An Overview of Hand Eczema

Eczema on the hands is a very common problem. It can appear dry, red, or inflamed—and it is often itchy. Chemical irritant exposure may cause some cases of hand eczema. Often, eczema will occur without any known irritant or allergen trigger, particularly when the skin is dry.

Symptoms

Eczema can affect one or both of your hands and it can develop on the back of your hands, on your palms, on the front or back of your fingers, in the creases that bend, or at the tips of your fingers. 

Most of the time, eczema on the hands comes and goes as episodic outbreaks. But, sometimes it is present all the time. The spots that are affected may stay the same or they can change—lesions can develop on new areas as some areas appear to heal. 

Eczema on the hands can show any of the following characteristics: 

• Red or dark patches 
• Dry spots 
• Chapped or cracked skin
• Bumpy areas 
• Thickened skin
• Scaly sections 
• Small bumps 
• Blisters that may leak fluid 

Sometimes hand eczema doesn’t cause any other symptoms besides the rash, but it is usually itchy. The itching can begin before an outbreak, and it often worsens during an outbreak. Pain is not common, but you can have painful lesions with hand eczema, especially if your skin cracks or bleeds.

Complications

Eczema is typically uncomfortable, but rarely harmful or dangerous. However, wounds and bleeding can occur due to severe skin breakdown or excessive scratching. This can expose your hands to an infection, which may require treatment with antibiotics.

It is not always obvious that your symptoms are caused by eczema because other conditions can cause these changes as well. Be sure to see your healthcare provider if you develop the symptoms of eczema on your hands or anywhere on your skin.

Causes

One specific form of eczema is atopic dermatitis, and it can occur on any area of your skin and has many causes. Hand eczema in the absence of eczema elsewhere on the body may occur when your hands are exposed to a product that irritates the skin. It can take a while for the irritation to heal, and if you continue to have repeated exposure, the affected areas may not heal.

There are a number of common irritants that can cause eczema to develop on your hands, including:

• Soap 
• Detergents
• Fabrics 
• Hairstyling products 
• Industrial materials 
• Powders
• Cosmetics 
• Dyes
• Food such as garlic or lemon

Recurrent exposure to these substances can cause a breakdown of the skin.

Risk factors that increase your chance of developing eczema from exposure to irritants include:

• Having wet hands for a long period of time
• Rubbing your hands with coarse towels or other materials
• Friction from repetitive motion when using abrasive materials—such as cooking tools, hardware tools, or beauty supplies. 

Keep in mind that some people are more prone to eczema than others. And some products may trigger eczema for you, while other products might not. For example, you may develop eczema from using a certain shampoo, but you might not have problems with dyes that could trigger eczema in someone else.

Diagnosis

You may notice that you have outbreaks on your hands when you are in certain situations or when your hands have been exposed to particular products. These patterns can help you and your healthcare provider figure out the cause of your eczema.

If you develop blisters on your palms and fingers, you may have a type of hand eczema called dyshidrotic eczema—it is also called pompholyx.

Diagnostic Testing

Your symptoms and pattern of outbreaks may clearly point to eczema as the cause of your skin condition. However, when the diagnosis is unclear, you may need additional testing.

Tests that may be used in the diagnostic evaluation of eczema include:

• Allergy patch test: Patch testing can help identify contact allergens that can trigger hand eczema flares.
• Culture: A culture is a procedure in which a sample of fluid from a blister or a scraping or swab of cracked skin is sent to a laboratory to see if an infectious microorganism (like bacteria) is present.
• Biopsy: In rare instances, a sample of skin can be surgically taken from the affected area and examined under a microscope. This is not a common diagnostic approach for hand eczema, and would only be used if the condition is very severe, does not improve with medication, or if the diagnosis is unclear.

Treatment and Prevention

Eczema can be treated so that the lesions are able to heal. Treatment is focused on protecting your hands from further damage and from an infection.

If your eczema has an external trigger, it is important that you avoid exposure to it as soon as possible.

While you are being treated for your hand eczema, protecting your hands will make the treatment more effective. Treatment options include moisturizing cream, topical corticosteroids, ultraviolet light therapy, and antibacterial ointments. Your healthcare provider may prescribe a topical corticosteroid to treat hand eczema; this will typically also relieve associated itching.

Protecting Your Hands 

When your hands are already tender and irritated, you should be gentle on them. Avoid rubbing with abrasive towels and don’t expose your hands to friction. It takes a great deal of self-control to avoid scratching when your hands are itchy or painful, but scratching worsens hand eczema and prevents it from healing.

Creams, lotions, soaps, and hand sanitizers that contain perfumes or alcohol can exacerbate hand eczema, so stick to products that are recommended by your healthcare provider.

Some people who have eczema find that wearing gloves is protective and soothing, and it can help the healing process.

Treatment Options

Your allergist or immunologist may recommend a regimen for treatment of your hand eczema:

• Creams: Applying unscented moisturizing cream can help keep your hands healthy, promoting healing.
• Corticosteroids: Prescription topical corticosteroids are effective in treating many cases of hand eczema that are not well-treated with moisturizing and trigger avoidance alone. High potency strength is often necessary in treating hand eczema, and these corticosteroids should not be used for longer than necessary to treat symptoms as they can cause skin thinning and other adverse effects.
• Ultraviolet light (UV) therapy: UV light therapy is a procedure that is done in a healthcare provider’s office. Your healthcare provider may recommend it for your hand eczema. 
• Antibacterial ointment: Prescription antibacterial ointments can be applied to open wounds and cracks in your hands if there is a concern about infection. 

With treatment and avoidance of the triggering factor or factors, the eczema on your hands should heal, but it can take weeks for the lesions to completely resolve. 

Prevention

Preventing additional outbreaks is particularly important so that your skin will be able to heal. Wash your hands with gentle, unscented soap if you have been exposed to an irritant. If your hands start to feel itchy while they still have some type of material on them, wash it off promptly. Pat hands dry instead of rubbing them with a towel (rubbing can further irritate an eczema rash).

Avoid triggers if you can. If you are prone to eczema, be gentle with your hands on a regular basis. It is also important to keep your fingernails short as this will help to prevent any accidental cuts that can be caused by scratching. Many people who work with chemicals wear gloves when working to avoid eczema. And get your healthcare provider’s recommendation for a gentle moisturizer that can help keep your skin healthy to avoid outbreaks of hand eczema.

A Word From Verywell

Most patients will never find one specific cause of hand eczema (allergic or irritant). The majority of hand eczema is related to hand dryness and not to any particular irritant. Irritants can certainly make eczema worse, but patients should focus on moisturizing their skin. Before you go to sleep, apply an unscented moisturizer and wear cotton gloves for better absorption into your skin. If this is not helping, allergy patch testing may be warranted.