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hand dermatitis

Etiology: - atopic dermatitis - contact dermatitis a) irritation - frequent or prolonged wet work (contact with water) - excessive hand washing b) allergic - dyshydrotic eczema - psoriasis - Tinea mannum (dermatophyte) infections - wet work, chemical exposures & friction may worsen hand dermatitis regardless of the cause Clinical manifestations: 1) allergic contact dermatitis a) generally involve, dorsal hands, finger web spaces, skin on the volar wrists, especially when the palms are spared b) erythema, edema, vesiculopapular dermatitis c) pruritus, very itchy d) delayed onset - initial episode may occur several weeks after exposure - recurrences develop 1-2 days after exposure e) may improve during vacation f) chronic exposure results in chronic eczema 2) atopic dermatitis - scaling, erythema, lichenification, hyperkeratosis 3) irritant dermatitis a) skin is red, dry, & hyperkeratotic with fissures b) burning pain is more common than itching c) rapid onset after exposure 4) dyshidrotic eczema a) involves palms & sides of fingers b) recurrent episodes of tense, fluid-filled vesicles c) pruritus, very itchy 5) psoriasis a) well demarcated plaques on palms, often with discrete 2-3 mm pustules, scaling & erythema b) instep of plantar surface of feet often affected c) nail dystrophy may be associated 6) Tinea mannum a) generally involves only 1 hand & 2 feet b) dry scaling, angular patches or diffuse erythema c) may involve nails d) diagnosis unlikely if feet not involved Special laboratory: - skin biopsy may be non-specific - patch testing may be useful - KOH prep of skin scrapings when suspecting fungi, yeast or scabies Differential diagnosis: - scabies Management: - avoidance of allergens & irritants - regular use of emollients - white petrolatum high-value care recommendation [1] - topical glucocorticoids, medium to high potency - referral for treatment with immunosuppressive agents for refractory hand dermatitis a) methotrexate b) mycophenolate c) azathioprine d) others

General

dermatitis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018
  2. Ibler KS et al Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. BMJ 2012;345:e7822 PMID: 23236031 http://www.bmj.com/content/345/bmj.e7822?etoc=
  3. Bikowski JB. Hand eczema: diagnosis and management. Cutis. 2008 Oct;82(4 Suppl):9-15. PMID: 19202671
  4. Thyssen JP, Johansen JD, Linneberg A, Menne T. The epidemiology of hand eczema in the general population-- prevalence and main findings. Contact Dermatitis. 2010 Feb;62(2):75-87 PMID: 20136890
  5. Perry AD, Trafeli JP. Hand dermatitis: review of etiology, diagnosis, and treatment. J Am Board Fam Med. 2009 May-Jun;22(3):325-30. Review. PMID: 19429739 Free Article
  6. Chan CX, Zug KA. Diagnosis and management of dermatitis, including atopic, contact, and hand eczemas. Med Clin North Am. 2021;105:611-26. PMID: 34059241