Hand Eczema

    Intro

    • Acute
      • Edema, vesicles, exudative
    • Chronic
      • Scaling, fissure, dry, and lichenified

    Can also classify as:

    • Endogenous Eczema
      • Dyshidrotic dermatitis
      • Atopic dermatitis
    • Exogenous Eczema
      • Contact Irritant Dermatitis
      • Contact Allergic Dermatitis
    • Most common: Contact irritant dermatitis

     

     

    Hx & Px

    • Localized?
    • Endogenous vs Exogenous
    • Acute vs Chronic
    • History of atopy
    • Known Allergens/Irritants?
    • Occupational?

     

    DDx

    • Endogenous Hand Eczema
      • Dyshidrotic Dermatitis
      • Atopic Dermatitis
    • Exogenous Eczema
      • Contact Irritant Dermatitis
      • Contact Allergic Dermatitis
    • Psoriasis: usually elsewhere + nail changes
    • Dermatophyte infection: "one hand, two feet" pattern, feet involved, funcal scraping
    • Scabies: Involvement elsewhere on skin, Burrows
    • Mycosis Fungoides
    • Lichen Planus

    Dyshidrotic Dermatitis

    • Crops of vesicles (clear, tiny) on non-erythematous base, often along sides of fingers
    • Intensely Itchy
    • Etiology unclear

     

    Atopic Dermatitis

    • Aka Atopic Hand Eczema
    • Positive history of atopy in childhood
    • Atopic dermatitis may be elsewhere as well
    • Increased skin markings on palmar surface
    • Fissures on fingertips, dry palms, itch common

     

    Contact Irritant Dermatitis

    • Most common form of hand eczema
    • History of atopy
    • Fissures, cracks, diffuse erythema
    • Irritants:
      • Chemical:
        • Solvents
        • Detergents, soaps, frequent hand washing
      • Physical
        • Friction
        • Extremes in Temperature

     

    Contact Allergic Dermatitis

    • 20% of contact dermatitis
    • Not on 1st exposure
    • More common on dorsal hand and flexural wrists
    • Appearance:
      • Bright red, often with vesicles, demarcated, severe itch
      • Painful when edematous
      • Patch testing needed
    • Common allergens:
      • Lanolin, formaldehyde, perfumes, latex

     

    Treatment

    • Patch Testing
    • Fungal Scraping
    • Hand Care Measures
      • Minimize water exposure
      • Moisturizers, barrier creams
      • Other
        • Use mild soaps/substitutes
        • Cotton liners in rubber or vinyl gloves
        • Measures to reduce scratching/rubbing
    • Drugs
      • Topical Steroids
      • Antibiotics if impetiginized
      • Topical Immunomodulators (tacrolimus, pimecrolimus)
      • Antihistamines for itch
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