Section 2.4 Eczema

Eczema: Is it different from dermatitis?

Eczema is a common inflammatory skin condition which affects both adults and children. Atopic eczema, also called atopic dermatitis, is the most common form of eczema. 

For the purpose of the Patch Test Certificate, we refer to ‘eczema’ as coming from within the body and ‘contact dermatitis’ from outside the body. Sometimes it is very difficult to differentiate between causes of eczema such as atopic eczema or  hand eczema and allergic or irritant contact dermatitis by examining the skin. Sometimes there may be a combination of all these conditions occurring simultaneously.

Atopic eczema may also 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 another form of eczema which affects the hands and occasionally the feet as well. This is referred to as ‘hand eczema’,  or hand and foot eczema also called ‘dyshidrotic eczema’ or ‘pompholyx’ or vesicular hand dermatitis. 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.

Atopic eczema is often associated with asthma and hay fever and tends to run in families. People with a history of atopic 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 atopic 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?

Figure 1 – Example of hand eczema

• Localised little bubbles or blisters under the skin (called vesicles)
• Cracks and splits
• Dryness and flaking
• Swelling and weeping

 

 

Aggravating factors in eczema

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

Skin irritants such as:

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

Other factors including:

• Sweating, often aggravated by wearing (occlusive) 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 (fungal infection) of the feet may cause a rash that looks like hand eczema

Managing eczema

Managing hand eczema can be difficult, especially when symptoms are intermittent in nature regardless of 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 moisturiser over the top).
• Use a soap substitute at home and at work if appropriate
• Limit the amount of wet work and hand washing performed (where possible)
• 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