An Overview of Hand Eczema

A hand rash can be caused by contact with irritants

In This Article

Eczema on the hands is a very common problem. It can appear dry, red, or inflamed—and it is often itchy. The main cause of eczema on the hands is skin exposure to chemical irritants.

If you develop eczema on your hands, it may take some time to identify the specific cause. Treatment is focused on reducing exposure to the harmful substance, and creams or prescription medications are sometimes necessary.

Symptoms

Eczema can affect one or both of your hands and it can develop on the back of your hands, on your palms, on the front or back of your fingers, in the creases that bend, or at the tips of your fingers. 

Most of the time, eczema on the hands comes and goes as episodic outbreaks. But, sometimes it is present all the time. The spots that are affected may stay the same or they can change—lesions can develop on new areas as some areas appear to heal. 

Eczema causes changes in the appearance of your hands and some people may become self-conscious about it.

Eczema on the hands can show any of the following characteristics: 

  • Red or dark patches 
  • Dry spots 
  • Chapped or cracked skin
  • Bumpy areas 
  • Thickened skin
  • Scaly sections 
  • Small bumps 
  • Blisters that may leak fluid 

Sometimes hand eczema doesn’t cause any other symptoms besides the rash, but it is usually itchy. The itching can begin before an outbreak, and it often worsens during an outbreak. Pain is not common, but you can have painful lesions with hand eczema, especially if your skin cracks or bleeds.

Complications

Eczema is typically uncomfortable, but rarely harmful or dangerous. However, wounds and bleeding can occur due to severe skin breakdown or excessive scratching. This can expose your hands to an infection, which may require treatment with antibiotics.

It is not always obvious that your symptoms are caused by eczema because other conditions can cause these changes as well. Be sure to see our doctor if you develop the symptoms of eczema on your hands or anywhere on your skin.

Causes

Eczema is also called dermatitis or atopic dermatitis, and it can occur on any area of your skin and has many causes. Hand eczema in the absence of eczema elsewhere on the body occurs when your hands are exposed to a product that irritates the skin. It can take a while for the irritation to heal, and if you continue to have repeated exposure, the affected areas may not heal.

There are a number of common irritants that can cause eczema to develop on your hands, including:

  • Soap 
  • Detergents
  • Fabrics 
  • Hairstyling products 
  • Industrial materials 
  • Powders
  • Cosmetics 
  • Dyes
  • Food such as garlic or lemon

Recurrent exposure to these substances can cause a breakdown of the skin, resulting in any of the superficial effects of eczema.

Risk factors that increase your chance of developing eczema from exposure to irritants include:

  • Having wet hands for a long period of time
  • Rubbing your hands with coarse towels or other materials
  • Friction from repetitive motion when using abrasive materials—such as cooking tools, hardware tools, or beauty supplies. 

Keep in mind that some people are more prone to eczema than others. And some products may trigger eczema for you, while other products might not. For example, you may develop eczema from using a certain shampoo, but you might not have problems with dyes that could trigger eczema in someone else.

Diagnosis

You may notice that you have outbreaks on your hands when you are in certain situations or when your hands have been exposed to particular products. These patterns can help you and your doctor figure out whether you have eczema and why.

If you develop blisters on your palms and fingers, you may have a type of hand eczema called dyshidrotic eczema—it is also called pompholyx.

Diagnostic Testing

Your symptoms and pattern of outbreaks may clearly point to eczema as the cause of your skin condition. However, when the diagnosis is unclear, you may need additional testing.

Tests that may be used in the diagnostic evaluation of eczema include:

  • Blood tests: A complete blood count (CBC) can help identify whether you could have an infection.
  • Allergy test: An allergy test can identify whether you have a hypersensitivity to a substance rather than eczema.
  • Culture: A culture is a procedure in which a sample of fluid from a blister or a scraping from cracked skin is sent to a laboratory to see if an infectious microorganism (like bacteria) is present.
  • Biopsy: In rare instances, a sample of skin can be surgically taken from the affected area and examined under a microscope. This is not a common diagnostic approach for hand eczema, and would only be used if the condition is very severe, does not improve with medication, or if the diagnosis is unclear.

Differential Diagnosis 

There are a number of conditions that can cause a rash on your hands. Because the management of similar conditions can be completely different from the management of eczema, it is important for your doctors to determine the cause of your symptoms.

Common problems that can be confused with eczema include:

  • Allergic dermatitis: This condition occurs when the body has an immune reaction to a harmless substance. The immune reaction can cause swelling, redness, and itching. It differs from hand eczema because substances that trigger hand eczema actually harm the skin.
  • Poison ivy: This is a strong reaction to the oil from a poison ivy plant. Poison ivy is characterized by redness and blistering of the affected areas. If you have the oil on your hands, you can spread the rash to your face, legs, or other parts of your body if you touch them before washing it off. The oil can also remain on fabric until it is washed and it can spread on your body from fabric as well.
  • Infection: You can develop an infection on your hand due to bacterial exposure. This can happen from an injury, an animal bite, or due to a weak immune system. An infection can cause redness, swelling, pus, or blisters, and it may be painful. Infections may cause your hand to feel warm and can induce a fever. A fluid sample (such as from the pus) can be sent for a culture to help identify an infection.

    Treatment and Prevention

    Eczema can be treated so that the lesions are able to heal. Treatment is focused on protecting your hands from further damage and from an infection.

    If you know the cause of your eczema, it is important that you avoid exposure as soon as possible. It is helpful to see your doctor, who may refer you to a dermatologist. A dermatologist is a physician who is specialized in skin disorders.

    While you are being treated for your hand eczema, protecting your hands will make the treatment more effective. Treatment options include moisturizing cream, topical corticosteroids, ultraviolet light therapy, and antibacterial ointments.

    Protecting Your Hands 

    When your hands are already tender and irritated, you should be gentle on them. Avoid rubbing with abrasive towels and don’t expose your hands to friction. It takes a great deal of self-control to avoid scratching when your hands are itchy or painful, but scratching worsens hand eczema and prevents it from healing. Your doctor may recommend an over-the-counter anti-itch medication or prescribe one if itchiness is a major problem for you.

    Creams, lotions, soaps, and hand sanitizers that contain perfumes or alcohol can exacerbate hand eczema, so stick to products that are recommended by your doctor.

    Some people who have eczema find that wearing gloves is protective and soothing, and it can help the healing process.

    Treatment Options

    Your doctor may recommend a regimen for treatment of your hand eczema:

    • Creams: Applying moisturizing cream can help keep your hands healthy, promoting healing.
    • Corticosteroids: In some cases, prescription corticosteroid creams have been recommended for topical (superficial) use.
    • Ultraviolet light (UV) therapy: UV light therapy is a procedure that is done in a physician’s office. Your doctor may recommend it for your hand eczema. 
    • Antibacterial ointment: Prescription antibacterial ointments can be applied to open wounds and cracks in your hands if there is a concern about infection. 

    With treatment and avoidance of the triggering factor or factors, the eczema on your hands should heal, but it can take weeks for the lesions to completely resolve. 

    Prevention

    Preventing additional outbreaks is particularly important so that your skin will be able to heal. Wash your hands with gentle soap if you have been exposed to an irritant. If your hands start to feel itchy while they still have some type of material on them, wash it off promptly.

    Avoid triggers if you can. If you are prone to eczema, be gentle with your hands on a regular basis. Many people who work with chemicals wear gloves when working to avoid eczema. And get your doctor’s recommendation for a gentle moisturizer that can help keep your skin healthy to avoid outbreaks of hand eczema.

    A Word From Verywell

    There is a strong chance that you could develop eczema on your hands at some point. If you recognize the cause, you may be able to avoid it. However, if your hands are highly sensitive, you might have frequent outbreaks of hand eczema. It is a good idea to focus on prevention if you are prone to this condition.

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    Article Sources

    1.  Christoffers WA, Coenraads PJ, Svensson Å, Diepgen TL, Dickinson-Blok JL, Xia J, et al. Interventions for hand eczema. Cochrane Database Syst Rev. 2019 Apr 26;4:CD004055. doi: 10.1002/14651858.CD004055.pub2.

    2.  Oosterhaven JAF, Voorberg AN, Romeijn GLE, de Bruin-Weller MS, Schuttelaar MLA. Effect of dupilumab on hand eczema in patients with atopic dermatitis: An observational study. J Dermatol. 2019 Jun 12. doi: 10.1111/1346-8138.14982. [Epub ahead of print]

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