Your Most Essential Guide to Hand Dermatitis
Doctor’s Note
As dermatologists, we understand that having dry hands can be more than bothersome. The discomfort of chapped skin along with occasional bleeding can greatly limit your daily activities. For patients, it's often hard to know what will help - we hope our online info will help you learn everything you need to know about dry hands. If you want to skip to the recs, click here!
What is Hand Dermatitis?
Hand dermatitis, also known as hand eczema, is a common skin condition affecting the hands. The condition appears as red, inflamed, itchy, and sometimes blistered skin. In more severe cases, skin may become thick, cracked, or develop infections.
Most of the time, hand dermatitis is caused by coming into contact with something that irritates the skin, such as chemicals, or contact with something that causes allergic reactions.
Work that requires keeping your hands wet can also irritate the skin of your palms. Hand dermatitis is most common among mechanics, health care professionals, food industry workers, janitors, construction workers, electricians, and beauticians / hairdressers.
Photos of Hand Dermatitis
Hand dermatitis can cause several uncomfortable symptoms. If you have this condition, you might notice redness, where the skin on your hands becomes red and inflamed. Itching is another common symptom, making your hands feel very itchy and causing you to want to scratch them. You might also experience swelling, which makes your hands look puffy. Dryness is another issue, where the skin on your hands becomes very dry and flaky.
Causes of Hand Dermatitis
So why does this happen? Nearly all forms of hand dermatitis involve disruption of the epidermis. When this happens, the skin cannot retain water and environmental triggers get in very easily.
But why does our hand skin get irritated to begin with? There's a few causes:
Atopic dermatitis – Due to genetics, you have sensitive skin.
Allergic contact dermatitis – You are allergic to a specific trigger. These rashes tend to form in a specific shape (where the allergen contacted your skin!). Common hand allergens include latex, fragrance, and nickel.
Irritant contact dermatitis – You have repetitive exposure to irritating triggers, like constant hand washing, detergents, solvents, oils, acids, wood, metals, plants, meats, vegetables, paper, dust, gloves, and fragrance. This is commonly induced by jobs, the most common being cleaners, health care workers, mechanics, and hairdressers.
Common hand dermatitis triggers include water, wet work, soaps, detergents, solvents, oils, acids, alkalis, metals, wood, plants, raw meat, vegetables, paper, dust, soil, topical medications, gloves, and cosmetics.
Preventing Hand Dermatitis
Preventing hand dermatitis involves a few important steps. It's very important to have a great daily skincare routine to protect your skin. Here are some easy tips to help prevent flare-ups:
Gentle Cleanser
- Opt for gentle, fragrance-free moisturizing cleansers
- Gently blot hands dry and immediately moisturize
Wear Gloves!
- Wear gloves when you are washing dishes, using cleaning supplies, or preparing food
Gentle Moisturizer
- Use a thick, cream-based moisturizer
- Place at every sink in home
- Best applied after every time you wash your hands
Take off Your Ring
- Take off any rings when washing hands, as the soap often gets stuck under the ring
Short, Lukewarm Showers
- Hot, prolonged showers can strip the skin of oils
- Keep showers short with lukewarm water
- After shower, gently pat dry and apply topical prescriptions followed by moisturizer
Avoid Sanitizer
- If possible, avoid alcohol-based sanitizers, as alcohol is very drying for your skin
- If needed, use a hand sanitizer with hydration, like this one from the Honest Company!
Routine Maintenance
- Even when the skin looks clear, continue your gentle skincare routine to prevent flares
Pocket Moisturizer
- Always carry a small tube of gentle cleanser/moisturizer so you can continue your routine on the go!
Limit Trigger Exposure
- Identify and avoid triggers
- Be cautious with new cosmetics, skin care products, and household cleaners
- Choose products labeled safe for sensitive skin
Covers Sores
- Cover any areas that may be open or bleeding (see below!)
Hand Dermatitis Over-the-Counter Treatment
Step 1: If you have open wounds, clean hands and apply liquid bandage to cover until healed (likely 1-2 weeks).
Step 2: Apply hydrocortisone twice daily x 2 weeks. Since the skin of the hand is so thick, not likely to be very effective but it can help if you need something quickly. You should ideally use greasy ointment instead of white cream.
Step 3: Apply moisturizer multiple times daily. It is best applied on WET skin. Note: Neutrogena’s Norwegian Hand Formula is the best hand moisturizer in my opinion. However, Neutrogena likes to tease us with availability. Sometimes this product is available, sometimes it is not. I do not understand Neutrogena’s mysterious ways when it comes to the production of their Norwegian Hand Cream.
Step 4: Wear gloves at night or when doing tasks around the house to protect irritated skin. This can be used at night or during tasks. The fingerless design helps with phone touch screens. Note: Nitrile is NOT latex! You can safely use nitrile if you have a latex allergy.
Step 5: For long-lasting hand dermatitis, consider using a home UVB (311nm) phototherapy device 2-3 times per week. Note this is NOT red light, blue light, LED, laser light, etc. It is Ultraviolet B (311 - 313 nanometer wavelength).
Hand Dermatitis Prescriptions
Sometimes, over-the-counter creams and lotions aren't enough to handle hand dermatitis. When that happens, doctors often prescribe stronger medicines that you can only get with a prescription. These prescription topicals are usually more powerful and can help manage the symptoms better. If over-the-counter options aren't working, it's important to talk to your doctor about getting a prescription. The most common prescriptions we use for hand dermatitis include:
Topical Steroids
- Reduces itching and inflammation
- Typically need strong steroids to penetrate the thick skin of the hand
- Best absorbed on wet skin
- Prolonged use can result in skin thinning
- Ex: Clobetasol, Betamethasone
Eucrisa Ointment
- Similar to a steroid but not a steroid
- Safe for regular daily use
- Reduces inflammation
- Approved for patients age 2 and up
- Caution: Risk of skin burning or stinging
Dupixent Injections
- Self-injections every 2 weeks
- Targets inflammation proteins (IL-4, IL-13)
- Used if topicals are not sufficient
- Risk of eye issues
- Note: Injection is very easy, and you DON'T see the needle!
Phototherapy
- UVB light treatment
- Reduces inflammation, itch, scale
- Can go into office for 2-3x per week or buy home unit
- Risks: Sunburn, skin aging, cancer risk
- Requires time commitment
What Is Patch Testing?
If you experience prolonged flares (meaning more than 4-8 weeks) or repeated flares, you might consider patch testing. Patch testing is a test used to identify specific allergens that may be triggering your eyelid dermatitis. Small amounts of various substances are applied to the skin using adhesive patches, and the skin's reaction is observed to pinpoint the cause of the inflammation. The typical patch testing schedule is:
If we're being honest, patients hate this test because you cannot shower for the week, or do anything that will make you sweaty. Despite its challenges, there is tremendous insight to be gained from this test!
The T.R.U.E Test is a commonly used system for patch testing. It tests for 36 allergens in total. To see what allergens are tested, click here!
Another commonly used system is called the North American 80 Comprehensive Series (NAC-80). It tests for 80 allergens in total. To see what allergens are tested, click here!
Friday Picture: Mann J, Caruana D, Luo E, Gottesman E, Agrawal N, Lozeau D, Hessel J, Neumann M, Khanijo S, Hasan Z, Rizvi K, Gunther R, Donovan D, Chan D, Lee-Wong M, Szema AM. Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge. Cureus. 2022 Aug 12;14(8):e27920. doi: 10.7759/cureus.27920. PMID: 36110455; PMCID: PMC9464419.
Hand Dermatitis Complications
Hand dermatitis can lead to several serious problems that affect daily life. One major issue is infections, which can happen when the irritated skin breaks. The skin can also become thick and tough from constant scratching. People in certain jobs are at higher risk because they often need to wash their hands or touch irritating substances. This can make their dermatitis worse and lower their quality of life. Besides physical discomfort, hand dermatitis can also cause emotional stress, leading to feelings of embarrassment and anxiety. These complications show how important it is to manage and treat hand dermatitis effectively.
Skin Infections
- Scratching can break the skin, increasing the risk of infections.
Thickened Skin
- Chronic scratching thickens the skin.
Occupational Risk
- People in working in healthcare, cleaning, and hairdressing are at high risk. Hand dermatitis can impact job performance.
Reduced Quality of Life
- Can interfere with daily activities. Tasks requiring fine motor skills, like typing, may become difficult.
Mental Impact
- Sometimes, hand eczema's visible symptoms can cause self-consciousness and social withdrawal.
Hand Dermatitis FAQs
What is the Best Hand Sanitizer for Eczema?
Look for hand sanitizers with added hydrating ingredients, like aloe or glycerin. Here is a good affordable option from The Honest Company.
Dermatitis Herpetiformis vs Dyshidrotic Eczema?
Dermatitis Herpetiformis (DH) is linked to gluten sensitivity (celiac disease) and causes rash on the elbows, knees, buttocks, lower back, and scalp. NO HANDS OR FEET.
Dyshidrotic Eczema (DE) causes blisters on the HANDS AND FEET. It is triggered by stress, allergies, or moist environments, and it’s treated with moisturizers and topical steroids.
What are the Best Gloves for Dermatitis Hands?
When dealing with dermatitis on the hands, choosing the right gloves is essential to protect your skin and prevent future irritation. The best gloves for dermatitis-prone hands are cotton gloves, because they are breathable and help keep the hands dry. They are Ideal for overnight use with moisturizers or for light tasks around the house. Apply a thick layer of fragrance-free moisturizer or prescribed ointment before putting on gloves. Be sure to avoid wearing gloves for extended periods to prevent moisture buildup and allow the skin to breathe! Here is a good affordable option from Amazon.
Why Are My Hands Still Dry After Using Sheer Hydration Lotion?
Your hands might still feel dry after using sheer hydration lotion if the lotion doesn’t contain enough moisturizing ingredients like ceramides or if it's not thick enough to lock in moisture. Try using a heavier cream or ointment, especially at night, to help keep your hands hydrated.
What Causes White Dry Skin on Feet?
White dry skin on your feet can be caused by a lack of moisture, frequent exposure to water, or wearing shoes that don’t allow your feet to breathe. Using a foot cream with urea or lactic acid can help exfoliate and moisturize the skin.
Why Are My Hands So Dry?
Dry hands can be caused by frequent washing, exposure to cold or dry weather, or using harsh soaps. It’s important to moisturize regularly, especially after washing your hands, to help keep them soft and hydrated.
How Do You Treat Cracked Fingers?
To treat cracked fingers, apply liquid bandage covered by a thick, moisturizing cream or ointment, especially before bed. Cover your hands with cotton gloves overnight to help the cream absorb. Avoid harsh soaps and try to keep your hands dry.
How Should You Dry Your Hands After Washing?
After washing your hands, pat them dry gently with a soft towel rather than rubbing them, as rubbing can irritate the skin. Make sure to dry between your fingers, and apply a moisturizer immediately afterward to lock in moisture.
What Causes Dry Hands?
Dry hands can be caused by frequent hand washing, exposure to cold weather, using harsh soaps, or not moisturizing enough. To prevent dry hands, use a gentle soap and apply a hand cream after washing.
How to Heal Cracked Fingertips?
To heal cracked fingertips, apply a healing ointment or cream several times a day. Cover the cracks with a bandage if they are deep, and try to avoid exposing your hands to water or harsh chemicals until they heal.
Why Are My Hands Always Dry?
If your hands are always dry, it might be due to frequent washing, exposure to irritants, or not moisturizing enough. Using a thick hand cream regularly, especially after washing your hands, can help improve moisture levels.
How to Get Softer Hands?
To get softer hands, regularly exfoliate to remove dead skin cells and use a rich, hydrating hand cream. Wearing cotton gloves after applying cream at night can help lock in moisture and soften your hands by morning.