Section 2.4 Eczema

Eczema: Is it different from dermatitis?

Eczema is an inflammatory skin condition and is one of the most common skin conditions, which affects both adults and children.

Sometimes people use the words ‘dermatitis’ and ‘eczema’ to mean the same thing, which can be confusing.

For the purpose of this manual, we like to say that ‘eczema’ comes from within the body and ‘contact dermatitis’ from outside the body. Sometimes it is very difficult to know the difference between hand eczema and allergic or irritant contact dermatitis just by looking at the skin. Sometimes there may be a combination of all these conditions occurring at one time.

Eczema may be referred to as ‘endogenous eczema’.

Eczema may affect all areas of the body, especially the skin folds in the inner elbows and behind the knees. However, there is a form of eczema which affects the hands and occasionally the feet as well. This is referred to as ‘hand eczema’. It was formerly called ‘dyshidrotic eczema’ or ‘pompholyx’. This form of eczema often comes and goes in cycles, which vary both in the length of the cycle and the length between episodes.

It is often thought by some people that eczema is contagious but it is not, therefore it cannot be passed onto other people.

Eczema is often associated with asthma and hay fever and tends to run in families. People with a history of eczema, even in infancy, are at higher risk of developing skin problems related to their work, particularly irritant contact dermatitis and contact urticaria. People with a history of eczema need to be vigilant about looking after their skin, particularly if they have contact with skin irritants at work and at home.

What does hand eczema look like?

• Little bubbles or blisters under the skin
• Cracks and splits
• Dryness and flaking
• The skin may also be itchy Example of hand eczema

Aggravating factors in hand eczema

There are many factors that may cause or worsen existing eczema. These include:

Contact with skin irritants such as:

• Water, especially frequent wetting and drying of the hands
• Soaps, detergents and shampoos
• Household cleaning products
• Paper toweling
• Solvents
• Cement
• Oils and grease

Other irritants or factors:

• Sweating, often aggravated by wearing (occlusive style) gloves for long periods of time
• Heat, from exposure to hot or warm environments
• Stress may cause eczema to flare in some individuals
• Sometimes severe inflammatory tinea or fungal infection of the feet may cause a rash that looks like hand eczema

Managing eczema

Managing hand eczema can be difficult, especially when it may come and go by itself, no matter what treatment is being used.

Unfortunately there is no way to stop a person from experiencing hand eczema, but there are many measures that can be used to control it. There are no treatments that help all sufferers. Sometimes trial and error is used to work out what is best for the individual. No diets have been found to reliably help.

A crucial part of managing hand eczema is to follow a good skin care routine both at work and home. Patients should be encouraged to:

• Use moisturising cream regularly (fragrance free is best)
• Use a cortisone ointment when eczema flares (apply cortisone and allow to sink in, then apply moisturizer over the top).
• Use a soap substitute at home, and at work if appropriate
• Limit the amount of wet work and hand washing performed
• If possible, wash hands in cool not hot water
• Wear appropriate gloves to protect the skin from irritants. However, beware that occlusive glove (tight-fitting, waterproof type gloves) may cause heat and sweating. Cotton gloves underneath are helpful. These should be changed regularly.

Recommended reading

https://dermnetnz.org/topics/atopic-dermatitis