic examination should be undertaken and the etiology should be clarified and addressed in the treatment concept, instead of just moving directly from a morphological diagnosis to therapy. Preventive measures should be included in the treatment concept according to etiology. A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others.

Seeking Clearer Recommendations for Hand Hygiene in Communities Facing Ebola: A Randomized Trial Investigating the Impact of Six Handwashing Methods on Skin Irritation and Dermatitis

“…It is also possible that occlusion of handwashing substances against the skin surface by PPE after handwashing could lead to increased irritation. While this means that our results are most relevant for community-level handwashing, they also inform further research for handwashing in medical settings both in Ebola contexts and wherever health-care workers commonly report dermatitis and skin irritation from frequent handwashing [32,47]. …”

Hand eczema: treatment

“…21 Basic topical therapy helps to reduce inflammation and itching, has corticosteroid-sparing effects and promotes epidermal barrier recovery. 1 The result of such an attitude may be a reduced adherence, application that is inadequate or in insufficient quantity, ultimately compromising treatment. 22,23 For acute and frequently oozing hand eczema, basic topical therapy should have drying, astringent and antibacterial effects; hand baths and soaks, moisturizing or moist dressings and hydrophilic creams or gels are indicated.…”

“…61 Cyclosporine is approved for systemic treatment of these diseases, but not hand dermatitis. 1 An increased risk for skin cancer may result under long-term use; thus, UV protection is recommended. In a double-blind study with 41 patients, cyclosporine 3 mg/kg/day for 6 weeks was as effective as topical betamethasone dipropionate, leading to a 57% reduction in hand eczema severity score.…”

“…At 6 months, acitretin achieved clearance/almost clearance in 44% of patients, compared to 0% of those treated with methotrexate. 1 The ESCD guidelines mention the lack of evidence for the efficacy of methotrexate for the treatment of hand eczema, but since this treatment has been used over the years, it may be considered if first-and second-line therapy has been insufficient or contraindicated. 68 A similar retrospective study reported that after 8-12 weeks of treatment, 36.8% of patients treated with methotrexate for hand eczema showed a good effect of treatment.…”

“…1 Clinically, it is a heterogenous condition under the aspects of aetiology, clinical manifestations and acuteness. 1 Clinically, it is a heterogenous condition under the aspects of aetiology, clinical manifestations and acuteness.…”