hand dermatitis

Etiology

• atopic dermatitis
• contact dermatitis
  • irritation
    • frequent or prolonged wet work (contact with water)
    • excessive hand washing
  • allergic
• dyshydrotic eczema
• psoriasis
• Tinea mannum (dermatophyte) infections
• wet work, chemical exposures & friction may worsen hand dermatitis regardless of the cause

Clinical manifestations

• allergic contact dermatitis
  • generally involve, dorsal hands, finger web spaces, skin on the volar wrists, especially when the palms are spared
  • erythema, edema, vesiculopapular dermatitis
  • pruritus, very itchy
  • delayed onset
    • initial episode may occur several weeks after exposure
    • recurrences develop 1-2 days after exposure
  • may improve during vacation
  • chronic exposure results in chronic eczema
• atopic dermatitis
  • scaling, erythema, lichenification, hyperkeratosis
• irritant dermatitis
  • skin is red, dry, & hyperkeratotic with fissures
  • burning pain is more common than itching
  • rapid onset after exposure
• dyshidrotic eczema
  • involves palms & sides of fingers
  • recurrent episodes of tense, fluid-filled vesicles
  • pruritus, very itchy
• psoriasis
  • well demarcated plaques on palms, often with discrete 2-3 mm pustules, scaling & erythema
  • instep of plantar surface of feet often affected
  • nail dystrophy may be associated
• Tinea mannum
  • generally involves only 1 hand & 2 feet
  • dry scaling, angular patches or diffuse erythema
  • may involve nails
  • diagnosis unlikely if feet not involved

Diagnostic procedures

• skin biopsy may be non-specific
• patch testing may be useful
• KOH prep of skin scrapings when suspecting fungi, yeast or scabies

Differential diagnosis

• scabies

Management

• avoidance of allergens & irritants
• regular use of emollients
  • white petrolatum high-value care recommendation
• topical glucocorticoids, medium to high potency
• referral for treatment with immunosuppressive agents for refractory hand dermatitis
  • methotrexate
  • mycophenolate
  • azathioprine
  • others

More general terms

• dermatitis