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Hands that crack
Hand eczema: the most exposed site on the body, and where occupation matters more than skin type.
Hands are the only part of the body we wash dozens of times a day, immerse in detergents, expose to cold and use to work. When the barrier fails the picture is always the same: dry, rough skin, redness, and painful fissures in the finger creases or on the fingertips, which reopen every time the hand bends.
Here the history is worth as much as the examination. Hairdressers, healthcare workers, cleaners, cooks, mechanics, construction workers: these are groups in which hand eczema is frequent, not from individual fragility but from exposure. Even gloves, which seem the solution, can contribute: prolonged occlusion macerates the skin, and in some cases the material itself causes problems.
There is a point where this page stops and a visit is needed: distinguishing irritant from allergic eczema. The first depends on accumulated damage and improves by reducing exposure; the second depends on a specific substance, continues as long as that substance is around, and is identified with allergy testing, which we perform at the Siena clinic. Treating the second like the first means months of creams while the cause stays in your pocket.
If it improves on holiday, the cause is at work
It is the most useful observation a patient can bring to the visit, and almost nobody thinks to mention it. Hand eczema that eases during holidays and returns on working days indicates that occupational exposure plays a part, and that changes the approach: treating the skin is not enough, what attacks it must be modified — products, gloves, washing frequency. Try to remember how your hands were in the last week of your holiday: it is clinical information.
How it shows
- Dry, rough, thickened skin on the hands
- Painful fissures in the finger creases or on the fingertips
- Redness and itching, sometimes blisters
- Worsening on working days and improvement on holiday
- Bleeding from fissures with movement
- Typical involvement of the backs of the hands more than the palms
How we proceed
- 1Dermatological visit: site, appearance, weekly and seasonal pattern
- 2Review of exposure: work, products, gloves, washing
- 3Distinction between irritant and allergic eczema
- 4Allergy testing where the history requires it (performed at the Siena clinic)
- 5Therapy and protective measures, with later review
Available treatments
- Dermatology visit
- Assessment of exposure
- Targeted therapy
- Scheduled follow-up
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Frequently asked questions
Should I use gloves?+
It depends, and that is not an evasive answer: gloves protect from contact, but worn for long periods they create an occluded environment that macerates the skin, and in some people the material itself is part of the problem. The practical rule is to use them for as long as necessary and no longer, with a cotton liner for prolonged use. Which material to choose is one of the things decided at the visit, not in a supermarket aisle.
The fissures keep reopening: how do I close them?+
For a fissure to heal the edges must stay together, and on a hand that bends and is washed constantly this almost never happens. Management therefore does not run through cream alone: mechanically protecting the fissure and drastically reducing washing in the acute phase both count. It is also why hand fissures heal slowly compared with the same lesion elsewhere.
Does hand sanitiser make it worse?+
On already compromised skin it can sting considerably, especially where there are fissures, and very frequent use contributes to dryness. It should be said, though, that in several settings gel is less aggressive than repeated washing with soap and water, which removes more lipids. The choice between them is not a matter of principle: it depends on how many times a day it is needed and what you handle.
Related reading
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