Let’s talk about hand eczema

Anyone who has been a mother, a caregiver, a food service employee, a medical or nursing professional or involved in mechanics or any profession where solvents come into play has at one time or another suffered from a condition we call hand eczema.

The word eczema is indeed derived from Greek roots that translate as “boil over” and this describes that often this condition is often associated with bubbly skin changes which are often described as “tapioca pudding bubbles” and represents one of the most common skin conditions in patients.

Although the condition represents a sensitivity to drying or irritant agents it is sometimes associated with a true allergy to contactants and represents a wide spectrum of severity and age groups.  We occasionally need a full allergy evaluation if routine treatments do not improve this condition.

Areas of the country where climate is more dry predispose the eczema prone population even further and unveil sensitivities that may not have been obvious in other settings.
Eczema as an overall condition is encountered in most as an infant/childhood rash that may be provoked by sensitivities to foods and environmental agents.  Individuals identified as eczema prone will likely grow up to be adults with many sensitivities to foods, cremes and lotions and will need to be vigilant about staying clear of identified contributing agents.

Additionally given enough abuse through “overzealous ” cleaning and washing anyone is at risk for the dry cracked misery of hand eczema.  Especially harmful are most “antibacterial” soaps which absolutely dry the skin and remove its protective layer rendering it a victim of further environmental contacts.  To add to this problem cracked skin of eczema is further made vulnerable to bacterial and yeast pathogens which often will complicate this skin condition by infecting a barrier poor epidermis.  Staph aureus is one of the pathogens that may indeed complicate the healing of eczema skin.  I will always culture skin that is non responsive to routine treatments and often find this pathogen as an implicated agent in the non healing of wounds.

So what is one to do to avoid eczema and it’s complications?  I advise clean but not over clean skin…gentle soaps such as a pure glycerin soap is advised for my patients, avoidance of harsh antibacterial soaps on a routine basis and excellent lubrication of skin to allow the normal barrier to exist.

Lipid cremes  and ointments are most helpful and I recommend some of my favorites to my patients.  Over the counter hydrocortisone ointment may also be utilized as a first step and of course if eczema is uncontrolled a visit to the dermatologist early on will often prove a smart move to arrest this process.

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