Hand eczema is present in the palms of the hands and soles of the feet, and sometimes it is difficult or impossible to distinguish from atopic dermatitis, allergic contact dermatitis, and psoriasis, which also usually involves the hands. Even biopsy of all these conditions may not produce a definitive diagnosis, because these three conditions can show spongiosis and hardening of the skin on the hands.
Inflammation of the skin of non-infectious hands is referred to as hand eczema. Hand eczema occurs a lot and, because it is a very visible condition associated with severe itching or pain, has serious consequences for the affected person including high psychological effects. Different disease patterns can be identified according to the course of the disease, the appearance of symptoms, severity, or catalyst. Prognosis is difficult to predict for individual cases of chronic hand eczema and usually differs from patient to patient. The success of the treatment depends on determining the cause of the condition, obtaining an accurate diagnosis, sustainable hand protection procedures and early, extensive, and appropriate internal treatments.
Video Hand eczema
Signs and symptoms
Usually, skin inflammation associated with hand eczema is accompanied by the formation of blisters and pronounced itching, but dense calluses and painful tears can also occur. The quality of life of affected people is greatly reduced, especially in cases of chronic forms of disease, and the psychological impact is often very high. This impact is enhanced by the high visibility of diseases in the hand, which can cause feelings of shame and fear of being rejected.
Maps Hand eczema
Cause
There are a number of different causes of skin inflammation of the hands, interactions that are also significant: environmental factors such as excessive water; contact with allergens or irritants; and genetic disposition. A single catalyst is rarely responsible for the development of hand eczema in patients.
Differences by catalyst
Three main factors play an important role in the development of chronic hand eczema: excessive contact with water and irritation (cumulative-toxic stress), contact with allergens, and atopic diathesis, which has a genetic component. Types of individual hand eczema are identified and named according to the major catalyst involved, ie cumulative-toxic, contact-allergic, or atopic eczema. Activities that create stress or repetitive skin, excessive contact with water or substances that irritate the skin at work or at home can cause damage to the ability to protect the skin and increase the likelihood of inflammation. This also applies to the wearing of protective rubber gloves and similar prolonged materials, since sweat occurs within these gloves. Impaired skin protective barrier also facilitates penetration by allergenic substances and promotes the development of contact dermatitis. Contact allergies play a very important role in the development of hand eczema. If the hands are exposed to repeated contact with substances that lead to allergies, the skin reacts with signs of inflammation. Many people affected by eczema also experience skin inflammation in their legs. Often, allergic contact for ingredients in shoe skin care can be a catalyst. Contact allergies in certain types of work is very problematic, especially if the work involves the handling of allergens, such as masonry or hairdressing.
Persons who are allergic to Peruvian Balsam may experience eczema if they use or consume products that use them as ingredients.
Severe and chronic eczema qualifies as one of the most common occupational diseases. Therefore, the patient should be referred to a dermatological specialist job as soon as possible. Patients with a history of neurodermitis, fever, or allergic asthma often develop hand eczema. These diseases reflect the individual's particular vulnerability or genetic predisposition to overreact to various environmental influences. This is described as atopy or atopy atopy. Atopic diathesis is often accompanied by genetically conditioned problems with a protective skin shield, which causes weakening of the skin's resistance to irritating substances and humidity, as well as easier penetration by allergens, which can lead to the development of contact allergies.
Differences according to applicable signs of skin disease (morphology)
The clinical appearance of different subtypes of hand eczema is different. The term dyshidrotic eczema is used to describe formations that primarily indicate pronounced, itchy blister formations, while callus and tear formations typically show hyperkeratotic fissured hand eczema.
Difference based on severity and of course
Regardless of the cause of the triggers or signs of existing skin diseases, the selection and planning of treatment options is important, as different types of diseases also vary in severity and travel.
While mild skin eczema recovers relatively quickly after dermatological therapy and patient participation, clearer hand eczema can persist for several weeks. Severe hand eczema is characterized by consistent or recurrent skin inflammation, which greatly affects patients. Hand eczema is described as chronic if it lasts at least 3 months despite dermatological treatment, or if relapse at least twice within a 12 month period (relapse). The severe and chronic patterns of hand eczema are often resistant to treatment, making this a very stressful condition for those affected.
Diagnosis
During the diagnosis, it is important to determine the type of hand eczema and plan the appropriate special treatment. An additional diagnosis of allergies will indicate whether contact allergy or atopy diathesis is the cause of hand eczema. Discussions about the frequency of contact with water, irritants, and allergens in the personal and professional environment will also help evaluate individual pressure on the patient's skin. Hands can also show other skin diseases and potential yeast infections or psoriasis should be ruled out. Usually, incorporating a patient's personal history into the account will help provide an accurate diagnosis.
Patch test has proven useful in diagnosing hand eczema.
Treatment
Hand eczema is a complex condition, and treatment should only be performed by a dermatologist with specialized knowledge. Treatment may be very expensive. Care should follow certain basic principles, and cases of chronic and severe eczema in particular require complex care concept. In addition to skin care, hand protection, and external applications (topical) with a preparation containing effective ingredients or light therapy, an internal therapy (systemic) may be considered.
Avoid the catalyst, basic procedures, and protection of the skin
First of all, catalysts for the development of chronic hand eczema, such as irritating skin damage, excessive contact with water or proven allergen substances, should be completely eliminated and avoided. Treatment for each type of hand eczema and its severity should include refilling of natural oils and moisture contained in the skin with creams and ointments free of fragrances and preservatives; this is an important basic step. In addition, protective procedures developed especially for individual skin pressure should be applied, eg. use of cotton or hypoallergenic plastic gloves. Depending on the needs of each individual, this procedure should be continued after hand healing of the eczema, as they will also have a preventive effect.
External care
External treatments should be oriented especially according to the signs of the disease. In the case of blister formation, drying treatments such as a hand soak containing synthetic tannins or oily oily preparations may inhibit itching. If callus development shows tear formation present, the focus should be on softening the skin with preparations containing urea or salicylic acid. To reduce inflammation, creams and ointments containing cortisone are often very effective. However, severe and chronic cases rarely respond adequately and require long-term care that may increase the risk of adverse events. In individual cases, and especially in cases of atopic eczema, dermatologists may prefer to use a cortisone-free cream or ointment-free ointment, which includes what is called a "calcineurin inhibitor" of tacrolimus or pimecrolimus.
Phototherapy
Phototherapy can be effective in the treatment of chronic hand eczema. However, not all dermatologists or dermatologists offer this form of therapy, and this involves long-term care for patients. A period of four to six weeks should involve 3-4 radiation sessions. The most common form of light therapy is PUVA therapy. It first treats the hands with creams containing ingredients that cause the skin to become light-sensitive, the hands then irradiated with UV-A (UV-A) rays. After two days of treatment, a one-day break must occur. Due to possible risks such as premature skin aging or chronic minor damage caused to the skin, phototherapy can not be considered for the long term.
Systemic care
In addition to skin care, skin protection, and external treatments, severe cases of chronic and chronic hand eczema often require systemic treatment. Various preparations are available for this. For acute and severe episodes that indicate blister formation, internal cortisone preparation, sometimes in combination with certain antibiotics, may be helpful in the short term. The active agent of ciclosporin, approved for the treatment of severe neurodermitis, may also be used for severe atopic hand eczema. Other substances that suppress the immune system also show effectiveness in some cases. However, these substances are not approved for hand eczema.
In recent years internal medicine has been approved for the first time for the treatment of chronic hand eczema. It involves a derivative of vitamin A, called alitretinoin, which is also naturally present in the human body. Alitretinoin can be used to treat all forms of severe chronic hand eczema that have not reacted to external cortisone preparations. The effectiveness of this form of treatment has been extensively tested in clinical course and proven before it is approved. The trial results showed that two-thirds of patients did not experience recurrence 6 months after treatment application, and treatment was effective if the eczema hand re-occur. The duration of treatment of alitretinoin is 3 to 6 months. During treatment and one month before starting and one month after completion, women of childbearing age should use contraception as well as tests for pregnancy every month since, like all vitamin A derivatives, the substance involved is teratogenic. Side effects mainly include temporary headaches during the early days of treatment, as well as the possibility of increasing the value of fat and blood cholesterol. Regular lab tests of blood values ​​are recommended for this monitoring.
Epidemiology
Hand eczema is a common condition: the study data show a prevalence of one year to 10% in the general population. It is estimated that only 50-70% of affected people consult a physician. Severe, chronic and recurrent eczema frequency is estimated at 5-7%. Approximately 2-4% of hand eczema patients also report that external (topical) therapy is insufficient.
Several factors affect long-term prognosis, including progression before the 20th anniversary, the severity of early manifestations, and eczema during childhood. Women, especially those under the age of 30, are more often affected than men.
References
Source of the article : Wikipedia
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