What Is Hand Eczema?
Eczema is a condition that causes patches of dry, itchy skin and other uncomfortable symptoms. It can occur anywhere on your body, including your hands. You also may hear hand eczema referred to as hand dermatitis. Dermatitis is a broad category of conditions that trigger inflammation on your skin.
Hand eczema is not just uncomfortable. It can make some everyday tasks difficult, such as buttoning a shirt, typing, writing, and much more. It also can have a serious emotional impact. People with hand eczema may withdraw from their social lives because they feel embarrassed and stigmatized. This boosts their risk of both depression and anxiety.
There are several different types of hand eczema. Some types are acute, meaning they last for only a short period before clearing up, but in up to 2 out of 3 people who develop it, hand eczema becomes chronic, which experts define as lasting for three months or longer or recurring at least twice within 12 months.
An estimated 5% to 15% of people have hand eczema at some point in their lives. It’s among the most common types of eczema.
What Are the Symptoms of Hand Eczema?
Eczema of the hand can cause many uncomfortable symptoms. Some of the symptoms you experience will depend on the type of hand eczema that you have, but each type shares at least some symptoms. Common symptoms include:
- Dry skin that cracks and peels
- Scaly, crusty skin
- Redness
- Itching
- Pain
- Burning
- Chronic rashes
- Bleeding
Some types of hand eczema, which we’ll get into below, have unique symptoms. For example, dyshidrotic eczema causes small, painful blisters to form on the palms of your hands and on your fingers.
What Are the Different Types of Hand Eczema and Their Causes?
Experts consider the following to be the five major types of hand eczema. Each type has unique causes, though some types often travel together. For example, atopic hand eczema puts you at higher risk of irritant contact dermatitis and allergic contact dermatitis. For many of these types, experts don’t fully understand their causes.
Irritant contact dermatitis. This is the most common type of hand eczema. It’s often triggered by contact with harsh chemicals, which can damage the protective outer layer of skin on your hands. But it also can develop from frequent contact with milder irritants like soap and water. Common irritants that can lead to this type of hand eczema include:
- Solvents
- Rubber gloves
- Detergents
- Bleach
- Certain hair care products
- Soap
- Pesticides and fertilizers
Jobs that require the use of chemicals like these come with a heightened risk of hand eczema. This includes working as a:
- Mechanic
- Hairstylist
- Nail technician
- Health care worker
Allergic contact dermatitis. Allergens that infiltrate your skin can set off your immune system, which identifies the allergen as a threat. This causes an allergic reaction every time you're exposed even to a small amount of the allergen. Over time, this can cause allergic contact dermatitis. A significant risk factor for it: irritant contact dermatitis. That’s because irritant contact dermatitis causes your protective outer layer of skin to break down, which allows allergens to get into your skin.
Common allergens linked to allergic contact dermatitis include:
- Nickel, found in many everyday items like jewelry
- Fragrance
- Chemical preservatives like formaldehyde
- Ragweed pollen, spray pesticides, and other airborne allergens
- Some medications, such as antibiotic ointments
- Urushiol, a very allergenic chemical found in poison ivy, poison oak, and poison sumac, as well as mango peels
- Some body washes, cosmetics, and hair dyes
- Some sunscreens and cosmetics, which cause a reaction when exposed to the sun
- Perfumes that contain an ingredient called balsam of Peru
Atopic hand eczema. Most common in people with atopic dermatitis (AD), this type of hand eczema mostly affects the back of your hands, your fingers, and your wrists. Atopic hand eczema has both genetic and environmental causes. For example, about half of all people with AD have a gene mutation that reduces the body’s production of the protein filaggrin, an essential ingredient for making your skin’s protective layer. Atopic hand eczema also can be caused by allergens in your environment. If you have atopic hand eczema, you have a higher risk of both irritant contact dermatitis and allergic contact dermatitis.
Dyshidrotic eczema. This type of eczema, which can develop on your fingers and hands as well as your feet, causes some different symptoms than the other common types of hand eczema. Its standout feature is small, painful blisters. Itchy, scaly skin can form on or around the blisters, and your skin can become dry and cracked as those blisters go away. Experts don’t know what causes it, but it’s likely a combination of genetics and allergies as well as having frequently sweaty or wet hands. Other names for it include:
- Dyshydrosis
- Acute palmoplantar eczema
- Vesiculobullous dermatitis
- Pompholyx
- Acute recurrent vesicular hand dermatitis
Hyperkeratotic hand eczema. Not as common as the other types of hand eczema, this one usually causes patches of thick, cracked skin to form on the palms of your hands. It also can affect the soles of your feet. Unlike other types of hand eczema, it causes little or no redness of the skin. Experts don’t know what causes it.
How Is Eczema of the Hand Diagnosed?
With so many types and causes, diagnosing hand eczema can be complicated. Your doctor will start by asking about your symptoms and examining your hands.
In some cases, your doctor may take a biopsy of your skin, removing a small amount of tissue that will be analyzed in a lab. This will help rule out other conditions like psoriasis or cancer.
Another diagnostic tool: the patch test. Your doctor will apply various allergens and common irritants to your hands or back to see if any of them cause a reaction. This can identify triggers for irritant contact dermatitis and allergic contact dermatitis. It’s most often used if you have chronic hand eczema.
How Is Hand Eczema Treated?
Your specific treatment will depend on the type of hand eczema that you have and its severity, but some general tips apply to all hand eczema
Avoid the cause. If you have contact dermatitis, the first step is figuring out what triggers it and then avoiding it. Your doctor can help you determine the trigger (or triggers).
Moisturize your hands often. Moisturizers and creams help maintain the protective barrier formed by your skin’s top layers. By keeping your skin hydrated, you help to prevent allergens and irritants from getting into your skin and causing symptoms. Your doctor can recommend or prescribe an effective moisturizer or cream. Make sure to moisturize every time you wash your hands or bathe.
Wash your hands gently. Vigorous hand washing can irritate your skin and worsen your symptoms. Follow these steps to keep your hands clean without agitating your eczema:
- Use lukewarm water, not hot water.
- Use a gentle soap, lathering your hands all over, including between your fingers and around your nails, for 20 seconds.
- Rinse thoroughly, making sure you don’t leave any soap on your hands.
- To dry your hands, pat with a clean, soft towel or use paper towels.
- Moisturize right away. Apply a generous amount of your moisturizer to your hands before they’re completely dry. Do this every time you wash your hands.
Medications may be necessary to control your symptoms, particularly if your hand eczema has become chronic. Options include:
Topical steroids, which help to reduce inflammation and ease your symptoms. However, you should not take them for more than two weeks at a time to avoid side effects, such as thinning of the skin. You may have to try more than one topical steroid before finding one that works effectively for you.
Topical calcineurin inhibitors (TCIs), which keep certain immune system cells from becoming active. That helps prevent symptoms like itching, redness, and inflammation.
Other medications. If you have severe hand eczema that does not improve with topical medications, your doctor may recommend an oral medication. No drug has been approved specifically for hand eczema, but some medications that act on the immune system may be prescribed off-label. These include:
- Cyclosporine and methotrexate, drugs often used to treat inflammatory conditions such as psoriasis
- Dupilumab (Dupixent), a biologic drug
- Oral corticosteroids
- Retinoids
- Janus kinase (JAK) inhibitors
What You Can Do to Manage Your Hand Eczema
The following tips can help ease your eczema and keep symptoms at bay.
- Avoid antibacterial hand cleansers that contain harsh ingredients like alcohol and solvents.
- Wear clean cotton gloves when doing household chores. Be sure to wash them with detergent that contains no fragrance or dyes.
- Use vinyl gloves and cotton liners during tasks that would get your hands wet. Afterward, turn your vinyl gloves inside out to wash them, then let them air dry.
- Irritants can get trapped under rings, so clean your rings often. Also, take them off while doing household chores as well as before you wash and dry your hands.
Show Sources
Photo Credit: Connect Images/Getty Images
SOURCES:
Cleveland Clinic: “Eczema,” “Dermatitis,” “Dyshidrotic Eczema (Dyshidrosis).”
Eczema Society of Canada: “Treating hand eczema.”
National Eczema Society: “Hand eczema,” “Find out more about filaggrin.”
Journal of Clinical Medicine: “Psychosocial Consequences of Hand Eczema—A Prospective Cross-Sectional Study.”
Lancet: “Hand eczema.”
British Association of Dermatologists: “Hand dermatitis (hand eczema).”
National Eczema Association: “Hand Eczema,” “Understanding the Various Types of Hand Eczema,” “Prescription Topical Treatments for Eczema.”
JAAD International: “Pediatric chronic hand eczema: Epidemiology, clinical presentation, and management.”
Mayo Clinic: “Contact dermatitis.”
Royal Society of Chemistry: “Urushiol.”
DermNet: “Atopic hand dermatitis,” “Hand dermatitis.”
Contact Dermatitis: “Hyperkeratotic hand eczema: Eczema or not?”
American Academy of Dermatology: “Dry, Scaly, and Painful Hands Could Be Hand Eczema.”
Allergy and Asthma Network: “Eczema and Washing Hands Frequently.”
