Hand Eczema

Hand eczema is eczema that predominantly affects your hands.

There are 3 main causes of hand eczema:

• Irritant eczema
• Contact allergic eczema
• Atopic eczema

You can have a combination of 2 or even 3 of these types.

Irritant eczema is by far the commonest cause of hand eczema. Irritant eczema is when abrasive chemicals (such as detergents in soap) strip away the skin’s natural barrier and cause inflammation. Soaps and hand washes are the main culprit - as we all wash our hands regularly. Detergents in soaps remove the natural oils on our skin, making it more vulnerable to irritation. We describe this in our blog The Skin Barrier and Eczema. This happens slowly over time - so you may not notice the soap causing it. The more you wash your hands, the more vulnerable they become. Alcohol gel isn’t a solution as alcohol also irritates the skin. People in professions such as healthcare, nurseries or kitchens are most at risk - as they wash their hands regularly. People with young children also tend to wash their hands a lot.

Contact allergic eczema is when you develop an allergy to a substance that comes in direct contact with your skin - such as creams and washes. We describe this in our post What Actually is Eczema?. There are many substances that you can be allergic to: fragrances are a big cause so all our products at Eczema Clinic are fragrance free. Preservatives are another culprit. Most creams contain some preservatives to prevent bugs growing in them. To avoid preservatives, you can use thicker ointments that are preservative free - such as Epaderm ointment. We have a collection called 6 Ingredients or Less that have the simplest ingredients in. Hand eczema can be caused by many other allergies - often your job can be to blame. Examples include latex gloves (in healthcare workers), garlic (particularly in chefs), dental putty (seen in dentists), gel nails (those who work in nail bars or who have artificial nails), amongst others. To identify contact allergies a test called patch testing can be done. This has to be done in person at a Dermatology clinic. 

Atopic eczema is discussed in our blog What Actually is Eczema?. This is the most common form of eczema. Some people have a localised form of atopic eczema that just affects their hands. These people are thought to have a grumbling atopic eczema that stays below the surface, but manifests itself on the hands due to hand washing stripping away the skin’s barrier.

Pompholyx eczema is a variant of hand eczema. As well as having, dry, scaling and red skin - people with pompholyx eczema get blisters. This can look dramatic but is treated in the same way as other forms of eczema. 

There are also rashes that can look like hand eczema. These include scabies (an infestation by a mite), psoriasis (another type of inflammation caused by the immune system) and dermatomyositis (a rarer rash that is often seen with muscle weakness and breathing difficulty). If your hand eczema isn’t getting better, see a Dermatologist for a diagnosis.

What can be done to treat hand eczema?

1. For all types of hand eczema moisturising is key. There’s no limit to how often you use a moisturiser - four, five, six or more times a day. Any of our Everyday Moisturisers will do, but we also have a collection of Hand Eczema Moisturisers. These are thicker moisturisers that come in smaller containers - so you can keep them with you all day. Using a thick ointment such as Epaderm ointment at night under cotton gloves can help sink the moisturiser in.

2. Avoid soaps, hand washes, shower gels and detergents. Use one of our soap substitute Washes instead.

3. Avoid wet work (eg washing up) - this is easier said than done, especially if it is your job. If you can, wear gloves to protect your hands from wet work. Try to minimise use of soap and use one of our soap substitute Washes instead. We also have an antiseptic washes, which adds extra protection from germs. ALWAYS moisturise AFTER you wash your hands.

4. Steroid creams will reduce inflammation. We often need to use stronger steroid creams on the hands, which need to be prescribed by a doctor. The skin on the hands is thick - which means it can tolerate strong steroid creams well. 

5. If this doesn’t help, think about seeing a Dermatologist for patch testing. This is a test, which can identify if you are allergic to something in one of your creams or in your home or workplace. This does require a commitment - wearing patches on your back for several days. You can read up about it here. We have a collection called 6 Ingredients or Less with minimal preservatives you can try whilst waiting for this.

6. Other specialist treatments provided by Dermatologists include:

• Hand PUVA: this is a form of phototherapy (light therapy) that targets just the hands.
• Alitretinoin: this is a medication derived from vitamin A called a retinoid. It is licensed for hand eczema but is quite expensive. To qualify on the NHS you have to have tried other treatments first.
• Other immunosuppression tablets, such as methotrexate, are sometimes used for hand eczema.

To read more about hand eczema you can visit these websites:

https://dermnetnz.org/topics/hand-dermatitis

https://www.bad.org.uk/pils/hand-dermatitis-hand-eczema/

To read up about contact eczema and patch testing you can visit these websites:

https://www.bad.org.uk/pils/patch-testing/

https://www.bad.org.uk/pils/contact-dermatitis/

https://dermnetnz.org/topics/contact-dermatitis

https://dermnetnz.org/topics/patch-tests