What should I do if I have eczema on my hands?

Eczema is a common skin inflammation that can develop on any part of the body. Hand eczema is mainly related to long-term contact with chemicals. For example, construction workers who often come into contact with cement, barbers who use hair dye and shampoo, or fishery workers, medical staff, and cleaners are all more likely to develop hand eczema. Some patients may also suffer from atopic dermatitis or psychological factors.

Hand eczema refers to eczema limited to the hands and is more common clinically. The cause of the disease is relatively complex. External factors are often related to occupational contact. According to the location and characteristics of the injury, there is a tendency for moist changes, symmetry and subjective itching during the course of the disease, and the diagnosis can usually be made.

Clinical manifestations of hand eczema

1. Keratotic eczema

It is common in men, with thickened keratinized patches on the palms or fingers. They are dry, have clear borders, and are inflammatory. They are more severe in winter and less severe in summer. They are often aggravated by excessive washing, soap, or detergents.

2. Dyshidrotic eczema

Deep blisters appear on the palms, fingers or sides, with itching and then scaling, sometimes in a collar-like shape. Inflammation is usually not obvious, but erosion and exudation may occur. Pustules may appear when infected. Some may present as dry scaly lesions with cracks but no blisters.

3. Discoid eczema

It is more common on the back of the hand, presenting as a few small coin-shaped scaly or erythematous exudative lesions, which tend to become moist. It is symmetrical and causes itching.

diagnosis

Treatment of hand eczema

1. General treatment

The cause should be found and removed, and washing with water or contact with various detergents should be avoided as much as possible. If the itching is obvious, antihistamines can be taken orally; those with excessive keratinization can take retinoic acid (retinoate capsules) or acitretin (etretinate) orally, but attention should be paid to side effects. For stubborn cases, you can take tripterygium wilfordii glycosides, cyclosporine, etc. orally. Topical medications can be used for symptomatic treatment of eczema.

There are many types of medicines that can be used for hand eczema, and they should be used under the guidance of a doctor. Before changing to a new medication, be sure to remove the previous medication. When changing medication, it is best to apply it to a small area of ​​eczema first, observe the effect, and decide whether to use it. Avoid aggravating the condition due to improper use of medications.

2. Cold and wet compress

(1) Commonly used wet compresses are 1:10,000 potassium permanganate solution (be careful to make sure the potassium permanganate is completely dissolved; undissolved potassium permanganate will burn the skin). Even if the wound surface is clean, it can also have a bactericidal, astringent and oxidative effect.

(2) Use 4 to 6 layers of gauze, making sure it does not drip water. Apply the wet gauze to the wound surface. The time and frequency of replacement should be determined based on the amount of exudate from the eczema. When the exudate absorbed by the gauze reaches half saturation, replace the gauze. When there is a lot of exudate, the dressing should be changed more frequently during wet compresses to avoid leaving the dressing soaked with exudate on the wound for a long time, which will irritate the surrounding normal skin and cause the wound to expand.

(3) For large-area eczema, proper attention should be paid to the nature, concentration and size of the compress area of ​​the drug.

(4) If the redness and swelling of the wound gradually subside, the exudate decreases, and the wound is dry, stop applying wet compresses and use paste instead.

(5) Please note when applying cold wet compress: the wet compress area should not exceed 1/3 of the total body area to avoid dehydration due to excessive evaporation from the body surface. The liquid for wet compress should not be too cold, otherwise it will easily cause compensatory vasodilation and cause a cold. When the room temperature is low, the medicine should be heated before applying it. If there is an infection, the gauze should be washed and disinfected (can be boiled) before use. The wet compress solution should be freshly prepared to prevent the effect from being affected by the deterioration of the solution.

3. Use of drugs containing corticosteroids

(1) Topical application of drugs containing corticosteroids for eczema is definitely effective and can be used for mild or small-scale eczema. For large-scale eczema or recurrent eczema, frequent, large-scale or long-term use of drugs containing corticosteroids can cause systemic and local skin side effects.

(2) The most prominent local skin side effects of corticosteroid-containing drugs are drug-dependent dermatitis and rebound dermatitis. Drug-dependent dermatitis refers to the inability to stop taking corticosteroids for eczema. Rebound dermatitis refers to the fact that after the application of topical corticosteroids, the symptoms of eczema can improve rapidly, but once the drug is stopped, redness, tenderness, itching, cracks, desquamation and even pustules may occur at the medication site (especially the face) within one or two days, and the eczema will become more severe. When the hormone is reapplied, the condition will improve or disappear quickly; if the drug is stopped again, rebound dermatitis will recur and be more severe than before. Therefore, try to avoid using large doses of topical corticosteroids for a long time or in a short period of time.