Your skin is your best accessory. Take good care of it.
Hand eczema is a chronic, multifactorial disease that results in skin irritation and inflammation and involves hands and wrist, and sometimes foot. It can be mild, moderate, or severe, and has long-lasting negative impact on quality of life as well as social life. In this article, I’ll discuss its symptoms, causes, and current treatment strategies.
What are the symptoms?
All types of eczema causes itching, redness, pain, dryness, and peeling or flaking.
What are the causes?
Both genetics and contact allergens or irritants like cleaning substances, bleach, and alcohol play a role in triggering the symptoms. Environmental factors such as pollution, tobacco smoke, and biological factors can also cause eczema (1).
Is hand eczema contagious?
No. You cannot acquire eczema from being in contact with someone who has the condition. However, due to damages that eczema causes, a person with eczema are more prone to bacterial, fungal, or viral infections, which in turn may be contagious (1).
How to treat hand eczema?
Acute hand eczema is recommended to be treated promptly, effectively and thoroughly before it becomes chronic. Chronic hand eczema may require a stepwise treatment approach combining topical, physical (UV light) and systemic options depending on the severity of the condition (2).
Here I will discuss the treatment options a little bit further (2).
1- Topical Therapy
Topical therapy helps to reduce inflammation and itching and also promotes the epidermal barrier recovery. It can be divided to three categories:
Basic Topical therapy:
The first-line of tropical treatment is to simply keep the hands moisturized. For acute and oozing hand eczema, therapy should have drying, and antibacterial effects; hand baths and soaks, moisturizers or moist dressings and hydrophilic creams or gels are usually recommended. In chronic hand eczema, A peeling agent (containing salicylic acid up to 20% if necessary, urea 10–20%) and a lipid-rich ointment are usually recommended.
Topical corticosteroids
Corticosteroids like Clobetasol propionate and mometasone futurate can reduce itching and the inflammation. They are very effective in short term. However, they are not being recommended for long term treatment because they may inhibit epidermal barrier repair and cause skin atrophy, which might interfering with the skin recovery.
Topical immune modulators
Immune modulators like Tacrolimus and pimecrolimus inhibit the release of inflammatory chemicals from immune cells, thus suppress the inflammation. The most valuable advantage of these compounds is their safety over long term usage, without the induction of atrophy or interference with barrier repair.
2- UV-phototherapy
Phototherapy, also called light therapy, can be prescribed to treat many forms of eczema that are resistant to topical corticosteroids. UV light suppresses overreactive skin immune cells that cause inflammation. However, long-term use of UV light can increase the risk of skin cancer.
3- Systemic therapy
Systemic treatment is mostly based on oral corticosteroids (prednisolone) and immunosuppressants (cyclosporine A, methotrexate). Alternatively, vitamin A derivative is being used for chronic hand eczema that is not responsive to topical corticosteroids.
4- Biologics (immunotherapy)
Biologics are different from the kind of drugs I discussed above. Traditional drugs are made from chemicals. Biological drugs, on the other hand, are made by a complex manufacturing process that involves living cells. The biggest advantage of biologics is that they are targeted, meaning that each one of them can inhibit a very specific protein in the immune system, and blocks the overactive inflammatory response in eczema patients (3).
As I mentioned earlier, the treatment options depend on the severity of the condition. Some people get better just by applying a good moisturizer and some need more medical intervention. But remember, hand eczema is usually a chronic disease that needs constant physician–patient communication and active patient self-management to adhere to the recommended treatment regimen.
If you need to know more about the disease and its management, please visit National Eczema Association at www.nationaleczema.org.
Stay amazing, Stay beautiful!
Dr. Zahra Motahari
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