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Itching on the skin of the hands and other symptoms: redness, peeling, rash, dryness
Last reviewed: 23.11.2021
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Pruritus on the hands can be a manifestation of external effects on the skin, many dermatological diseases, the result of infections, general body sensitization and autoimmune reactions.
In addition, intense pruritus - severe itching on the hands and other parts of the body - occurs in some systemic diseases.
Causes of the pruritus on the hands
Symptoms such as rashes on the hands and itching often accompany skin diseases. And the most common causes of localization of itching on the upper limbs include all types of skin inflammation - dermatitis.
First of all, it is simple or irritant contact dermatitis, not associated with an allergic reaction; It occurs due to external irritation of the skin with detergents, solvents, pesticides, benzoic and phenolic compounds, alkalis, acids and their derivatives, paints (including those used when applying tattoos), and fiberglass. And the first signs of irritation appear after a while in the form of redness of the skin. In hyperkeratotic form, the damaged epidermis loses moisture, which leads to desquamation - the formation of dead skin scales and their desquamation; skin burning, itching of the hands and cracks also appear. Puffiness and intraepidermal bullosa rash (blisters) leading to maceration are less common.
In allergic contact dermatitis , patients experience allergies - hypertrophied immune response to a variety of factors. In such cases, clearly limited hyperemia of the epidermis is visible with vesicles filled with serous exudate, that is, itching on the hands and redness with a rash.
Itching from the sun on the arms (shoulders, forearms) is the result of the reaction of skin in some people to UV radiation in photocontact dermatitis. All the details in the publication - Photodermatitis on the face, legs and arms
Note that there may be itching on the hands of the grass of the family Ranunculaceae (ranunculus), including acrid buttercup, lumbago and horn. Also in the list of plants, irritants, which can cause rashes on the hands and itching, appear ivy, dicentre, akalif, mirabilis, many milk-emitting herbaceous plants.
Allergic factors, under the influence of which atopic dermatitis develops (from the Greek. Atopos - inappropriate, wrong, unusual), are more pronounced in children. And filled with liquid pimples on the hands and itching, causing frequent crying and restless sleep, may appear in the first months of the infant's life. Domestic pediatricians are not associated with infections of the rash (spots and vesicles) and itching in the child on the hands and face, chest, abdomen and lower limbs is diagnosed as exudative diathesis.
In older children, this symptom of a recurrent allergic reaction manifests itself in the ankles and wrists, popliteal and antekubital fossae, that is, itching is localized in the crook of the arms. The disease often persists in adults, and, as experts note, such patients have a family history of allergic rhinitis or asthma.
Under certain conditions, the symptoms of atopic dermatitis in women can be aggravated, causing itching on the hands during pregnancy. In addition, skin symptoms in pregnant women are associated with increased nervous load and insufficient intake of vitamins (in particular, group B), and bile stagnation. See also - Itching during pregnancy.
There is a condition in which itching on the hands and blisters, blisters and flushing of the skin is localized mainly in the intertrigial (contiguous) areas of the body; it is also often itchy on the arms up to the elbow and on the shoulder, on the inside, constantly touching the body. This condition is called blistering dermatitis or pemphigoid bullosa.
In the list of causes of pruritus (including localized on the upper extremities) should be called eczema of the palms (the descriptive term from the Greek. Ekseo - boil up); dry eczema is characterized by itching on the hands and peeling of the skin.
But, with all the variety of eczematous lesions, there is one type called recurrent vesicular dermatitis, dyshydrotic eczema or pompholi, which affects only the extremities, that is, patients complain of itchy skin on their hands and feet. Therefore, this disease is also called palm-planar spongiotic dermatitis. It is distinguished by numerous papules recessed into the epidermis, rapidly evolving into blisters (which burst to form areas of erosion and soak), intense itching on the fingers and between the fingers (less often the toes), as well as itching and cracks on the palms and soles of the feet.
A small rash on the hands, similar to a nettle burn, merging into large areas of hyperemia and itching, which is aggravated by burning sensation - the main manifestations of urticaria or allergic urticaria, which is considered either an idiopathic condition, or an autoimmune reaction, or a side effect of a number of pharmaceuticals. There are also solar urticaria, which is visually and etiologically identical to the photodermatitis mentioned above (obviously, excessive synonymy and disorder of dermatological terminology have an effect).
Why else can itch on the right, left hand, in the article - Itches the right, left palm
Itchy skin on hands and infections
Itching of the skin on the hands is caused by Sarcoptes scabiei scab. This contagious disease is characterized by the appearance of lesions on the skin (in the form of nodules or pimples stretched into a line), skin thickening, the formation of scales and their peeling, and also strong (especially at night) itching between the fingers, around the nails, on the hands, wrists and above - to the elbows, with the transition to the skin of the shoulders, underarms, chest and abdomen.
Also, the outer layer of the skin is colonized by fungi, dermatophytes Trichophyton mentagrophytes, Trichophyton schoenleinii, Microsporum (genus Arthroderma and Ascomycota) developmental athlete whose symptoms include redness, swelling and itching on the hands, the formation of bubbles of various sizes on the palms and fingers, scaly edges and itchy plaques in the shoulders or forearms. And itching around the nails, under the nails on the hands is a sign of nail mycosis, accompanied by increased proliferation of keratinocytes of the basal layer of the epidermis.
At infection of the skin of the hands with the fungus Trichophyton rubrum, the hand rubromycosis is diagnosed, among the symptoms of which are noted not only the itchiness of the oval focal inflammatory elements on the dorsal surfaces, but also redness of the palms.
Although the exact cause of acute lichenoid pitiriasis in adolescents and young adults has not been definitively established, cytomegalovirus, parvovirus B19, herpevirus type IV, and Toxoplasma appear among its probable pathogens. With this disease, pruritus causes exanthema in the form of scaly-covered pink papules and vesicles that form on the folds of the elbow and knee joints. In chronic pyritiase, itchy red spots are localized on the palms and soles.
Small red papular rash on the hands and feet and itching of the skin appear in intestinal yersiniosis, a contagious disease with fever and diarrhea caused by Yersinia enterocolitica enterobacteria (transmitted by rodents and ingested by ingestion of infected products).
[6]
Itching on hands for systemic diseases
In the presence of congenital gluten intolerance (celiac disease) and malabsorption syndrome, every tenth patient has herpetic dermatitis herpetiformis, manifested by rashes and itching on the extensor surfaces of the elbows and knees, on the shoulders (as well as on the scalp and buttocks).
With endocrine diseases such as diabetes mellitus - due to too high glucose levels in the blood - there may be itchy skin on the palms, legs and other areas of the body. Also appear diabetic blisters (bullosis diabeticorum) - on the skin of the arms, legs and back. And in young men with uncontrolled insulin-dependent diabetes, obesity can form cholesterol deposits protruding above the skin surface, diagnosed as secondary eruptive xanthomatosis, which accompanies itching in the upper and lower extremities.
An autoimmune disorder, called primary biliary cholangitis or primary biliary cirrhosis, in almost 80% of cases causes itching and spots on the palms.
There may be itching on the hands without a rash, and this is most often associated with excessive dryness of the skin of the hands. Usually xerodermia (from the Greek. Xeros - dry and derma - skin) is noted in cases of hypovitaminosis, as well as hypervitaminosis A; with stagnation of bile (cholestasis); in patients with end-stage renal disease (uremic pruritus occurs in 60% of cases); after hemodialysis; in diseases of the thyroid gland (in patients with thyrotoxicosis and diffuse toxic goiter); with peripheral neuropathies and neurological pathologies; in lymphomas, first of all, Hodgkin's lymphoma and cutaneous T-cell lymphoma.
Paraneoplastic itching of various localization can be felt in the early stages of development of malignant tumors of the lung, colon, mammary glands, brain.
At the same time, it is impossible to disregard the rash without itching on the hands - in the form of dotted red or purple spots (petechiae) that appear with iron deficiency anemia, aplastic anemia, thrombocytopenic purpura, leukemia in adults and acute myelogenous leukemia in children.
Also in people with ulcerative colitis and granulomatous enteritis (Crohn's disease), erythema nodosum is observed: small red nodules on the hands (hand, wrist) and legs (in the ankles and lower legs).
Risk factors
Exogenous risk factors should be considered: exposure to chemicals, ultraviolet radiation, allergenic substances, viral, fungal and bacterial infections. As well as taking or parenteral administration of drugs; for example, sulfonamides, aspirin, some antibiotics, steroid drugs, opioid injections, etc. Cause severe itching.
Since, as you have seen, skin itching on the hands occurs with many different diseases and pathologies, the presence of skin disease, allergies or diseases of internal organs, endocrine disorders or autoimmune disorder in a person maximizes the risk of this symptom.
And with very dry skin or an inherited tendency to skin reactions (sensitization), it is even more difficult to avoid.
Pathogenesis
At any localization of an itch, the mechanism of its appearance is due to the release of mast cells of the skin (mast cells) of an organic nitrogen compound, a mediator of local immune responses - histamine. Under the influence of exogenous and endogenous factors, histamine is activated, which, on the one hand, increases the activity of eosinophils and neutrophils, and on the other hand, by binding to H1 and H2 neurons in the epidermis and papillary skin, induces an itchy sensation with edema. The latter is explained by the fact that histamine causes vasodilation and increases the permeability of the capillary walls, which is why fluid accumulates in the intercellular space of the skin tissue.
In addition, neurokinin 1 (NK1) mediator is released, which binds to neurokinin receptors (NKR1) on the membranes of keratinocytes, endothelial cells and mast cells. This, in turn, provides the activation of proinflammatory cytokines - interleukin-31 (IL-31), leukotriene B4, tumor necrosis factor (TNF), involved in the transmission of an itch signal through afferent nerve fibers.
When autoimmune etiology and genetic susceptibility to skin reactions, itching on the hands is an abnormal response of T cells to the hemidesmosomes BP180 and BP230 membranes of the basal epithelial cells.
Read more this issue is covered in the publication - Pathogenesis of itchy skin.
[11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]
Epidemiology
According to experts of the European Society of Allergy, the prevalence statistics for atopic dermatitis vary from one source to another, but the availability of diagnostic criteria suggests that the overall incidence of atopic dermatitis in major European countries increased to 10-20% of the population, and in North America - to 23-26 % It also increased significantly among children up to seven years old, in some countries up to 24% of all children in this age group.
Globally, according to some estimates, up to 3% of adults and about 20% of children have some form of eczema. Two thirds of cases of eczema begin in children under five years old, and about 60% of children with eczema have it when they become adults.
According to the National Health Interview Survey 2010, in the US, the prevalence of eczema in adults (aged 18–85 years) was 9.7-10.6%. Moreover, 3.2% of the respondents had a history of asthma and / or hay fever.
Studies of the last decade have shown a high risk of allergic dermatitis in children in the first year of life. For example, in Germany more than 40% of infants are at risk, and in Europe as a whole, more than one third of all newborns are at risk.
Allergic contact dermatitis, according to the British Association of Dermatologists, is generally diagnosed in 1-1.5% of British patients.
Without specifying the localization, about 8% of adult Norwegians experience chronic itching (for more than a month and a half).
Diagnostics of the pruritus on the hands
In dermatology and allergology, diagnosis consists in identifying the causes of itching. In addition to the physical examination of the patient and a detailed history, as well as examination of the skin using a dermatoscope, blood and urine tests, scrapings in affected skin areas and other studies are necessary.
In many cases, an allergist, an endocrinologist, a hematologist, or an oncologist who use instrumental diagnostics of the relevant organs (x-rays, ultrasonography, computed tomography, etc.) take part in determining the etiology of pruritus.
Of course, in the presence of these symptoms, differential diagnosis is necessary, which allows to distinguish between contact dermatitis from allergic or atopic, and scabies - from athlete.
What tests you need to take and other details of the examination of patients are detailed in the material - Diagnosis of pruritus
Treatment of the pruritus on the hands
Dermatologists, allergists, endocrinologists, pediatricians know how to relieve itching on their hands. And each specialist coordinates the treatment of itchy skin with its etiology, although in most cases the therapy is aimed specifically at relieving the symptom, and not at eliminating its cause (the latter is not always possible).
What medications are prescribed to take orally? Antihistamines last generation. Their specific names, contraindications and side effects, as well as standard dosage, are detailed in the materials - Skin Itch Pills or Allergy Pills
Doctors recommend taking itching with vitamins B3, B6, B12, beta-carotene, tocopherol, ascorbic acid, rutin; children also have vitamin D.
If in the old days from eczema used zinc talker with glycerin (now it is an external antiseptic called Tsindol), today ointments for eczema on hands are used - Ointment for eczema, as well as Creams for eczema
Exhaustive information about what itch ointments and creams help to cope with this problem and how to apply them correctly is given in the publications - Itch Ointment and Creams for itching.
From allergic and atopic dermatitis appointed Ointments from dermatitis.
In the treatment of itching that occurs when dermatophytosis, use the ointment from the fungus between the fingers.
And the main treatment for scabies is - Ointment for scabies
Physiotherapy can be applied to patients with skin diseases, read - Physiotherapy for dermatitis and dermatosis
Homeopathy is not welcomed by dermatologists, however, among homeopathic remedies there are also quite effective ones (for example, Aloe, Hepar sulfur, Calcarea carbonica, Arnica, Graphites, Medorrhinum), but they should be prescribed only by a homeopath.
Alternative treatment
Alternative doctors give advice on how to get rid of itching on the hands at home. To moisturize dry skin prone to irritation and flaking, it is recommended to lubricate it with glycerin, petroleum jelly or crude pressed olive oil.
In vaseline, you can add a few drops of essential oil of tarragon or tea tree. And in olive oil - a pinch of ground turmeric and lubricate itchy places two or three times a day for several days. The oil is rich in omega-fatty acids, and turmeric (Curcuma longa rhizome) relieves inflammation and itching thanks to its bioactive components, curcumin, and alpha and beta turmerone.
If itchy hands with contact dermatitis, cold compresses give a quick effect. And compresses with a solution of baking soda or applications of raw yeast dough, applied for one and a half to two hours, help with itching and dry weeping eruptions - if you have atopic or allergic dermatitis.
See also:
A good alternative to pruritus is oatmeal baths. It is necessary to grind oatmeal (150 g) into powder, pour it with warm water (about a liter), let it swell for 20 minutes. For a bath with itching hands, it is enough to pour the oatmeal into the basin with moderately warm water, mix and lower the hands for a quarter of an hour. Similarly, spend the bath for the whole body (but the oatmeal need to take twice as much).
When eczema is advised to make lotions from apple cider vinegar with the addition of honey (a teaspoon per 100 ml).
Apply and treatment with herbs - in the form of trays, compresses, lotions or irrigation with decoction of such plants as: starfish, sage and tricolor violet (grass), common porridge (root), burdock (root), comfrey (root), broad-leaved cattail ( rhizome), curly sorrel (root), camomile flowers and calendula medicinal, large plantain (leaves).
Complications and consequences
Feeling itchy, a person begins to scratch an itchy place: researchers have long established that, in fact, scratching the skin soothes itching, because it causes a weak pain pulse, and this causes the neurons of the spinal cord to switch to the transmission of pain signals.
Temporary relief from scratching the itch on the hands takes place, but scratching can have negative consequences and complications. First, severe itching disrupts normal sleep, and in some it becomes the cause of increased nervousness and irritability (leading to a neurotic state).
No less serious problems are associated with a high probability of a secondary bacterial infection - strepto-and staphylococcal, which affects the skin with damaged epithelial layer. Infection leads to tissue inflammation, ulceration, and foci of necrosis with pus. At the same time, secondary pyoderma, erysipelas, impetigo, etc. Can develop.
Prevention
For the prevention of dermatological infections relevant recommendations regarding the observance of the rules of personal hygiene.
If you have sensitive skin, protect it when dealing with household chemicals and substances that can irritate the skin on your hands.
In the case of an allergic reaction, atopic dermatitis, eczema prevention is difficult, as with systemic diseases of the endocrine nature or pathologies of autoimmune origin.
Forecast
Itching on the hands is rarely chronic with infections and allergies. But the rash with itching caused by chronic diseases with autoimmune disorders can manifest for a long time - sometimes disappearing in remission, then appearing after some time, entering into a period of exacerbation.