Diagnosis of Hand Dermatitis

Without proper diagnosis and treatment, hand dermatitis can persist and become chronic. It can often become disabling because it affects one's ability to perform at work and home. Additionally, hand dermatitis may interfere with sleep, cause emotional discomfort, and negatively affect interpersonal interactions.
Some studies suggest that early diagnosis may be important in preventing chronicity.

Approach

A thorough history and physical examination is essential in helping to deduce the possible cause(s) of hand dermatitis. Is the patient atopic. Especially important is an occupational and social history. It is often challenging to distinguish irritant contact from allergic contact dermatitis.

The important aspects of the history and physical exam include:

Dermatitis specific history

  • Patient's description of dermatitis and symptoms
  • temporal associations (waxings/wanings)
  • relationship of dermatitis to work, effect of vacations and travel
  • Change in pattern or behavior of dermatitis
  • Previous and current therapies by physician and patient
  • Dermatitis at sites other than hands
  • Chemicals, detergents, medicaments, lubricants, cleansers, frictional contacts, and type of gloves encountered at work, home, or in hobbies
  • Frequency of hand washing, type of soap and lotions
  • Personal care products including nail polish

Occupational history

  • Does patient think present dermatitis linked to occupation?
  • job title, job description, regular and occasional chemical exposures and sources
  • employer, location of employment, time at current job, previous occupations
  • Description of work when rash began
  • Other workers affected?

Specific occupation exposures

  • Construction worker-sensitized to chromium from cement exposure
  • Hair dresser-allergic to paraphenylenediamine (dyes), cocamidopropyl betaine (surfactant-detergent), or glycerol monothioglycolate (permanent wave and straightening solutions)

Social-Hobbies and household activities, sports, exposure to animals

Patch Testing

Patch testing should be considered for all with chronic dermatitis. The gold standard method for diagnosis of allergic contact dermatitis is patch testing which is an office procedure. The allergens are applied to the back.

The following should be tested:

  • Patients with chronic hand dermatitis
  • Dermatitis becomes intractable
  • Dermatitis responds to treatment but flares immediately on cessation of topical or systemic corticosteroids

Other Investigations

Other investigations may be needed to determine the cause of hand dermatitis:

  • A skin scraping for KOH, or culture to rule out fungal infection
  • A biopsy is occasionally helpful
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