Hand Eczema

What is hand eczema?

Hand eczema, also called hand dermatitis, is inflammation of the skin of the hands. It is one of the most common skin problems in adults and can range from mild dryness and cracking to severe, painful disease that makes it difficult to work or carry out everyday tasks.

Who gets it?

Hand eczema is common, affecting roughly 5 in 100 people. Although children with an eczema tendency can develop it, hand eczema is seen more often in teenagers and adults, especially those with a past history of atopic eczema or whose hands are often wet or in contact with irritants. Jobs with a higher risk include healthcare, hairdressing, catering, cleaning, floristry, mechanical and construction work, and caring for young children. Frequent hand washing and use of hand sanitiser can also contribute.

What causes it?

Hand eczema usually has more than one cause, and the causes often overlap.

Irritant contact dermatitis is the most common type. It develops when the skin barrier is gradually worn down by repeated contact with water, soaps, detergents, cleaning products, solvents, oils or friction. The more often and the longer the hands are exposed, the higher the risk.

Allergic contact dermatitis develops when the immune system becomes allergic to a specific substance that touches the hands, such as rubber chemicals in gloves, preservatives and fragrances in hand creams and soaps, nickel, hair dye, or acrylates in nail products.

Atopic hand eczema occurs in people with a tendency to eczema, whose skin barrier is naturally weaker.

Some types of hand eczema have a particular pattern, such as pompholyx, which causes recurrent crops of small, very itchy blisters on the palms and sides of the fingers.

Is it hereditary or contagious?

Hand eczema is not passed down directly, but a tendency towards it can run in families alongside atopic eczema, asthma and hay fever. Hand eczema is not contagious.

What does it look and feel like?

The skin may be dry, rough, scaly, red or darker than usual, and itchy, sore or burning. It can become thickened, and painful cracks or splits can develop, especially on the fingertips and over the knuckles. Some types cause small blisters, which can weep and then peel. On brown and black skin, inflamed areas may look darker or greyish rather than red.

Hand eczema can affect grip, dexterity and the ability to work, and can be embarrassing in social situations. It can also become infected, which may cause increased pain, weeping and crusting.

How is it diagnosed?

The diagnosis is made from your symptoms and by examining the skin. Your dermatologist will ask about your work, hobbies, household tasks and the products you use, because identifying the causes is central to managing hand eczema. Patch testing is often recommended to look for an allergic cause. Occasionally, skin scrapings are taken to rule out a fungal infection, which can look similar.

What are the treatment options?

Dr Mounsey will work out what is driving your hand eczema, which is often a mix of irritation, allergy and an underlying eczema tendency. Patch testing is frequently helpful and he carries this out himself. Treatment combines practical hand care, such as soap substitutes, regular emollient use and appropriate gloves, with steroid ointments of the right strength and calcineurin inhibitor creams. Persistent or severe hand eczema may need tablets such as alitretinoin, ciclosporin or methotrexate, or advanced treatments such as JAK inhibitor tablets or biologic injections. Dr Mounsey can also provide advice relevant to your work.

What is the outlook?

Most hand eczema can be controlled, although it cannot always be cured, and when an allergy is identified and avoided, allergic hand eczema may clear completely. Hand eczema can be persistent, particularly if exposure to irritants or allergens continues. Identifying and reducing contact with the causes, and protecting the skin, make a substantial difference to how well it settles.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/hand-dermatitis-hand-eczema

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.