Hand allergies in adults

Often, with the formation of rashes on the skin of the hands, burning and itching, dryness and small cracks, we immediately think about allergies. Yes, in the overwhelming majority of cases, it is reactions to various external stimuli that lead to such symptoms. However, the more correct term doctors use to describe this condition is dermatitis. This term describes a common group of acute and chronic eczematous disorders that affect the dorsal (dorsal) and palmar sides of the hands. Often, hand allergies in adults are called eczema.

But it is important to distinguish this problem from many other pathologies of an infectious, traumatic or autoimmune nature.

Allergic eczema is one of the most common skin conditions affecting both adults and children. It may be referred to as “endogenous” or “atopic eczema”. Pathology especially affects the protective barrier of the skin. Sometimes people use the words “allergy”, “dermatitis”, and “eczema” to refer to the same skin condition. And this can be confusing, as several different concepts are mentioned.

Allergy is a general concept, a term that refers to an excessively violent reaction of the immune system to completely harmless substances that the hands come into contact with. Eczema is a concept that reflects chronic inflammation of the skin associated with internal problems of the body, and dermatitis is an acute or chronic reaction associated with external influences.

Eczema is often associated with asthma and hay fever, is hereditary, and often runs in families across multiple generations. People with eczema from a very early age are at a higher risk of developing work-related skin problems, especially contact dermatitis and contact urticaria. People with an unfavorable heredity for eczema should be vigilant about skin care if they come into contact with irritants at work and at home.

Causes of hand allergies in adults

Allergic dermatitis is very common, especially in young women, and accounts for 20-35% of all dermatitis. Hand allergies can occur at any age, including childhood. It is especially common in people who in childhood suffered from “diathesis” on the cheeks and food allergies.

Experts estimate that chronic hand dermatitis affects 10-15% of the population. Hand allergies in adults are especially common in industries such as cleaning, food manufacturing, metalworking, hairdressing, healthcare, housework, painting, and mechanical work. Skin rashes occur mainly due to contact with irritants, especially if the epidermis suffers from dryness, is injured, exposed to aggressive chemical compounds.

Allergic dermatitis often results from a combination of several causes, including:

• Genetic and unknown factors (constitutional hand dermatitis). In atopic dermatitis, a deficiency of proteins such as filaggrin in the stratum corneum leads to impaired barrier function, resulting in water loss and easy penetration of irritants and allergens.
• Injuries (contact irritant dermatitis). Irritants include water, detergents, solvents, acids, alkalis, cold, heat, and friction. They can damage the outer stratum corneum, remove lipids and impair the protective function of the skin. Water loss and inflammation lead to further deterioration of the barrier function.
• Immune reactions (allergic contact dermatitis). Contact allergy is a delayed-type hypersensitivity reaction with arousal and memory phases involving T-lymphocytes and cytokine release. In other words, the skin slowly becomes inflamed, but then the reactions do not go away for a very long time.

If dermatitis is often caused or aggravated by work, then it is allocated to occupational allergic dermatitis.

Exacerbating factors for hand allergies

There are many factors that cause allergies or worsen an already existing process. These factors include contact with skin irritants such as:

• water, especially frequent wetting and drying of hands, the use of antiseptics, especially with alcohol;
• soaps, detergents and shampoos;
• household cleaners, especially those containing acids and chlorine;
• paper towels;
• solvents;
• oils and lubricants;
• sweating, often aggravated by wearing latex gloves worn for a long time;
• dry skin from exposure to hot or cold environments.

Other factors that can cause eczema to worsen include.

• Stress. For some people, allergies develop or worsen during stressful events. This is due to the release of a large number of stress hormones that support inflammation and change the response of the immune system.
• Fungal infections of the nails and feet – they can also lead to allergies on the hands.

Hand allergy symptoms in adults

Allergic eczema can appear on any part of the body, especially in the folds of the skin in the elbows and under the knees. However, there is a form of allergy that only affects the hands and sometimes the feet as well. Earlier it was called “dyshidrotic eczema” or “pompholyx”, today it is called acrodermatitis.

This form of allergy is often exacerbated, has a cyclical course, varying significantly in different people, both in the length of the cycle and in the length between acute episodes. Some people think that skin rashes are contagious. But it is not an infection, so it cannot be passed on to other people. Sometimes it is very difficult to understand what is happening with the skin of the hands, whether it will be “allergic” or “irritant” contact dermatitis. Often a combination of all these conditions is formed.

In the acute phase, the allergy can be very irritating, the skin turns red and itchy, there is a burning sensation and severe dryness. Allergy on the hands has an acute, recurrent and chronic phase.

Acute hand dermatitis is characterized by:

• red spots, papules (tubercles) and plaques;
• swelling of the skin;
• blisters and weeping, crusting;
• cracks.

Features of chronic hand dermatitis include:

• dryness and roughness of the skin;
• rough crusts;
• skin lichenification (thickening, manifestation of skin pattern, scales).

There are various causes and clinical manifestations of allergic dermatitis on the hands.

Atopic hand dermatitis. It depends on the constitutional weakness of the barrier function of the skin and is triggered by contact with irritants. It can occur on one or both arms, on the back of the hands. Red plaques of a rounded shape appear on the skin. Patients may also have eczema elsewhere, including the feet, forearms, and skin folds.

Numular dermatitis (discoid eczema) usually affects the dorsum of the hands and fingers in the form of round weeping plaques. Other areas of the body may not be affected.

Vesicular dermatitis hand is also known as pompholyx, dyshidrotic eczema. Severely itchy clusters of flesh-colored blisters occur on the palms and sides of the hands and fingers. Similar symptoms often occur on the legs. It is likely that this form of dermatitis is caused by emotional stress and increased sweating (hyperhidrosis) due to exposure to allergens.

Chronic recurrent vesiculosquamous dermatitis. This form is a common pathology of the palms and fingers, in which blisters are accompanied by chronic peeling and cracks.

Dermatitis of the fingertips. Digital dermatitis can be limited to one or more fingers.

True allergic contact dermatitis. Allergic contact dermatitis can be difficult to distinguish from other forms of hand dermatitis and irritant contact dermatitis. There are about 30 common allergens and more than 100 rare ones. Common allergens include nickel, fragrances, latex (with gloves), and p-phenylenediamine (permanent hair dye).

Manifestations depend on the allergen, but may include:

• periodic outbreaks after contact with the allergen, occurring over a period of several hours to several days;
• irregular, asymmetric distribution of the rash;
• a sharp, delineated border of rashes (for example, on the wrist, corresponding to the cuff of a rubber glove).

In general, allergic rashes look like:

• small blisters or blisters under the skin;
• cracks and weeping;
• dryness and flaking of the skin;
• burning and severe itching.

Hand allergy treatment in adults

Dealing with hand allergies can be difficult, especially when rashes come and go on their own, no matter what treatment is used. Unfortunately, there is no way to stop allergies permanently, but there are many measures that can be taken to prevent flare-ups. There is no universal treatment that will help all patients. In many ways, tactics depend on the specific diagnosis and form of rashes.

Diagnostics

Allergic dermatitis is usually easy to diagnose and classify based on history and physical examination, given:

• acute, recurrent or chronic course;
• a past history of skin diseases and allergies;
• dermatitis on other parts of the body.

The differential diagnosis includes:

• psoriasis (symmetrical, well-circumscribed, red, scaly plaques);
• herpes zoster (unilateral or asymmetric, peripheral scale).

Patients with chronic hand dermatitis may need skin testing to detect contact allergens. Needle biopsy and skin scraping (for evaluation under a microscope) may be needed to rule out other causes of hand inflammation.

Modern treatments

Patients with all forms of hand allergies should be especially attentive to skin care.

• Minimize contact with irritants (even water). When washing your hands, use a detergent without harsh soaps, rinse thoroughly and make sure your hands are completely dry. Please note that cream cleansers are not antimicrobial.
• Completely avoid touching allergens that have been identified by skin testing.
• Apply thick emollients before work and reapply after washing or when the skin dries out (this can be up to 10 to 20 times a day).
• Wear protective gloves. Vinyl gloves are less allergenic than rubber and latex. They must be disposable. If you are wearing reusable gloves, they should not have holes. They should not be worn for a long time. Skin sweating under gloves exacerbates dermatitis. Lined gloves or inner cotton gloves enhance comfort.

With exacerbations, medications can help. Steroid creams or ointments reduce inflammation. Use stronger steroid creams for dermatitis on the back of the hands and less concentrated ones on the palms. A cream formulation is usually best for vesicular (acute) hand dermatitis, and an ointment for chronic dermatitis. They should be applied to areas of active dermatitis once or twice a day for several weeks, then stopped gradually, mixing half, then two-thirds with regular baby cream.

Calcineurin inhibitors (tacrolimus and pimecrolimus) have some evidence of efficacy in hand eczema and may be used as an alternative to steroid medications. But only a doctor prescribes any kind of medicine.

A secondary bacterial infection, which often occurs with scratching and cracking of the skin, may require an oral antibiotic.

Severe acute flare-ups of hand dermatitis are treated with prednisone (systemic steroids) for 2 to 4 weeks. Chronic, difficult-to-treat hand dermatitis can be treated with second-line drugs such as Azathioprine, Methotrexate, Cyclosporine, Alitretinoin, or phototherapy.

Prevention of hand allergies in adults at home

An important part of hand allergy prevention is taking care of your skin, both at work and at home. It should include:

• regular use of moisturizers;
• use of hypoallergenic soap in the shower and when washing hands;
• limiting the number of wet work and hand washing;
• if possible, hand washing in cool, not hot water;
• wearing gloves to protect yourself from skin irritants.

However, be aware that occlusive gloves (tight fitting, waterproof) can cause overheating of the hands and sweating. Cotton gloves on the bottom can be more useful than rubber ones, and it’s important to change them regularly.

Popular questions and answers

Regarding hand allergies and their treatment, we spoke with general practitioner, endoscopist, head of the organizational and methodological office Lidia Golubenko.