Hand Dermatitis: A Review of Clinical Features, Diagnosis, and Management

Deborah A. Kedrowski, RN; Erin M. Warshaw, MD, MS

Disclosures

Dermatology Nursing. 2008;20(1):17-25. 

In This Article

Hyperkeratotic Hand Dermatitis

Epidemiology, clinical presentation. Hyperkeratotic hand dermatitis is more common in men and mainly occurs between the ages of 40 to 60 years old (MennE9, 2000; Warshaw et al., 2003). The skin does not usually blister but may be dry and scaly with hyperkeratotic plaques (see Figure 8). Cracking and fissuring may be uncomfortable and painful (MennE9, 2000) and may last for years (see Figure 9). Etiologic factors include atopy, contact allergy, irritation, and friction. Patch test results are usually negative but are used to exclude underlying contact allergies. The cause of hyperkeratotic dermatitis is unknown. A history of manual labor is a suggested etiology in some patients. Most patients with hyperkeratotic dermatitis tend to have a stable chronic clinical course. The eruption is characterized by dry, thick, hyperkeratotic plaques involving the palmar and/or plantar surfaces (Warshaw et al., 2003). Pruritus is usually noted (Wilkinson, 2000), and when present, deep fissuring may lead to pain (MennE9, 2000; Warshaw et al., 2003).

Figure 8.

Hyperkeratotic hand dermatitis with plaques

Figure 9.

Hyperkeratotic hand dermatitis with cracking and fissuring

Differential diagnosis. Skin lesions classified as hyperkeratotic dermatitis of the palms are a localized inflammatory reaction and have no tendency to generalization. Derma to mycosis, ACD, ICD, and scabies need to be excluded (MennE9, 2000).

Treatment/management. Due to a marked propensity for relapse, exacerbations, chronicity, and inconsistent response to therapy, finding an effective treatment regimen often poses a major challenge (Wilkinson, 2000). Avoiding irritants and hydration/barrier creams are usually the first line of treatment, and patients should be encouraged to use a heavy, petrolatum-based ointment (MennE9, 2000). Ointments occlude and hydrate the skin and are generally better suited for the treatment of hand eczema than creams (Warshaw et al., 2003). Although it may be impractical to use ointments during the workday, they can be used at night. Application under occlusion with cotton gloves overnight may be effective. Treatment with crude coal tar or coal tar in petrolatum is helpful in some cases. Treatment periods for 6 to 8 weeks should be expected (MennE9, 2000). Oral and topical PUVA treatment is a possible treatment modality (MennE9, 2000; Warshaw et al., 2003). Relapses are to be expected even after complete remissions have been induced. For some patients, long-term treatment with topical or oral retinoids is successful (MennE9, 2000).

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