Hand Rash

Dyshidrotic eczema is the medical term for rashes on the hands and feet. This is most often a skin sensitivity condition related to irritation. The textbook definition of dyshidrotic eczema refers to an abnormality of the sweat glands, however, this is not accurate as the exact cause is unclear.

The rash many times appears as dry scaling areas or bubbles in the skin. The palms of the hands are more frequently involved than the soles of the feet. Individuals between the ages of 20 and 40 are most commonly affected. This rash is rare before puberty and among the elderly.

The condition is exacerbated by multiple factors including environmental conditions, illness and internal stress. It is more common in high-stressed "uptight" individuals. It is also common in individuals that wash their hands frequently or handle paper products, solvents, harsh soaps or detergents. As for the feet, the eruption is aggravated by pressure, friction, sweating and tight footwear.

Recommendations

Each person must first identify factors that may irritate the skin. If exposed to harsh soaps, detergents, or solvents, direct contact with these substances should be avoided. Hand washing should be done only when necessary. A water-free cleansing soap will decrease skin irritation and moisturize the skin.

Conservative measures addressing washing and lubrication should be attempted prior to any anti-inflammatory treatment. Anti-inflammatory treatments may be necessary if the rash is resistant. Traditional cortisone creams and lotions for inflammation are safe when used correctly. When used incorrectly, cortisone may cause thinning of the skin. In higher strengths, it may be internally absorbed causing adverse side effects. Topical anti-inflammatory creams, lotions or sprays are very effective for controlling itching and skin inflammation. Both steroid and non-steroid medications should be used twice daily followed by a thick moisturizer. The moisturizer "seals" the medication on the skin and provides a protective coating over the hands and feet.

For those who must wash their hands frequently or expose themselves to irritating substances, use of a silicone foam protective barrier is very effective in controlling skin irritation.

As for the feet, avoid restrictive footwear and wear shoes that "breathe." To minimize the problem of sweating, there are socks available in sporting good stores that provide a "wick-like" action to help keep the feet dry.

Remember, this rash is a skin sensitivity condition that may recur without apparent cause or warning.

Tips on Care

• Keep in mind, this is a skin condition of irritation that can be due to internal and external factors. Frequent irritation, over-washing or use of harsh soaps and cleaning chemicals are common causes. Stress may also be a triggering factor.
• This is a chronic problem that can be controlled but not cured.
• Moisturizers and topical anti-inflammatories are the treatments of choice. Application is necessary at least two times daily.
• Heavy cream moisturizers, not lotions, should be applied over the anti-inflammatories. These creams may also be applied liberally throughout the day.
• Minimize water contact. If you must wash your hands, use a soap substitute that does not require water.
• Cotton gloves will help protect the hands and aid the absorption of topical medications. They are generally available at hardware or drugstores. If rubber gloves are used, cotton gloves should be worn as liners to prevent irritation.
• Deep cracks and fissures may be sealed with flexible collodion or super glue applied directly to the skin.
• Do not pick the scales or cracks in the skin. Open and cracked skin is vulnerable to infection. Be sure to protect your hands with frequent moisturizing.
• Hand and foot eczema may flare with irritation, stress, changes in weather, or for no identifiable reason.

If conservative measures are not effective, consider other possibilities such as contact sensitivity, infection or possibly psoriasis. Consult your dermatologist for more extensive evaluation and treatment.