Hand dermatitis

What should I do about my red, chapped, cracked hands?  This is a common question from patients and friends this time of year.  It seems to be a problem for many people at age 8 to 80.  Here is a quick review of common causes and a few tips to revitalize your hands.

The medical term for this condition is hand dermatitis (rash on the hands).  There are a few common causes of hand dermatitis.

1. Irritant dermatitis – Likely the most common cause especially in the winter.  Rash comes from dry air, cold temperatures and hand sanitizers at this time of year.  Most hand dermatitis has at least some element of irritant dermatitis.  To help with irritant dermatitis, wear warm gloves as much as possible in the harsh cold temperatures, avoid friction and hand sanitizers, and choose a moisturizer with a skin barrier protectant called dimethicone.  Examples of commonly available hand creams with a significant amount of dimethicone are Gloves in a Bottle and Cetaphil Cracked Skin Repair Balm and Cerave Therapeutic Hand Cream.  
2. Allergic dermatitis – Rash can be exacerbated by an allergic reaction most often to fragrance and preservatives in hand creams and the ever present “cure all”, Neosporin.  When hands are at their worst, use plain Vaseline to avoid most of the common allergens that may exacerbate a rash.  I often recommend Vaseline at night along with prescription strength topical steroid in the early days of treatment of the most severe cases.
3. Psoriasis and eczema – These two common skin conditions often affect the hands.  These conditions are more likely to also have pustules and blisters that come in crops.  In addition to following the tips above, we sometimes treat psoriasis on the hands with prescription topicals and Excimer laser treatments.  
4. Fungus – This is the wild card.  It is the equivalent of having athletes foot on the hands. The medical term is tinea manuum.  For all of the conditions above, we use a topical steroid to improve the rash.  However, topical steroids make fungus grow.  To complicate matters, once fungus has been treated with topical steroid, usually a topical antifungal won’t work.  In this case, we have to back track and treat with oral antifungals for a few weeks to kill the fungus first.  Fungus is often a secondary problem, where a patient has one of the problems above and has fungus too.   Avoid using topical steroids until you see a dermatologist and rule out fungal infection.  

Other than the tips above, I have one last crazy tip… Crazy Glue.  Yes, that clear glue that comes in the little tubes.  The one that says right on the tube “DO NOT USE ON SKIN”.  For hands with cracks, it helps to glue the cracks closed.  This helps the cracks heal faster and keeps infection from invading the cracks by sealing them off.  After a shower or bath when the hands are VERY CLEAN and soft, gently push the cracks together and glue them closed.  Leave the glue on until it peels off.  Most of the time the glue will stay on for 3-7 days, in which time the cracks are healed.   Just make sure the cracks are clean and free of debris before you apply the glue.  

Hopefully these tips will help in this winter!  How about you?  Any favorite hand creams that you love when your hands are at their worst?

any of these skin care products and more in our Spring Boutique.  Our staff and Dr Rosenberger can help you find the optimal products for your skin health and beauty.

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