Skip to main content

Advertisement

SpringerLink
Log in

Hand Dermatitis: Utilizing Subtype Classification to Direct Intervention

  • Contact Dermatitis (S Jacob, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion statement

Hand dermatitis is a common inflammatory skin condition with typical clinical signs including redness, hyperkeratosis, scaling, edema, vesicles, and fissuring. It often becomes chronic and disabling, leading to significant morbidity, disability, and economic loss. The pathogenesis of hand dermatitis is multifactorial, and the treatment is challenging. The most common exogenous cause of hand dermatitis is contact with irritants such as soap and water, leading to an irritant contact dermatitis. Atopic dermatitis is a significantly associated endogenous cause of hand dermatitis. Exposure to a contact allergen is also an important cause of hand dermatitis, and it is recommended that all patients with persistent or treatment refractory hand dermatitis undergo patch testing, especially prior to the initiation of systemic immunosuppressive therapy. Preventative measures including the identification and elimination of irritants or allergens are essential in all cases of hand dermatitis. In addition, a stepwise approach of escalating therapy is advised. Initially, we recommend frequent application of emollients, along with the use of a potent topical corticosteroid daily for up to 6 weeks. A concomitant short, 1–2-week course of oral steroids may also be needed in severe cases to achieve rapid resolution. Once well controlled, maintenance therapy with either twice weekly topical corticosteroid application or topical calcineurin inhibitor application may be indicated for cases of chronic dermatitis. If topical corticosteroids are ineffective and the patient has access to phototherapy, we would next recommend a course of localized PUVA or UVB therapy. In severe, refractory cases of hand dermatitis unresponsive to topical steroids and phototherapy, systemic therapy such as an oral retinoid or immunosuppressive medication may be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Heading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Thyssen JP, Johansen JD, Linneberg A, Menne T. The epidemiology of hand eczema in the general population—prevalence and main findings. Contact Dermatitis. 2010;62:75–87.

    Article  PubMed  Google Scholar 

  2. Agner T, Andersen KE, Brandao FM, et al. Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients. Contact Dermatitis. 2008;59:43–7.

    Article  PubMed  Google Scholar 

  3. Bryld LE, Hindsberger C, Kyvik KO, Agner T, Menne T. Risk factors influencing the development of hand eczema in a population-based twin sample. Br J Dermatol. 2003;149:1214–20.

    Article  CAS  PubMed  Google Scholar 

  4. Meding B, Lantto R, Lindahl G, Wrangsjo K, Bengtsson B. Occupational skin disease in Sweden—a 12-year follow-up. Contact Dermatitis. 2005;53:308–13.

    Article  CAS  PubMed  Google Scholar 

  5. Meding B, Wrangsjo K, Jarvholm B. Fifteen-year follow-up of hand eczema: predictive factors. J Invest Dermatol. 2005;124:893–7.

    Article  CAS  PubMed  Google Scholar 

  6. Rystedt I. Long term follow-up in atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1985;114:117–20.

    CAS  Google Scholar 

  7. Cvetkovski RS, Rothman KJ, Olsen J, et al. Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol. 2005;152:93–8.

    Article  CAS  PubMed  Google Scholar 

  8. Diepgen TL, Purwins S, Posthumus J, Kuessner D, John SM, Augustin M. Cost-of-illness analysis of patients with chronic hand eczema in routine care in Germany: focus on the impact of occupational disease. Acta Derm Venereol. 2013;93:538–43.

    Article  PubMed  Google Scholar 

  9. Meding B, Swanbeck G. Consequences of having hand eczema. Contact Dermatitis. 1990;23:6–14.

    Article  CAS  PubMed  Google Scholar 

  10. Dickel H, Bruckner T, Bernhard-Klimt C, Koch T, Scheidt R, Diepgen TL. Surveillance scheme for occupational skin disease in the Saarland, FRG. First report from BKH-S. Contact Dermatitis. 2002;46:197–206.

    Article  CAS  PubMed  Google Scholar 

  11. Diepgen TL, Agner T, Aberer W, et al. Management of chronic hand eczema. Contact Dermatitis. 2007;57:203–10.

    Article  PubMed  Google Scholar 

  12. Augustin M, Kuessner D, Purwins S, Hieke K, Posthumus J, Diepgen TL. Cost-of-illness of patients with chronic hand eczema in routine care: results from a multicentre study in Germany. Br J Dermatol. 2011;165:845–51.

    Article  CAS  PubMed  Google Scholar 

  13. Coenraads PJ, Diepgen TL. Risk for hand eczema in employees with past or present atopic dermatitis. Int Arch Occup Environ Health. 1998;71:7–13.

    Article  CAS  PubMed  Google Scholar 

  14. Menne T, Johansen JD, Sommerlund M, Veien NK. Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema. Contact Dermatitis. 2011;65:3–12.

    Article  PubMed  Google Scholar 

  15. Schwanitz H. Atopic palmoplantar eczema. Berlin: Springer; 1988.

    Book  Google Scholar 

  16. Molin S, Diepgen TL, Ruzicka T, Prinz JC. Diagnosing chronic hand eczema by an algorithm: a tool for classification in clinical practice. Clin Exp Dermatol. 2011;36:595–601.

    Article  CAS  PubMed  Google Scholar 

  17. Johansen JD, Hald M, Andersen BL, et al. Classification of hand eczema: clinical and aetiological types. Based on the guideline of the Danish contact dermatitis group. Contact Dermatitis. 2011;65:13–21.

    Article  PubMed  Google Scholar 

  18. Lerbaek A, Kyvik KO, Ravn H, Menne T, Agner T. Incidence of hand eczema in a population-based twin cohort: genetic and environmental risk factors. Br J Dermatol. 2007;157:552–7.

    Article  CAS  PubMed  Google Scholar 

  19. Meding B, Swanbeck G. Epidemiology of different types of hand eczema in an industrial city. Acta Derm Venereol. 1989;69:227–33.

    CAS  PubMed  Google Scholar 

  20. Skoet R, Olsen J, Mathiesen B, Iversen L, Johansen JD, Agner T. A survey of occupational hand eczema in Denmark. Contact Dermatitis. 2004;51:159–66.

    Article  PubMed  Google Scholar 

  21. Flyvholm MA, Lindberg M. OEESC-2005--summing up on the theme irritants and wet work. Contact Dermatitis. 2006;55:317–21.

    Article  PubMed  Google Scholar 

  22. Flyvholm MA, Mygind K, Sell L, Jensen A, Jepsen KF. A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses. Occup Environ Med. 2005;62:642–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Held E, Mygind K, Wolff C, Gyntelberg F, Agner T. Prevention of work related skin problems: an intervention study in wet work employees. Occup Environ Med. 2002;59:556–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Jungbauer FH, van der Harst JJ, Groothoff JW, Coenraads PJ. Skin protection in nursing work: promoting the use of gloves and hand alcohol. Contact Dermatitis. 2004;51:135–40.

    Article  CAS  PubMed  Google Scholar 

  25. Weisshaar E, Radulescu M, Bock M, Albrecht U, Diepgen TL. Educational and dermatological aspects of secondary individual prevention in healthcare workers. Contact Dermatitis. 2006;54:254–60.

    Article  PubMed  Google Scholar 

  26. Kappes UP, Goritz N, Wigger-Alberti W, Heinemann C, Elsner P. Tandem application of sodium lauryl sulfate and n-propanol does not lead to enhancement of cumulative skin irritation. Acta Derm Venereol. 2001;81:403–5.

    Article  CAS  PubMed  Google Scholar 

  27. Slotosch CM, Kampf G, Loffler H. Effects of disinfectants and detergents on skin irritation. Contact Dermatitis. 2007;57:235–41.

    Article  CAS  PubMed  Google Scholar 

  28. Yokota M, Maibach HI. Moisturizer effect on irritant dermatitis: an overview. Contact Dermatitis. 2006;55:65–72.

    Article  PubMed  Google Scholar 

  29. Warshaw EM, Ahmed RL, Belsito DV, et al. Contact dermatitis of the hands: cross-sectional analyses of North American Contact Dermatitis Group data, 1994-2004. J Am Acad Dermatol. 2007;57:301–14.

    Article  PubMed  Google Scholar 

  30. Amaro C, Goossens A. Immunological occupational contact urticaria and contact dermatitis from proteins: a review. Contact Dermatitis. 2008;58:67–75.

    Article  PubMed  Google Scholar 

  31. Janssens V, Morren M, Dooms-Goossens A, Degreef H. Protein contact dermatitis: myth or reality? Br J Dermatol. 1995;132:1–6.

    Article  CAS  PubMed  Google Scholar 

  32. Mahler V. Hand dermatitis—differential diagnoses, diagnostics, and treatment options. J Dtsch Dermatol Ges. 2016;14:7–22 .This article highlights Danish guidelines in the diagnosis and treatment of hand dermatitis.

    PubMed  Google Scholar 

  33. Loden M, Andersson AC. Effect of topically applied lipids on surfactant-irritated skin. Br J Dermatol. 1996;134:215–20.

    Article  CAS  PubMed  Google Scholar 

  34. Ramsing DW, Agner T. Preventive and therapeutic effects of a moisturizer. An experimental study of human skin. Acta Derm Venereol. 1997;77:335–7.

    CAS  PubMed  Google Scholar 

  35. Held E, Lund H, Agner T. Effect of different moisturizers on SLS-irritated human skin. Contact Dermatitis. 2001;44:229–34.

    Article  CAS  PubMed  Google Scholar 

  36. Draelos ZD. The effect of ceramide-containing skin care products on eczema resolution duration. Cutis. 2008;81:87–91.

    PubMed  Google Scholar 

  37. Kucharekova M, Van De Kerkhof PC, Van Der Valk PG. A randomized comparison of an emollient containing skin-related lipids with a petrolatum-based emollient as adjunct in the treatment of chronic hand dermatitis. Contact Dermatitis. 2003;48:293–9.

    Article  CAS  PubMed  Google Scholar 

  38. Tam CC, Elston DM. Allergic contact dermatitis caused by white petrolatum on damaged skin. Dermatitis. 2006;17:201–3.

    Article  PubMed  Google Scholar 

  39. Moller H, Svartholm H, Dahl G. Intermittent maintenance therapy in chronic hand eczema with clobetasol propionate and flupredniden acetate. Curr Med Res Opin. 1983;8:640–4.

    Article  CAS  PubMed  Google Scholar 

  40. Veien NK, Olholm Larsen P, Thestrup-Pedersen K, Schou G. Long-term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol. 1999;140:882–6.

    Article  CAS  PubMed  Google Scholar 

  41. Schoepe S, Schacke H, May E, Asadullah K. Glucocorticoid therapy-induced skin atrophy. Exp Dermatol. 2006;15:406–20.

    Article  CAS  PubMed  Google Scholar 

  42. Jensen JM, Pfeiffer S, Witt M, et al. Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis. J Allergy Clin Immunol. 2009;123:1124–33.

    Article  CAS  PubMed  Google Scholar 

  43. Kao JS, Fluhr JW, Man MQ, et al. Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: inhibition of epidermal lipid synthesis accounts for functional abnormalities. J Invest Dermatol. 2003;120:456–64.

    Article  CAS  PubMed  Google Scholar 

  44. Loden M, Wiren K, Smerud KT, et al. The effect of a corticosteroid cream and a barrier-strengthening moisturizer in hand eczema. A double-blind, randomized, prospective, parallel group clinical trial. J Eur Acad Dermatol Venereol. 2012;26:597–601.

    Article  CAS  PubMed  Google Scholar 

  45. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for the use of topical glucocorticosteroids. American Academy of Dermatology. J Am Acad Dermatol. 1996;35:615–9 .These guidelines highlight topical corticosteroid use in the treatment of hand dermatitis. The American Academy of Dermatology recommends once daily use of topical steroids for 1 month followed by maintenance therapy 2-3 times per week.

    Article  CAS  PubMed  Google Scholar 

  46. Clemmensen A, Andersen F, Petersen TK, Hagberg O, Andersen KE. Applicability of an exaggerated forearm wash test for efficacy testing of two corticosteroids, tacrolimus and glycerol, in topical formulations against skin irritation induced by two different irritants. Skin Res Technol. 2011;17:56–62.

    Article  CAS  PubMed  Google Scholar 

  47. Ramsing DW, Agner T. Efficacy of topical corticosteroids on irritant skin reactions. Contact Dermatitis. 1995;32:293–7.

    Article  CAS  PubMed  Google Scholar 

  48. Baeck M, Goossens A. Immediate and delayed allergic hypersensitivity to corticosteroids: practical guidelines. Contact Dermatitis. 2012;66:38–45.

    Article  CAS  PubMed  Google Scholar 

  49. Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing—recommendations on best practice. Contact Dermatitis. 2015;73:195–221 .These guidelines highlight the importance of patch testing to identify allergic contact dermatitis in patients with chronic hand dermatitis.

    Article  PubMed  Google Scholar 

  50. Schnopp C, Remling R, Mohrenschlager M, Weigl L, Ring J, Abeck D. Topical tacrolimus (FK506) and mometasone furoate in treatment of dyshidrotic palmar eczema: a randomized, observer-blinded trial. J Am Acad Dermatol. 2002;46:73–7.

    Article  PubMed  Google Scholar 

  51. Belsito DV, Fowler Jr JF, Marks Jr JG, et al. Pimecrolimus cream 1 %: a potential new treatment for chronic hand dermatitis. Cutis. 2004;73:31–8.

    PubMed  Google Scholar 

  52. Hordinsky M, Fleischer A, Rivers JK, Poulin Y, Belsito D, Hultsch T. Efficacy and safety of pimecrolimus cream 1 % in mild-to-moderate chronic hand dermatitis: a randomized, double-blind trial. Dermatology. 2010;221:71–7.

    CAS  PubMed  Google Scholar 

  53. Arellano FM, Wentworth CE, Arana A, Fernandez C, Paul CF. Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis. J Invest Dermatol. 2007;127:808–16.

    Article  CAS  PubMed  Google Scholar 

  54. Eichenfield LF, Lucky AW, Boguniewicz M, et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1 % in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol. 2002;46:495–504.

    Article  PubMed  Google Scholar 

  55. Ring J, Barker J, Behrendt H, et al. Review of the potential photo-cocarcinogenicity of topical calcineurin inhibitors: position statement of the European dermatology forum. J Eur Acad Dermatol Venereol. 2005;19:663–71.

    Article  CAS  PubMed  Google Scholar 

  56. Hanifin JM, Stevens V, Sheth P, Breneman D. Novel treatment of chronic severe hand dermatitis with bexarotene gel. Br J Dermatol. 2004;150:545–53.

    Article  CAS  PubMed  Google Scholar 

  57. Tzaneva S, Kittler H, Thallinger C, Honigsmann H, Tanew A. Oral vs. bath PUVA using 8-methoxypsoralen for chronic palmoplantar eczema. Photodermatol Photoimmunol Photomed. 2009;25:101–5.

    Article  PubMed  Google Scholar 

  58. van Coevorden AM, Kamphof WG, van Sonderen E, Bruynzeel DP, Coenraads PJ. Comparison of oral psoralen-UV-A with a portable tanning unit at home vs hospital-administered bath psoralen-UV-A in patients with chronic hand eczema: an open-label randomized controlled trial of efficacy. Arch Dermatol. 2004;140:1463–6.

    PubMed  Google Scholar 

  59. Rosen K, Mobacken H, Swanbeck G. Chronic eczematous dermatitis of the hands: a comparison of PUVA and UVB treatment. Acta Derm Venereol. 1987;67:48–54.

    CAS  PubMed  Google Scholar 

  60. Sezer E, Etikan I. Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. Photodermatol Photoimmunol Photomed. 2007;23:10–4.

    Article  PubMed  Google Scholar 

  61. Bissonnette R, Worm M, Gerlach B, et al. Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema. Br J Dermatol. 2010;162:420–6.

    Article  CAS  PubMed  Google Scholar 

  62. Ruzicka T, Lynde CW, Jemec GB, et al. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008;158:808–17.

    Article  CAS  PubMed  Google Scholar 

  63. Thestrup-Pedersen K, Andersen KE, Menne T, Veien NK. Treatment of hyperkeratotic dermatitis of the palms (eczema keratoticum) with oral acitretin. A single-blind placebo-controlled study. Acta Derm Venereol. 2001;81:353–5.

    Article  CAS  PubMed  Google Scholar 

  64. Granlund H, Erkko P, Eriksson E, Reitamo S. Comparison of cyclosporine and topical betamethasone-17,21-dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol. 1996;76:371–6.

    CAS  PubMed  Google Scholar 

  65. Wolverton SE. Comprehensive dermatologic drug therapy. Third Edition: Elsevier Inc.; 2013.

    Google Scholar 

  66. Agarwal US, Besarwal RK. Topical clobetasol propionate 0.05 % cream alone and in combination with azathioprine in patients with chronic hand eczema: an observer blinded randomized comparative trial. Indian J Dermatol Venereol Leprol. 2013;79:101–3.

    Article  PubMed  Google Scholar 

  67. Scerri L. Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol. 1999;455:343–8.

    Article  CAS  PubMed  Google Scholar 

  68. Egan CA, Rallis TM, Meadows KP, Krueger GG. Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Dermatol. 1999;40:612–4.

    Article  CAS  PubMed  Google Scholar 

  69. Shaffrali FC, Colver GB, Messenger AG, Gawkrodger DJ. Experience with low-dose methotrexate for the treatment of eczema in the elderly. J Am Acad Dermatol. 2003;48:417–9.

    Article  PubMed  Google Scholar 

  70. Gill J, Pratt M. A severe case of recalcitrant pompholyx. J Cutan Med Surg. 2015;19:494–7.

    Article  PubMed  Google Scholar 

  71. Pickenacker A, Luger TA, Schwarz T. Dyshidrotic eczema treated with mycophenolate mofetil. Arch Dermatol. 1998;134:378–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, MC 5334, Redwood City, CA, 94063, USA

    Gina P. Kwon MD & Jennifer K. Chen MD

  2. Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Caroline Z. Tan BA

Authors
  1. Gina P. Kwon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caroline Z. Tan BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer K. Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gina P. Kwon MD.

Ethics declarations

Conflict of interest

Gina P. Kwon declares that she has no conflict of interest.

Caroline A. Tan declares that she has no conflict of interest.

Jennifer K. Chen declares that she has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Contact Dermatitis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwon, G.P., Tan, C.Z. & Chen, J.K. Hand Dermatitis: Utilizing Subtype Classification to Direct Intervention. Curr Treat Options Allergy 3, 322–332 (2016). https://doi.org/10.1007/s40521-016-0090-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-016-0090-4

Keywords

Search

Navigation