Hand and Foot eczema
Form of eczema characterized by highly irritable, scaly, fissured, hyperkeratotic
patches on the palms and/ or soles. The aetiology is unknown. This disorder
takes a chronic course and may be extremely refractory to treatment.
Definition and Epidemiology
The term 'hand eczema' implies an inflammation of the skin (dermatitis)
that is confined to the hands. Hand eczema is considered a 'common condition',
with a point prevalence of 1 - 5% among adults in the general population,
and a one-year prevalence of up to 10%, depending whether the disease
definition includes more pronounced or mild cases (Agrup 1969; Bryld 2000;
Meding 1987). The prevalence may be increasing in some countries (Meding
1987). Recently, a decreased prevalence has been observed, and attributed
to decreased occupational exposure to irritants (Meding 2002). It is twice
as common in women as in men, with the highest prevalence in young women
(Meding 1987; Yngveson 2000). Reasons for this sex difference are unknown,
although greater exposure of women to wet work is probably contributory.
Predisposing and external factors both play a part in hand eczema. Being
atopic (having a tendency to develop asthma, hay fever or eczema) is the
major predisposing factor responsible for hand eczema; one-third to half
the patients with hand eczema can be considered atopics (Coenraads 1998;
Meding 1990; Svensson 1988). The commonest external cause is contact irritants,
or mild-toxic agents. Water is an example of a contact irritant. A distinction
is made between irritant contact dermatitis and allergic contact dermatitis
(which is caused by skin contact with allergens). Allergic contact dermatitis
is less common than irritant contact dermatitis, and only occurs in persons
who have developed a specific contact allergy to a specific substance
such as rubber. Ingested allergens (e.g. nickel) may also provoke hand
eczema (Menné 1994).
There are also several types of hand eczema where the cause is unknown.
These forms of hand eczema may be referred to as: pompholyx, dishydrotic
eczema or dishydrosis, nummular eczema, tylotic eczema and hyperkeratotic
eczema. In many patients with chronic hand eczema a combination of the
above mentioned factors seems to play a role. Hand eczema may be accompanied
by similar skin changes on the feet. The relevance of psychosomatic factors
remains speculative (Menné 2000).
Itch is common among patients with hand eczema. Itch itself can result
in sleep loss to patients and to members of their family. A vicious cycle
of symptoms and skin damage can develop, the so-called itch/scratch/itch
In addition to itch, the social stigmata associated with a visible skin
disease can be a great burden. The hands are important organs of communication
and expression. Therefore any impairment in function and form may result
in major psychosocial problems, e.g. anxiety, low self-esteem and social
Painful cracks and blisters, besides their effect on daily life outside
work, can prevent manual work leading to significant disability and huge
economic loss to both individuals and society (Mathias 1985). Hand eczema
accounts for an estimated 90% of occupational skin disease (Halkier-Sørensen
'96). High prevalence has been documented in specific occupational groups,
such as nurses, hairdressers and bakers (Smit 1993; Tacke 1995). These
estimates exclude people affected through housework and many other occupational
groups not included in routine surveillance systems.
Theoretically, identifying and eliminating an allergic contact factor
(e.g. rubber allergy) could cure the eczema. In clinical practice, such
cases are rare. This has led to many diverse therapies being used to control
the disease such as:
1. skin protection measures, including gloves
2. topical treatments (bland emollients, corticosteroid creams/ointments,
coal tar and derivatives, irradiation with UV-light or X-rays)
3. systemic treatments (oral corticosteroids, other immunosuppressants
such as cyclosporin).
Previous studies have suggested that hand eczema tends to run a long lasting
and chronic relapsing course (Hogan 1990).
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