Various treatments help chronic hand dermatitis

Aruba - Though its impact can be socially and financially crippling, chronic allergic contact dermatitis (ACD) of the hand responds to aggressive drug therapies combined with on-the-job precautions, according to Donald V. Belsito, M.D., M.B.A., professor and director of dermatology, University of Kansas Medical Center.

"Chronic hand dermatitis is estimated to affect 5 percent of men and 10 percent of women, and depending upon the occupation, the prevalence can be even higher. Up to one in three nurses have been reported to have some form of hand dermatitis," Dr. Belsito says. "It affects people emotionally."

"They worry about their disease and are embarrassed by it. And they're functionally affected by having hand dermatitis in that they can't do what they enjoy. Patients can have problems with doing activities of daily living, and many are concerned about interacting with others because of the way their hands appear."

"Occupationally, patients are very much affected. They're concerned that they'll need to leave their jobs and about what that would mean in terms of their financial future if they were to be fired. That's true even though in terms of itching, burning, rashes and other symptoms, these people with hand dermatitis were no more affected than people who had similar types of eczemas on their face, trunk or other body locations," he says.

Diagnostic clues The location and character of chronic hand dermatitis often provide clues regarding its causes.

"When it's in the finger webs," he says, "it's usually atopic dermatitis or dyshidrosis. But it could be those diseases potentially worsened by irritation or allergy. When it's coin-shaped, then you're usually dealing either with nummular dermatitis or psoriasis. When it's on the palms and it blisters, it's usually dyshidrosis, although in some cases it can be allergic as well. When it's on the palm and it's very thick and scaly, then it's usually psoriasis or dyshidrosis. But again, one needs to be concerned about chronic allergy, and these patients certainly deserve patch testing."

Scaling on the dorsal surface usually indicates allergy or atopic dermatitis. Dermatitis that affects one palm much more than the other often points to occupational triggers, as well as allergies, irritation, dyshidrosis or psoriasis brought out by wet work or repeated hand trauma. Similarly, pulpitis commonly strikes the hands of dentists and others who rely on fine motor movements, typically affecting the first three fingers most significantly. It can be caused by allergy, irritation or friction, or occasionally psoriasis or dyshidrosis.

"Whenever you're dealing with a hand dermatitis," Dr. Belsito says, "one must always be concerned about infections. Fungal and candidal infections can look eczematous. So anything that scales deserves a fungal culture to rule out these infections. Some bacterial infections also can present with vesicles, so getting a culture of the fluid, particularly if there's any pustular component, can be very helpful."

Even if a patient presents with a primary complaint of hand dermatitis, it's also helpful to examine all the patient's skin.

For dermatitis limited to a patient's hands, for example, allergy represents the most likely diagnosis, followed by irritant contact dermatitis. But if dermatitis affects the hands and feet, the most likely diagnoses are allergy and psoriasis.

For any dermatitis that affects the hands, asking questions including whether there's any temporal relationship to possible irritants encountered on the job helps determine if the condition is work-related.