Protecting Your Hands From Hand Dermatitis This Winter Season
Your hands look awful
Your hands look awful. They feel terrible. They itch. They sting. Sometimes they hurt, or bleed and the itching is driving you nuts. Painful cracks can develop on your fingertips or the tops of your hands. To ease the pain and itch you might have tried hydrocortisone, five types of skin moisturizers, and changing soaps, all to no avail. What is going on, you wonder. You are asking yourself, "Do I have an infection. Can anyone else catch this from me? Is there something I'm doing wrong? Did I pick something up at work? By visiting your dermatologist in Bridgeton, St. Louis, MO you can find relief for your painful, itchy hands.
Understanding Dermatitis
The most frequent type of hand dermatitis we see in our office is Contact Dermatitis, which is usually Irritant Dermatitis. However, one must keep in mind, especially when the response to treatment is disappointing, that an Allergic Contact Dermatitis can also be involved. A typical appearance for a contact dermatitis is what looks like dryness, chapping and redness on the top of the hands and between the fingers, since the skin there is much thinner than it is on the palms.
Another tip-off is involvement next to and under the rings, such as the wedding rings a person wears all the time. This is because soap residues, which are irritants, get caught under the rings and are not rinsed off all the way. Not only does the skin under the rings remain moist, but also it has soap or detergent residues trapped under the rings with the moisture-a set-up for skin inflammation.
Irritant dermatitis tends to be worse in the cooler months because the wind and dryer air diminish the skin's natural protective oil barrier function, leading to invisible cracks in the skin, which enable minor irritants to have a greater irritant effect than they would with a more intact protective oil barrier on the skin. The most common example of a substance I see in practice that contributes to irritant hand dermatitis is liquid soap. Frequently it poses no problems during the summer months, but once the cooler, windy and dry weather starts, the tops of the hands get dry, and the tops of the knuckles get sore and cracked. As things progress, even the palms and tips of the fingers start to be affected with redness, hardening of the fingertip skin and fissures.
Who Suffers from Hand Dermatitis?
Maceration (the medical term for the prune-like changes of the skin from prolonged water immersion) and defatting by frequent hand washing can be seen in many professions including housewives, food handlers, physicians, dentists, nurses and bartenders who wash their hands multiple times daily. Jobs that involve exposure to various chemicals such as acids, alkalis, and solvents can provoke irritant contact hand dermatitis, as can jobs which expose the skin to friction, cold or dry air.
Diagnosis and Treatment
It is not uncommon for an irritant contact dermatitis and an allergic contact dermatitis to be indistinguishable based on physical examination alone. If protective and therapeutic measures for the hand dermatitis fail to bring about resolution or improvement, Patch Testing may be recommended.
Other diagnostic considerations if hand dermatitis is failing to respond as expected to therapy are possible. Sometimes there are secondary bacterial infections (Staph aureus, for example) of the fissures or tinea (a superficial fungal infection, usually involving just one hand) and other less common but some potentially serious disorders may be other possible reasons.
Treatment always involves adopting a new hand care regimen for protecting your hands. Start with always wearing protective cotton-lined vinyl or latex (if you're not latex allergic) gloves when you do any work involving chemicals (bleaches, ammonia, household cleaners, dishwashing soap, etc.). Make sure to cuff the wrists, as well, so that when you bend your elbows the soapy water doesn't run up your arms and then back down into the gloves. If that happens, the gloves will only serve to hold the potentially offending agents against the skin for a longer period of time and make things worse! If the wrists are cuffed, the liquid pools in the cuffs when your elbows are bent, then back down the outside of the gloves when you straighten your arms out again.
Protect Your Hands
Stop using the liquid soap to wash your hands-completely. A mild bar soap is better, or if its an emergency, you can carry a small bottle of alcohol based hand disinfectant with you, which is about 70% alcohol. Make sure when you wash your hands to completely wash any soap residue out from under your rings and to get the area completely dry. Application of a moisturizer after washing is a good idea, but your doctor may want you to apply a prescription topical steroid cream or ointment.
If you can't avoid direct contact with some irritants at work, your doctor may recommend a barrier cream or film for your hands. Bedtime is the perfect opportunity to restore the hands' natural protective oil layer by applying a heavy, often even greasy feeling moisturizer. It can go right over any medicated cream or ointment being used and it will help the medication penetrate into the skin.
If your hands aren't improving, even after medication and pampering, Allergic Contact Hand Dermatitis may be considered as a possible diagnosis. Sometimes the cause is easily determined. At other times, Patch Testing is recommended. These are allergy tests performed in dermatologists' and allergists' offices to determine what substances are causing your skin rashes. Your dermatologist can then use that information to counsel you on what substances you need to avoid, what products contain those substances, and alternative products you may use.
So, what all this means is simple-if your hands are really giving you trouble, even if they've been that way for a long, long time, don't be discouraged. There's a good chance a dermatologist can help you and your hands look and feel better.
by: Gen Wright
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