Eczema of the palms

Palmar eczema is a common, often chronic condition with many causal and contributing factors.

Palmar eczema can be categorized into irritant eczema; exfoliative eczema; atopic eczema; fingertip eczema; allergic eczema; hyperkeratotic eczema; nummular eczema; dyshidrotic eczema; lichen simplex chronicus, and the "id" reaction. Each of these types is discussed separately. Irritant palmar eczema is the most common type, followed by atopic palmar eczema. Allergic contact dermatitis is the cause of palmar eczema in about 10-25% of cases.

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Causes and pathogenesis of palmar eczema

Women are more likely to get sick than men. Occupational risk factors include contact with chemical irritants, work in a humid environment, chronic friction, and work with sensitizing (allergenic) chemicals.

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Exogenous factors in the development of palmar eczema

Irritants include chemicals (such as solvents, detergents, alkalis, and acids), friction, cold air, and low humidity. Allergens may have work-related and non-work-related sources of allergen exposure. Immediate type I allergies may include reactions to latex and food proteins, while the more common delayed type IV allergies may include reactions to rubber additives, nickel, medications (bactracin, neomycin, and hydrocortisone), and common chemical ingredients in personal care products (such as preservatives, fragrances, sunscreens, and other additives). Food allergens may also play a role. Infections may cause "icb" reactions, including palmar eczema, as a reaction to a distant focus of fungal or bacterial infection.

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Endogenous factors in the development of palmar eczema

Atopic diathesis (hay fever, asthma, atopic eczema) is often a predisposing factor and can contribute to susceptibility to the disease and chronicity of the process, despite appropriate treatment and precautions.

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Symptoms of Palmar Eczema

The entire skin should be carefully examined for diagnostic clues and contributing factors and to exclude other dermatoses (eg, psoriasis). The condition is variable; acute, subacute and chronic eczematous changes are observed. Although the association between the clinical picture and the etiology cannot be established with sufficient reliability, some signs may be helpful: xerosis, erythema, burning on the dorsum and inner surface of the palms lead to suspicion of irritants. Nummular eczema, dorsum of the palms and fingers, suggests the possibility of allergy, irritation or atopy; sometimes contact urticaria (allergy type I) is the culprit. Profuse, recurrent, intensely itchy vesicles on the lateral surfaces of the fingers and palms may indicate dyshidrotic eczema. In case of fingertip eczema (dryness, splitting, soreness, no itching), consider the presence of an irritant, an endogenous factor (atopy in winter) or friction eczema. In case of erythema, peeling, itching in the area of the base of the fingers, atopy can be assumed.

If it is possible to determine which irritants or allergens the patient has been in contact with and eliminate this contact at the very beginning of the disease, the prognosis for complete recovery is good. Continuous or prolonged contact with irritants and allergens can lead to a chronic process. Abstinence from contact with provoking factors and appropriate care often improve the condition, but in some patients the disease does not completely disappear.

Treatment of palmar eczema

Treatment of palmar eczema involves identifying irritants that should be avoided. These include frequent hand washing and exposure to water, soap, detergents, and solvents. Chronic friction trauma is also an irritant that can lead to chronic recurrent dermatitis. Protective measures (eg, vinyl gloves for handling water or chemicals) should be taken. Medium-strength topical corticosteroids (group II-IV) are prescribed twice daily. Ointments are preferable to creams. Occlusion under polyethylene film can be used. Very strong corticosteroids (group I) should be avoided unless the dermatitis is severe. Topical corticosteroids for hand dermatitis are more effective if they are given intermittently rather than continuously.

In case of severe dermatitis, a topical corticosteroid with very high pharmacological efficacy is applied after wet compresses with Burow's solution twice a day for the first 3-5 days of treatment, after which a medium-strength corticosteroid is prescribed twice a day for several weeks. Hand baths with Balneotar oil can be prescribed. Two or three capfuls of oil are dissolved in a bowl of water and the hands are immersed for 15-30 minutes. The procedure is performed twice a day. After it, a topical corticosteroid is applied.

Systemic steroids (prednisone 0.75-1 mg/kg/day tapered over 3 weeks) may occasionally be needed to control severe, acute inflammation. Most patients improve with removal of irritants, topical corticosteroids, and frequent, regular use of emollients. If allergy is suspected (palmar swelling, vesicles, itching, and especially if the dorsum of the hands is involved or there is fingertip eczema), patch testing should be performed to identify causative or maintaining allergens. Testing should include allergens appropriate to the patient's occupation. In chronic, torpid disease, the patient should be referred to a dermatologist. Other treatments for palmar eczema include topical psoralen in combination with ultraviolet A irradiation and superficial short-focus x-ray therapy. In cases of disability, low doses of methotrexate (5-15 mg weekly) or low doses of cyclosporine orally daily are used.