Eczema on the hand

definition

Eczema in general is a reddening of the skin, mostly caused by allergic reactions, which is usually moderately to severely itchy, but can also become flaky.
Eczema is an acute or chronic inflammatory reaction of the skin.

For more information, see the main Eczema article.

Causes and forms of eczema on the skin

The body's T cells are primarily responsible for the development of eczema on the hand.

In the area of ​​the hands, the T cells in the area of ​​the skin are activated as soon as they come into contact with a solid, liquid or gaseous substance that the body classifies as foreign. So-called memory cells are then formed.

If there is renewed contact with the same substance, these memory cells are activated and migrate to the surface of the skin.
These cells are also called antigen-specific effector cells, which ultimately ensure that the allergic reaction in the hands is activated.

The memory cells then ensure, on the one hand, that so-called mediators are released in the area of ​​the skin, which then release messenger substances, and on the other hand, that skin cells go into apoptosis, i.e. be killed and disintegrate.

It is not known why some people are more prone to eczema and others are not.
Most of the time, people are more often affected, who generally have a variety of other allergies, such as Suffer from hay fever or a house dust allergy.
It is believed that overactivation of the immune system leads to the symptoms described.

In most cases, the mediators released during the overreaction of the immune system described above lead to a widening of the skin vessels, which means that more blood flows into the superficial area of ​​the skin.
This results in the skin becoming red. The messenger substance histamine is probably also involved in the occurrence of eczema, because the release triggers the often painful itching that accompanies the reddening of the skin.

In the case of eczema on the hand, a basic distinction is made between acute, i.e. suddenly occurring eczema, and chronic skin irritations that only appear after a few days to weeks.

Acute hand eczema occurs after a period of up to approx. 48 hours after contact with the foreign substance.
Acute eczema is usually triggered by an allergic reaction.
Chronic eczema is mostly toxic. Toxic eczema is a reaction of the body and skin that is not primarily triggered by the immune system, but mostly by toxic substances that get through the epidermis into deeper layers.

A toxic reaction corresponds in strength and danger to a burn, scalding or chemical burn.

Read more on the subject below Rash on the hands

Symptoms of eczema on the hand

In the case of acute contact dermatitis of the hand, skin reddening and severe itching occurs after 48 hours at the latest. The skin can also peel moderately to heavily on the affected area.

In addition, with pronounced eczema, blisters can also form in the area of ​​the affected skin.
Sometimes it also happens that the bubbles open and fluid comes out.

Read more about the topic here: Blisters on the hand

In the case of pronounced eczema on the hand, the affected area also becomes crusted.

The difference between acute and chronic hand eczema is not only the time of occurrence, but also the sequence of symptoms.
While acute hand eczema is usually a clear sequence of symptoms (Redness, blistering, scaling, opening of the blisters) in chronic eczema, all symptoms appear at the same time.

Common triggers for eczema on the hand

In acute contact eczema, allergens such as nickel, potassium dichromate, such as those used in shoes, or acrylate, such as those found in toilet seats, are usually the triggering factor.

Many people have a contact allergy to nickel and notice this for the first time when wearing nickel earrings.

The main triggers for hand eczema are liquids or gloves.

diagnosis

Usually the diagnosis of eczema on the hand is one Eye diagnosis.
Either because they scaly, reddish skin changes comes to light or because, in the advanced stage, it is already typical, in part weeping blistering has come.

The numerous other causes such as scalds or are also important Burns to be excluded by asking the patient.
A detailed medical survey should also clarify whether such a skin reaction has already occurred and, if so, whether the patient can remember after which contact.

It is also important to ask if there are others Allergies, how hay fever, Pollen allergy or Neurodermatitis there, as there is most likely a connection between frequent allergies and contact eczema in the sense of an over-sensitive skin or an overactive one immune system gives.

The question about is also important and complementary rheumatic diseases and the family history of skin conditions.

In dermatology, in addition to eye diagnoses, there are always many borderline cases where it is not entirely clear whether it is really wine eczema that is allergic-related.
Especially since it is not necessarily clear what the patient is allergic to. In this case, and especially if suspicious eczema in the hand area occurs again and again, one should Allergy test be made.
The common eczema-causing substances are applied to the skin and a corresponding skin reaction is awaited. The substances are applied to an adhesive strip and are applied to an area of ​​skin, e.g. glued to the back or back of the hand.

With this also as Prick testing In the designated procedure, the allergens animal hair, food, pollen and house dust are usually included in the test series.
The first reactions on the skin can usually be seen and assessed after 20-30 minutes. Depending on the field under which the reddening occurs, the allergen on it is to blame for the reaction.

Pictures of those affected

Therapy for eczema on the hand

The most important measure in the treatment of hand eczema is to identify and eliminate the triggering substance. If this cannot be found and if it remains on the skin at regular or irregular intervals, any therapy used is hardly effective.

For the acute treatment of hand eczema, it is important to first recognize and correctly assess the stage of the eczema.

For acute weeping eczema of the hand, creams and lotions with a cortisone content are used. The preparation should only be applied to the affected areas and spread thinly.
Regular repetition is necessary until the redness and the blisters have dried up and gone.

In addition to the cortisone creams and lotions, greasy pads without medicinal substances can also be applied. Mention should be made here of moist compresses, Ringer's solution sodium chloride, antiseptic pads or black tea.

If the hand is already encrusted and with little oozing areas, very moist pads should also be chosen here without a medicinal component. This includes hydrophilic creams with a high fat content.

Follow-up treatment should be with creams that promote wound healing (e.g. Chamomile, sage or arnica) or with creams containing urea or with creams with unsaturated fatty acids.

For the treatment of chronic, very dry hand eczema, very greasy creams and lotions should be used. Creams with antipruritic substances such as Polidocanol can be used here.

Furthermore, anti-inflammatory additives are used in the ointments. Liquor carbonis detergens, tumenol, shale oil and evening primrose seed oil should be mentioned.
When using creams and lotions, make sure that the composition of various ingredients is as low as possible. The background to this is that patients suffering from hand eczema are allergic to certain substances recognized by the body as foreign.

The greater the composition of the creams and lotions (Number of ingredients), the greater the risk that patients will develop eczema again.

Summary

Hand eczema is a skin reaction to various substances that occurs mostly in the area of ​​the palm but also on the back of the hand or on the fingers.

Most of the time hand eczema starts with one Redness the affected area of ​​skin after touching a certain substance. After the reddening it comes to Scaling. One closes Blistering on.

After a while, and with very severe eczema, these blisters may open and empty.

The cause of hand eczema can be seen allergic reaction as well as so-called toxic reactions. By allergens, e.g. nickel or other mostly metallic covers, alloys etc., an immediate reaction in the skin area leads to the reddening described. This process is also called acute hand eczema designated. In contrast, chronic eczema is mostly due to it toxic reactions triggered. Like a burn or scald, this is a direct skin reaction without the immune system assuming the role it plays in acute eczema. Another difference is that acute hand eczema mostly the same Course of symptoms to have. So after the reddening, flaking and possibly blistering appear afterwards. In the chronic variant it mostly happens all symptoms at the same time. Eczema is usually a visual diagnosis. However, it is not yet known what someone is allergic to. With the so-called Prick test Test strips containing allergens are stuck to the patient's skin, either on the hand or on the back or upper arm. If there is no reaction after a few minutes, the patient is not allergic to any of the allergens on the test strip. If there is an allergy, the first reddening or even blistering can be read off after 20-30 minutes at the corresponding location of the allergen.

The treatment of hand eczema depends on the stage of the eczema. The most important measure is that Switching off the allergenthat led to the onset of the allergy. Creams and lotions are also used, some with cortisone.