Red, scaly areas on the palms and fingers are a common sign of hand dermatitis. Sometimes tiny tapioca-like vesicles occur just below the skin (called pompholyx). It may affect the very young or very old but is most common in adults. The risk of hand dermatitis in anyone's lifetime is about 17% in one study. For those with a history of allergies, asthma, hay fever or atopic dermatitis, it is 60%.
Some patients have a hand eczema because of too much water contact, e.g., washing their hands too many times. There are certain jobs and professions that tend to trigger hand eczema--those with lots of water contact or "wet work," e.g., food service, janitorial, hair, health care, and being a homemaker with young kids. Also, hobbies or exercise that involve frequent contact with water (e.g., swimming) can be a cause.
Anyone with a history of chronic hand dermatitis needs patch testing to rule out allergic contact dermatitis. Typical allergens include cosmetic and hygiene products, nickel (metal) and gloves.
If you notice an obvious trigger to your eczema, tell your doctor. For example, if your hands get worse in cold weather, keep them warm at all times! If your hand dermatitis flares every time you hold your keys, or handle a metal object, you may have a nickel allergy. This would be confirmed by skin reactions to a belt buckle or costume jewelry, etc. If you have a history of hay fever or allergies to, e.g., dogs, cats, pollen, etc., your hands may be reacting in a similar way. Do you flare every time you put on your favorite golf glove? Finally, if you have a bad foot fungus, it can sometimes come up on your hands--typically just one hand at first.
So, please tell your doctor if you:
The key to treatment is trying to restore the skin's water barrier with good emolliation. After every contact with water, if possible, apply an emollient (moisturizer) such as a cream or ointment. Aquaphor, Eucerin cream, Neutrogena hand cream or Cetaphil cream are recommended. Other options include Vaseline and CeraVe. Some people like wearing spa gloves for 30 minutes or so after applying the emollient to allow it to soak in.
No lotions please! Lotions (which are almost all water) are to be avoided. Often times they merely serve to dry and chap already damaged skin. If it pours, pour it out!
Keep your hands warm. Some, but not all patients, with hand eczema get worse with exposure to the cold. Their eczema is worse in the winter or if they travel to the East Coast. If this is you, never let your hands get cold. If you walk outside in the morning, put on gloves beforehand. There are even heated gloves available (search for "heated gloves" on the internet).
Steroid ointments, as provided by your doctor, may be applied once or twice a day and should be used when the eczema is flaring. Very strong topical steroids (e.g., clobetasol, fluocinonide) may be used for a short-term burst, but it is best to limit their use for no more than a week or two at a time as they can thin the skin. Some patients notice cracking and increased sensitivity of the skin after prolonged use. Once the strong steroid has done its job and calmed the eczema, switch over to a weaker steroid (e.g., triamcinolone, desonide) or just a plain emollient, e.g, Aquaphor, Eucerin cream, etc. Make sure you avoid putting the steroid on areas that do not have eczema (don't need it), e.g., back of the hands for most patients.
One of the best things you can do for your hands is a nighttime soak. Each night, immediately before going to bed, soak your hands for 30-60 seconds in warm but not hot water (e.g., fill the bathroom sink with warm water--sitting water is better than running water.) After the soak, gently pat dry. Then, immediately apply the steroid ointment, Aquaphor, or Vaseline and go to bed. It can greatly heal the skin overnight. Some like to wear white cotton gloves (found at drug or hardware stores) to reduce the grease on the bedding. Don't use the topical steroid daily for more than 2 weeks. Switch over to Aquaphor or Vaseline so as not to thin the skin.
Fissures or painful cracks of the hands and feet are common. For just one or two fissures, polysporin or bacitracin, applied under a bandage overnight, is beneficial. Super glue (e.g., Krazy Glue) can also be used to glue the fissures closed. (Buy the super glue that has a brush applicator, like a nail brush type. There is also a glue especially designed for fissures that can often be found in the pharmacy section). Spread the fissure apart, get the glue down as deep as possible in the split, let it close and then put a layer of glue over the top. Find a comfortable position and let it dry for 5 minutes. This should work well to keep the fissure closed for 2-3 days. It is very effective for corners of nails but also heels and elsewhere.