How Much Do You Know About Hand Eczema?

Hand eczema (HE) is a common inflammatory skin disease that occurs on the hands. It is characterized by heterogeneity, recurrence, and a long course of disease. The lifetime prevalence rate is 15% to 31%, which will have a great impact on the patient's physical and mental health and quality of life. Affected by occupational factors, more and more people have been troubled by hand eczema in recent years, especially workshop workers who have long-term contact with mechanical lubricants and organic reagents in the working environment; especially since the COVID-19 pandemic, the prevalence of hand eczema among medical staff who frequently wash their hands and overuse disinfectants has increased significantly. On the other hand, since women are the main force in domestic labor, they need to wash their hands frequently and come into contact with various detergents, and estrogen is closely related to autoimmune regulation, making women more sensitive to chemicals than men, so the incidence rate in women is higher than that in men.

1. Classification of hand eczema

1. Classification by cause

2. Classification based on disease course

2. Prevention and treatment of hand eczema

1. Preventive measures for hand eczema

Because hand eczema often recurs and is difficult to cure, it is particularly important to take correct and effective preventive measures. The key to prevention is to protect the skin of the hands, avoid contact with irritants or allergens, and strengthen moisturizing work.

Proper use of gloves can effectively help people who frequently come into contact with irritants or allergens at work or in life, and who have wet hands for a long time. It should be noted that the material and use of gloves are also very important. Wearing airtight rubber gloves for a long time can cause skin fever and sweating, which can lead to irritant contact dermatitis. Rubber additives and latex are also common allergens that cause allergic contact dermatitis and contact urticaria.

Wearing gloves and using moisturizers together can achieve the best protective effect. Damage to the skin barrier is the central link in the recurrence of hand eczema. Strengthening moisturizing can reduce the risk of hand eczema for healthy people, and help patients reduce symptoms such as redness, swelling, and itching. At the same time, it promotes the recovery of skin barrier function. Long-term persistence can also reduce the recurrence of hand eczema.

Appropriate supplementation of vitamin C and calcium is also beneficial to the repair of the skin barrier. When choosing a moisturizer, avoid products containing fragrances or preservatives, and lipid-rich emulsions may be more conducive to repairing the skin barrier. However, it is necessary to be vigilant that the use of moisturizers in a humid environment may increase the penetration of allergens and irritants, thereby causing diseases or aggravating the condition.

2. Drug treatment of hand eczema

Topical glucocorticoid ointment is currently the first-line treatment for hand eczema. The type of hormone should be selected according to the nature, location and severity of the skin lesions, and the duration of hormone use should be controlled as much as possible. For patients with mild to moderate hand eczema with mild symptoms and a short course of disease, medium-acting glucocorticoids such as 0.1% mometasone furoate cream and 0.1% triamcinolone acetonide cream can be applied topically for 2-4 weeks; for severe patients with severe chronic hypertrophic eczema, potent glucocorticoids such as 0.1% betamethasone valerate cream can be used for 4-8 weeks or super-potent hormones such as 0.05% clobetasol propionate gel can be used for 2 weeks. After the symptoms improve, topical glucocorticoids or topical calcineurin inhibitors can be used twice a week on the original lesions that are prone to recurrence, and moisturizers can be used in combination to reduce the frequency of recurrence.

Retinoic acid drugs can be used for severe chronic hand eczema that is not well-responsive to topical glucocorticoids. Usually, 10 to 30 mg of alitretinoin is taken orally once a day with meals, depending on the severity of symptoms and the patient's weight. For women of childbearing age, since retinoic acid can increase the risk of severe fetal malformations, strict contraception should be observed one month before, during, and one month after the use of alitretinoin. It is also recommended to use contraception for at least 2 years after stopping treatment.

For patients with obvious symptoms of itching and redness and swelling, symptomatic treatment can be carried out with oral antihistamines such as loratadine and cetirizine. However, it should be made clear that antihistamines have no effect on the overall condition and course of hand eczema.

Immunosuppressants such as cyclosporine, methotrexate, and azathioprine can alleviate symptoms in the short term and can be used when other treatments for hand eczema are ineffective. However, they are off-label and should not be used for a long time. Due to the strong side effects, blood and urine routine tests, liver and kidney function, and other related indicators should be monitored during medication. If blood cell reduction occurs, the medication should be stopped immediately.

【References】

[1]Scientific Committee of the Dermatology Branch of the Chinese Medical Doctor Association, Professional Committee of Allergic Diseases of the Dermatology Branch of the Chinese Medical Doctor Association, etc. Consensus of Chinese experts on the diagnosis and treatment of hand eczema (2021 edition) [J]. Chinese Journal of Dermatology, 2021, 54(1): 19-26. DOI: 10.35541/cjd.20200281.

[2]Kim Hee Joo et al. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema [J]. Annals of dermatology, 2021, 33(4): 351-360.

[3] Elsner P, Agner T. Hand eczema: treatment [J]. J Eur Acad Dermatol Venereol, 2020, 34 Suppl 1:13-21.

[4] He Chunyan, Qin Yeping. Characteristics of hand skin and countermeasures for hand health problems[J]. Chinese Journal of Aesthetic Medicine, 2021, 30(1): 172-176.