What is hand eczema?

Hand eczema is a collective term for inflammatory skin changes on the hands.

So it is not one specific disease with one specific cause.

Hand eczema can occur due to repeated irritation, contact allergy or an atopic disposition. In many people, several factors are involved at the same time.

Typical symptoms are:

• Dry, rough and scaly skin.
• Redness or other color changes.
• Itching, stinging and a burning sensation.
• Small blisters or weeping areas.
• Thickened, hard skin.
• Painful fissures in fingers, fingertips and palms.

On darker skin, the inflammation may appear brownish, grayish or violet instead of clearly red.

Some experience eczema especially on the backs of the hands. Others get it between the fingers, around the nails or on the fingertips.

And then there are those where the skin becomes so dry and thickened that it cracks every time the fingers are bent.

It can make completely normal things like buttoning a shirt, peeling potatoes or opening a bottle painful.

What are fissures?

The small cracks that occur in very dry skin are called fissures.

A fissure is a crack in the skin, which can be superficial or go deeper into the skin layers.

When the skin has become hard, dry and less elastic, it can no longer follow the fingers' movements without being stressed.

Therefore, the cracks often occur around the fingertips, knuckles and joints.

If the crack reaches down to living skin tissue, it can sting, bleed and be very painful.

But remember: Cracks in the hands are a symptom – not a diagnosis.

You can have cracks without actual eczema. And you can have hand eczema without cracks.

What happens in the skin when the hands crack?

This is where it gets interesting.

When the skin barrier is intact, it limits water loss and protects against the environment.

When the barrier is damaged, the so-called transepidermal water loss, TEWL, often increases.

This means that more water evaporates through the skin.

At the same time, irritating substances can more easily affect the living skin layers.

The skin cells react by releasing inflammatory signaling substances, and the immune system is activated.

It can cause redness, swelling, itching and stinging.

With prolonged inflammation and repeated mechanical stress, the skin can become thickened.

It is called lichenification or hyperkeratosis, depending on the nature of the change.

The thickened skin can feel hard and less supple.

And when you bend your fingers, it can crack.

This also explains why a hand cream alone is not always enough.

If the skin continues to be exposed to the same stresses, and at the same time there is active inflammation, you are constantly working against the skin's ability to recover.

You must both protect the barrier and manage the inflammation that may be present.

Why do you get hand eczema?

The hands are among the most exposed areas on the body.

We use them all day. We wash them, sanitize them, work with them, expose them to cold and come into contact with a long range of chemical and mechanical influences.

Therefore, hand eczema is particularly common in people who work with water, cleaning, food, patients, hair products or other substances that stress the skin.

1. Water and soap – why do the hands get dry?

It may seem strange that water can help make the skin dry.

But it is actually one of the most important explanations for hand eczema.

The outermost layer of the skin is called the stratum corneum. It consists of skin cells surrounded by an organized mixture of lipids.

Among the most important lipids are ceramides, cholesterol and free fatty acids.

Together they help the skin hold onto water and limit the penetration of irritating substances.

With repeated contact with water, the outermost skin layer swells. When the skin subsequently dries, it changes volume again.

If the process is repeated many times, it can contribute to disrupting the skin barrier.

Detergents and soap can at the same time remove the skin's surface lipids and affect the proteins in the outermost skin layer.

The result can be increased water loss, dryness and irritation.

So it is not because water molecules simply take the skin's lipids with them when they evaporate. The mechanism is more complex and deals especially with repeated rehydration, dehydration and influence from wash-active substances.

The more often the skin barrier is stressed, the harder it has to work to restore itself between the influences.

2. Wet work – one of the biggest risk factors

In dermatology, we use the term wet work.

It covers, among other things, work with frequent hand washing, prolonged contact with water or repeated use of liquid-tight gloves.

Hairdressers, nurses, cleaning staff, kitchen staff and others with a lot of wet work have an increased risk of hand eczema.

A systematic review of research on hand hygiene found a clear connection between frequent hand washing and the risk of hand eczema.

This does not mean that you should stop washing your hands.

It means that you should avoid unnecessary washing and protect the skin as best as possible.

3. Cold and dry air

Many experience that their hands get worse in winter.

It is not by chance.

Cold outdoor air and dry indoor air can increase the stress on an already vulnerable skin barrier.

At the same time, temperature changes, wind and friction from clothes and gloves can worsen the discomfort.

If your hands always start to crack when autumn comes, I would start the protective skincare before the cracks occur.

It is much easier to maintain a reasonably well-functioning skin barrier than to have to rebuild the comfort in skin that is already cracked.

4. Contact allergy

Sometimes hand eczema is not only due to irritation.

It can also be due to allergic contact eczema.

Here, the immune system has developed a specific hypersensitivity to a substance.

It can for example be certain preservatives, fragrances, rubber chemicals or metals.

With allergic contact eczema, very small amounts of the relevant allergen can trigger an outbreak.

And an important detail: You can develop contact allergy to a substance you have used for years without previous problems.

If your hand eczema keeps coming back, even though you take good care of the skin, it can therefore be relevant to be examined for contact allergy.

Read more in our article about contact eczema – the difference between irritation and allergy.

5. Atopic disposition

If you have had childhood eczema or atopic dermatitis, your skin may be more disposed to develop hand eczema.

This is due in part to the fact that the skin barrier in people with atopic dermatitis is often more vulnerable.

This does not mean that everyone with atopic eczema gets hand eczema.

But it means that the same influences can be harder to tolerate.

I go through this connection in more detail in the article about atopic eczema.

What can hand eczema be confused with?

It is not all dry, itchy or scaly hands that are due to hand eczema.

Fungus on the hands

Fungal infection on the hand, tinea manuum, can give scaly, dry skin.

It is often most pronounced on one hand and can occur together with athlete's foot.

Fungus requires a different treatment than eczema. If the diagnosis is uncertain, the doctor can examine the skin and possibly take a fungus sample.

Psoriasis

Psoriasis can give well-defined, thickened and scaly areas on the palms.

It can be difficult to distinguish from chronic hand eczema based on appearance alone.

Dyshidrotic eczema

Dyshidrotic eczema, also called pompholyx, typically gives small, deep-seated and often very itchy blisters on the sides of the fingers or in the palms.

It is considered a clinical pattern of hand eczema and can have several different triggering factors.

Infection

If the skin becomes increasingly warm, swollen, painful or gets pus, there may have occurred an infection.

It must be assessed by a doctor.

What can you do yourself about dry, cracked hands?

If your hands crack, I would start with three things.

First: Reduce the influences that damage the skin.

Next: Use moisturizing and barrier care regularly.

And finally: Get any active eczema treated correctly.

It sounds simple, but it is often here that the biggest difference lies.

Wash your hands gently

Use lukewarm instead of very hot water.

Choose a mild, fragrance-free cleansing product when washing is necessary.

Avoid scrubbing your hands with brushes, coarse sponges or peeling products.

Pat your hands dry, also between the fingers.

And use hand cream afterwards.

Is hand sanitizer better than soap for hand eczema?

It depends on the situation.

Alcohol-based hand disinfection can in many cases be less stressful for the skin than repeated washing with water and soap, especially when the hands are not visibly dirty.

But hand sanitizer can sting on cracked skin, and it does not replace hand washing in situations where soap and water are necessary for hygiene reasons.

Therefore, always follow relevant hygiene recommendations at your workplace.

Use gloves correctly

Protective gloves can be a great help with cleaning, dishwashing and other wet work.

But gloves can also cause problems.

When the skin is enclosed in a liquid-tight glove, the humidity and temperature increase. The skin can become softened, and friction and sweat can worsen irritation.

Therefore, protective gloves should only be used when they are necessary, and not longer than the task requires.

For longer use, a clean, dry cotton glove under the protective glove can be useful.

Also remember that gloves must be suitable for the chemicals you work with.

A regular glove does not necessarily protect against all cleaning products, solvents or other substances.

What do you do about deep cracks in the fingertips?

With deep fissures, it is important to protect the area against further mechanical stress.

A suitable plaster or wound dressing can in some cases protect the crack while the skin gets rest.

Avoid picking off hard skin edges or trying to grind the skin away.

If the crack is deep, very painful, bleeds repeatedly or does not heal, it should be assessed by the doctor.

I do not recommend peeling or scrub on active hand eczema with cracks. It will often be another unnecessary stress on the skin barrier.

When is skincare not enough?

It is important to understand that hand eczema is an inflammatory skin disease.

A moisturizing cream can help protect the skin barrier, but it does not necessarily treat the active inflammation.

With actual hand eczema, the doctor will often use a local corticosteroid cream in an appropriate strength and period.

With recurring or chronic hand eczema, there may be a need for further treatment or referral to a dermatologist.

The options can include light therapy and special prescription medicines, depending on the type and severity of the disease.

When should you be examined for contact allergy?

If the hand eczema keeps coming back, you should consider whether there is a contact allergy or a persistent influence at work or at home.

The dermatologist can examine for contact allergy with a patch test, also called a patch test.

Here selected allergens are placed on the skin under controlled conditions, and the reactions are read after a specific schedule.

A patch test is something else than a regular prick test.

It especially examines delayed contact allergic reactions.

Can hand eczema be an occupational injury?

Yes, hand eczema can be work-related.

If your symptoms started or worsened in connection with your work, it is important to talk to the doctor about the connection.

This applies, among other things, if you work with frequent hand washing, cleaning products, food, hairdressing chemicals or prolonged use of gloves.

Work-related hand eczema can in relevant cases be reported as an occupational disease.

And here it is important not just to try to rub the problem away, while the same influences continue.

When the hands finally get good again, you do not necessarily stop the skincare.

If your everyday life continues to stress the hands, they still need protection.

Consistency beats intensity.