About hand eczema

Person scratching hand eczema
Person scratching hand eczema

Hand eczema is one of the most common types of eczema. It mainly affects the palms but can also affect other parts of the hand. The main symptoms are dry, itchy and red skin affecting the whole hand, including the fingers. Other symptoms include cracking, soreness and bleeding. In some cases, blisters develop. The skin is generally dry, scaly and thickened, and the fingers can become swollen when the eczema is flaring. If the eczema is severe over a long time, the hands can become very painful, making it difficult to carry out day-to-day tasks such as doing up buttons, holding a pen or using a computer.

What types of hand eczema are there, and how are they caused?

Coming into contact with irritants such as dust, detergents, cleaning agents, airborne sprays or even just frequent hand-washing can cause irritant hand eczema (irritant contact dermatitis of the hands).

Allergic hand eczema (allergic contact dermatitis of the hands) arises as a result of an allergic reaction to a particular substance in the environment. It is possible to be allergic to a number of different substances, but common causes of contact sensitivity include nickel, fragrances, preservative chemicals, rubber and various plants, amongst other things.

Pompholyx eczema (also known as dyshidrotic eczema/dermatitis) is another type of eczema that affects the hands (and feet). Usually pompholyx eczema involves the development of intensely itchy, watery blisters, mostly affecting the sides of the fingers, the palms of the hands and soles of the feet. The onset can be sudden and the cause is unknown, although it is thought that factors such as stress, sensitivity to metal compounds (such as nickel, cobalt or chromate), heat and sweating can aggravate this condition.

How is it treated?

It is important to avoid any relevant irritants or allergens, and apply emollients and topical steroids as necessary.

Emollients (medical moisturisers) are the main first-line treatment for eczema and are necessary to keep your skin moisturised. Emollients can be bought over the counter in pharmacies and some supermarkets, or supplied on prescription. There is a wide range of emollients, which vary in their levels of greasiness. The dryer the skin, the greasier an emollient is needed. Ointments are the greasiest type of emollient. It can help to apply an ointment before bed and wear cotton gloves overnight.

A leave-on emollient or an emollient soap substitute should be used for washing, since soap de-greases the skin and can also act as an irritant. It is a good idea to carry around a small dispenser of emollient to use for handwashing during the day, so you can avoid detergent hand washes. [While Covid-19 remains a threat, we are recommending that people wash their hands with soap, as soap is more effective than emollient at breaking the lipid envelope surrounding coronavirus particles, and removing the virus from the skin.]

Topical steroids are the most common treatment for inflammation in eczema. They should be used according to the instructions of your GP. Hands usually require stronger steroids (the skin of the palms is thick), so potent topical steroids are usually prescribed (moderately potent for children). They should be used for a short treatment burst, generally 2 weeks. If the skin is infected, you may be prescribed an antimicrobial treatment in the form of a cream or a tablet.

Treatments for severe hand eczema that has not responded effectively to emollients and potent topical steroids include phototherapy and the drug treatment alitretinoin (Toctino).

For more information on hand eczema, please see our Hand eczema factsheet