Causes of Hand Dermatitis

There is usually no one clear-cut cause. Many conditions can present with hand dermatitis. Often several conditions can co-exist.

Irritant contact dermatitis (80%)

  • Repeat water exposure is probably the most important irritant.
  • Frequent or prolonged exposure repetitive insults water, soaps, detergents, cleansers, solvents, degreasers, lubricants, oils, coolants, unidentified, food products, fiberglass dust, metals, plastics, resins, and mechanical trauma inhibiting repair of the epidermal barrier
  • A brief exposure to strong irritant such as battery acid is also a caus.

Signs and symptoms include:

Usually symmetrical and affects dorsal fingertips and webspaces.

  • Dry, chapped skin. With repeat exposures, areas of itchy, red, scaly, swollen skin
  • Skin may burn or sting with contact to everyday items.
  • If exposure to irritants persists, skin can crack, scale, and become very dry.
  • Blisters are very uncommon and open areas may develop later forming crusts and scales

Allergic contact dermatitis (20%)

  • Common allergens include nickel, Balsam of Peru (added to fragrances, foods, skin care products), fragrance, and preservatives.
  • Occupational allergens may include topical antibacterials, metallic salts (eg, chromate, nickel), organic dyes, plants, plastic resins, and rubber additives, and others.
  • Usually develops a few hours after allergen touches the skin

Signs and symptoms include:

  • In acute phase-usually vesicles or small blisters with itchy, swollen, red skin.
  • In later phases skin can become dry with crusts, scales, and fissures
  • Overtime if exposure to allergen persists skin can darken and become thick and leathery.
  • Distribution commonly dorsal hands, particularly fingers.

Atopic dermatitis

Adults with atopic dermatitis usually have involvement of the hands and or eyelids

Signs and symptoms include:

Intense itchiness; acute skin lesions are erythematous papules with excoriations, vesicles, and serous exudates. Chronic phase characterized by thickened skin, accentuated skin markings (lichenification), and fibrotic papules.

Hyperkeratotic

Characterized by hyperkeratosis. In contrast to other types of vesicular palmoplantar eczema, vesicles do not dominate clinical picture. May resemble psoriasis. More common in middle age to elderly men.


Vesicular palmoplantar dermatitis is a term sometimes used to encompass the following 4 types of hand dermatitis.

Pompholyx

  • Most acute acute onset of symmetric vesicular palmoplantar dermatitis.- may resemble tapioca pudding. Tends to reur
  • Most common in adolescents and young adults.

Signs and symptoms include:

Often a burning or itching sensation precedes the development of blisters, vesicles last 1-2 weeks, desquamate, and resolve without rupture.

Dyshidrotic dermatitis

Dyshidrotic dermatitis or chronic vesiculobullous dermatitis: A type of dermatitis characterized by small vesicles on lateral aspects of fingers, palms, and soles. May cause fissures ad hyperkeratosis. No relationship to sweating.

Autosensitization or 'ID reaction'

Generally a sudden onset of itchy blisters appearing on lateral aspects of fingers and palms. Secondary to inflammatory fungal infection of the feet

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