Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Hand eczemared, itchy and flaking hands
Hand eczema is an inflammation of the skin on the hands with itch, redness, flaking and sometimes blisters or cracks. It is not caused by bacteria or fungi and is not contagious. In most forms several factors act at once, both from the outside and from within.
What is hand eczema?
Eczema is the collective name for skin problems with itch, redness, small bumps, blisters, flaking and sometimes weeping. It is an inflammatory reaction of the skin, not caused by bacteria or fungi, and therefore not contagious. Some forms are hard to treat and last a long time. In most forms of hand eczema several factors play a role, both external and internal.
How does hand eczema develop?
There are four main forms, each with its own cause.
Irritant contact eczema develops from irritation of the skin with regular or prolonged contact with irritating substances: frequent contact with water (especially in wet occupations such as housework, hairdressing, care, cleaning, catering, bakery and retail), soap and cleaning agents, juices from vegetables, fruit, meat and fish, organic solvents, dry or extreme air, and mechanical factors such as friction.
Allergic contact eczema develops from contact with substances a person is allergic to, such as chromate in cement, epoxy resin in glue, substances in cut flowers, hair dye, rubber, nickel, fragrances or preservatives.
Constitutional (atopic) hand eczema is linked to an inborn tendency towards eczema; people who had atopic eczema as a child more easily develop hand eczema later in life.
Protein-related contact eczema is rare and causes a quick itch reaction after contact with proteins, for example in latex, potato skin or flour.
Is hand eczema contagious?
No. Hand eczema is an inflammatory reaction of the skin and is not caused by bacteria or fungi. It cannot be passed on.
What are the symptoms?
Hand eczema can be acute or chronic. Acute eczema causes redness, swelling, bumps, blisters and sometimes weeping; the blisters dry into flakes and crusts and the skin peels. In chronic eczema the redness is usually less intense, flaking is prominent and the skin is often thickened with coarser skin lines. Painful cracks can form in the stiff or dry skin. Because hand eczema itches, there are often signs of rubbing and scratching: small wounds, crusts and thickening. Different features can occur alongside and after one another.
How is the diagnosis made?
The dermatologist usually recognises hand eczema from its appearance. You will be asked in detail about skin-stressing factors in work, household and hobbies, and whether eczema runs in the family. For chronic hand eczema lasting more than three months that does not respond well to treatment, a patch test is advised to detect a contact allergy. The test substances are taped to the back and assessed after 48 and 72 hours. If a work-related allergy is suspected, referral to a centre for occupational dermatology may follow.
What is the treatment?
Local therapy: topical corticosteroids are the first choice, with potent (class 3) and very potent (class 4) preparations preferred. They are combined with a neutral greasy ointment or cream, not applied at the same time. Only when corticosteroids cannot be used is tacrolimus ointment 0.1% an alternative. For thickened (hyperkeratotic) hand eczema, salicylic acid can be added.
Phototherapy (PUVA, UVA-1 or UVB) is often only temporarily effective; symptoms often return after stopping.
Systemic therapy: alitretinoin is the only registered medicine for chronic hand eczema. For severe hand eczema that does not respond enough after six weeks of topical corticosteroids, treatment starts with alitretinoin 30 mg, with review after twelve weeks and possible extension to 24 weeks. For blistering (vesicular) hand eczema, ciclosporin can be considered. Other tablets such as methotrexate, azathioprine or acitretin come into play when these therapies do not work well enough. For very severe or stubborn hand eczema a short course of prednisone can help, but long-term use is discouraged. Alongside treatment, a neutral cream or ointment is always prescribed to keep the skin supple.
Non-medicinal: avoid contact as much as possible with irritating substances and with substances you are allergic to, at home and at work. When contact with water is unavoidable, vinyl gloves with a cotton lining help; for chemicals, nitrile gloves are preferred. Improvement at weekends or on holiday points to a work-related cause.
What can you do yourself?
Treat the skin gently. Wash sparingly with skin-friendly soap without abrasives, rinse well and pat dry. Limit how often you wash your hands and use a neutral moisturising cream or ointment at least twice a day, preferably after every wash. Keep nails short, preferably do not wear rings, and protect the hands against cold, dry and windy weather.
What is the outlook?
Hand eczema has a reputation for being stubborn and long-lasting. If you consistently avoid contact with irritants, excessive hand washing and any allergens, the eczema often decreases sharply or disappears. The chance of it returning always remains.
Frequently asked questions about hand eczema
Is hand eczema contagious?
No. Hand eczema is an inflammatory reaction of the skin and is not caused by bacteria or fungi. It cannot be passed on.
Is my work causing it?
Often yes. Wet occupations and contact with irritants are a major cause. Improvement at weekends or on holiday points to a work-related cause.
What helps against the cracks and dryness?
Regular use of a neutral greasy cream or ointment, especially after every wash, and avoiding irritants. For inflammation the doctor often prescribes a corticosteroid.
Should I wear gloves?
For contact with water, vinyl gloves with a cotton lining help; for chemicals, nitrile gloves. In rare cases a glove itself can cause an allergy.
Will hand eczema ever go away?
It can decrease sharply or disappear if the triggers are consistently avoided, but the tendency to return remains.