Hand dermatitis: Determining cause is first step in treatment

March 1, 2008

For many of the conditions, available treatments control rather than cure the problem. But before deciding on treatment, the most important step for the dermatologist is to determine the cause of the condition.

Key Points

Dr. Bikowski says the most common causes of hand dermatitis are:

1) Atopic dermatitis

3) Dyshidrosiform eczema

The most common presentation is an eczematoid eruption (dermatitis) - an itchy, red, scaling rash, which may involve either the dorsum or the volar surfaces of the hands, fingers or both, he says.

A person's atopic history may indicate an increased predisposition to hand dermatitis.

"If the cause is a irritant, identifying the exogenous cause is also key, because if you can remove the precipitating event ... then it's easier for treatment to succeed," Dr. Bikowski tells Dermatology Times.

Whatever the source of the dermatitis, he says all the patients have skin barrier dysfunction.

"All of the causes of dermatitis compromise the skin barrier function. So, no matter what the cause, when you talk about therapy, the first thing we have to talk about with the patient is skincare."

Repairing the barrier

"Currently, several products are available designed to help restore the skin barrier function by replacing missing ceramides in the stratum corneum," Dr. Bikowski says.

Among them, CeraVe (Coria Laboratories) comes as a cleanser, a lotion and a cream, and is available over the counter (OTC). It's been available for a little more than a year.

ProDerm Technology from Quinnova is a foam. The company is currently applying for Food and Drug Administration (FDA) approval for its use as a moisturizer.

TriCeram from Osmotics Pharmaceuticals is another option.

Also, Elizabeth Arden offers a number of OTC products containing ceramides.

Dr. Bikowski says that it helps to give the patient a topical anti-inflammatory.

"That's usually going to be a topical corticosteroid. Routinely, I use either clobetasol ointment, which is generic, or Vanos (a fluocinonide cream 0.1 percent), which is a brand name, high-potency steroid manufactured by Medicis," he says.

In addition to these combination treatments, Dr. Bikowski advises using a hand protectant such as TheraSeal (Coria Labs).

If the skin presents with a lot of weeping and oozing, Dr. Bikowski urges performing a culture to ensure that no secondary bacterial infection is involved.

"In severe cases, it may be necessary to give prednisone by mouth. My preference is prednisone, 30 mg each morning for 10 days, 20 mg each morning for 10 days, then 10 mg each morning for 10 days."

The final step is to create a physical barrier. Both latex and vinyl gloves may serve the purpose, but the latex may cause allergic reactions.

Dr. Bikowski recommends donning white cotton gloves and the latex or vinyl gloves over them to absorb perspiration.

"Patient compliance is imperative for a successful result, and that's not always easy to obtain," Dr. Bikowski says.

Disclosure: Dr. Bikowski has a vested interest in Coria Labs, Quinnova and Medicis.