Eczema, a word of Greek origin, can be translated into Turkish as “boiling”. In eczema, the skin resembles the bubbling of boiling water. In some regions, the small water-filled bubbles in eczema are likened to small air bubbles formed in a dough that is fermented, and the disease is also expressed as “yeast”. Eczema located on the hands is a very common skin disease in the society. It presents with dryness, redness, dandruff, blisters and watering on the hands. It can develop after the hands of people who are predisposed to develop a skin reaction are exposed to various substances. Skin irritation may develop after excessive contact with water, dry air, soap, detergent, chemicals, rubber gloves, and personal care products. Even seemingly harmless baby products, even water, can cause the disease to progress.
Types according to the causes of hand eczema
According to the causes of the disease, it can be examined in two main groups as internal and external origin. Intrinsic eczema is called atopic eczema (which is genetically associated with allergic predisposition), kneehydrotic eczema (often in the form of pinhead-sized water bubbles), numular eczema (occurs in the size of a coin). Extrinsic ones are skin responses triggered by contact allergens. Depending on external causes, it may appear as hand eczema, allergic contact eczema or irritation contact eczema. Photosensitive eczema (eczema that develops due to sensitivity to light) can develop due to both internal and external causes. In addition, apart from these two reasons, neurodermatitis, which develops only by scratching, can also cause hand eczema.
Who is it seen in? Who is in the increased risk group?
Although the disease can be seen all over the world, it can be seen more frequently especially in individuals who are hereditary prone to skin reactions. These people may have a history of hay fever, asthma, and food allergies. Cleaning can be seen more frequently in people who are busy with dishes, in professions such as baker workers, hairdressers and brick workers who are exposed to irritation and allergic substances due to their work, in occupational groups such as dental technician, doctor, nurse, and in those who deal with cement and paint work. The hobbies of the person are as important as his profession. The materials that people who deal with painting, models, gardening etc. come into contact with during their hobbies should also be questioned. In some people, it may also develop due to cortisone creams used for treatment.
Eczema clinical picture and stages
In the acute (initial) period of eczema, numerous water-filled blisters on a red and swollen surface and their rapid opening, watering and crusting occur. In the subacute (developing after the acute period) period, numerous dandruff and crusting are observed on a slightly reddened surface. The dandruff is in the form of small rings, especially on the edges. In the chronic (advanced) period, the skin thickens, dandruff is evident on it, and clefts may develop. Depending on the cause of the disease, it can progress in different periods and itching may occur in every period.
The substances we use and encounter in our daily lives can be a cause or exacerbation of the disease. Some drugs and sun rays can trigger the disease, especially in eczema that develops due to photosensitivity. Occupationally, contact with oily products, metallic liquids and cooling materials can cause irritation.
How does eczema affect quality of life?
Itching can significantly affect patients’ quality of life. In addition to negatively affecting daily life, it can cause problems in the school life of children and in the business life of adults.
How is eczema diagnosed?
For a definitive diagnosis, a detailed history is taken from the patient by the doctor. A patch test is performed to evaluate the responsible items in the history.
The diagnosis of irritant contact eczema can be made simply by knowing which substances cause eczema on your skin and how often.
The diagnosis of allergic contact eczema is made by patch tests performed in the skin and venereal diseases department. Standard prepared allergen substances and substances suspected from the materials that patients come into contact with are adhered to your back in small patches. It opens two days later, and the doctor and nurse look at your back and decide which substance is the reaction. The same area is re-evaluated 24-48 hours later to confirm the irritation and allergic response and to evaluate possible prolonged allergic responses. In addition, diseases considered in the differential diagnosis are investigated by history, physical examination and various methods.
What research methods are recommended in the differential diagnosis?
In order to exclude fungal diseases that are located in the hand, after the scraping method, microscopic and microbiological examinations can be used to search for fungi. If necessary, biopsy can be taken to exclude various skin diseases and pathological evaluation can be performed. Laboratory and radiological examinations can be performed for conditions accompanying internal diseases.
What are the treatment methods?
-The basis of treatment is to avoid contact with the agent by revealing the cause. It can be difficult at times to stay away completely.
Prolonged contact with water and soap causes the loss of the natural protective layer of the skin. Moisturizing and barrier creams recommended by your doctor can help in this regard. Barrier creams and foams can physically prevent agents from entering the skin. However, it can be disturbing if the content is oily and creates a thick layer.
-People with long-term disease may require treatment for several months. Topical steroid creams are used for the improvement of itching and redness, and the healing of the skin. Topical steroid creams should be used as recommended by the doctor in order to see the full effect and not develop side effects. If the disease is more watery, wet dressing application with the drugs recommended by the doctor, and if the thickness is significant, treatments that dissolve the skin may be on the agenda.
– If the disease is very severe, steroids can be given by mouth, vein and muscle applications other than the skin.
– If there is no response to these treatments, other treatment options such as pimecrolimus, cyclosporine, methotrexate and phototherapy can be applied.
– If there is a secondary infection to the disease, appropriate treatment should be done.
– Before starting the treatment, the doctor should be informed about pregnancy, breastfeeding, internal diseases, drugs used regularly for different reasons.
What are the protective measures?
Reducing contact with irritation and allergic conditions is one of the most important measures. For this reason, the following warnings should be taken into consideration.
-Assistant support in cleaning, dishwashing, child care or using a dishwasher and washing machine.
It is important to use short-term prophylactic gloves. It should be noted that the use of gloves for a long time can increase sweating. It will be appropriate to wear cotton gloves inside the gloves.
– If the doctor recommends, barrier and moisturizing creams should be applied.
Wearing gloves for a short time during shampooing will reduce the negative effects of weak irritants on the skin.
– During applications such as cleaning the toilet, the contact of your hands with the detergent should be cut off.
It is recommended to wash hands with non-perfumed soap.
– Direct hand contact with substances such as tomatoes, oranges, lemons should be avoided.
It is important to avoid and protect possible allergens during hair dyeing.
– It is better to wash hands with lukewarm water instead of hot or cold water.
-Removing the rings while working will reduce the irritants that may remain under the rings.
– If you have hobbies such as painting, flower model, etc., the materials you use during these processes should be questioned.
– If an occupational eczema is considered, a short-term job change may come to the fore with the suggestion of physicians, if there is a permanent problem.