OVERVIEW

What is chronic hand eczema?

Hand eczema is an inflammatory skin condition affecting the hands, while chronic hand eczema refers to cases that persist for more than 3 months or recur at least twice within a year.

It may present as redness, papules, peeling, blisters, thickened skin with lichenification, and in severe cases, cracking and erosion of the skin.

Treatment primarily involves avoiding suspected triggers and irritants, followed by topical corticosteroids. For severe or refractory cases, oral steroids, immunosuppressants, or phototherapy may be considered.

Is chronic hand eczema common?

It is a relatively common occupational skin disorder, with a prevalence of approximately 4%–10%.

Among occupations involving frequent "wet work," such as healthcare workers, hairdressers, homemakers, and food handlers, the incidence can reach as high as 40%.

Which department should I visit for chronic hand eczema?

Dermatology.

SYMPTOMS

What are the common manifestations of chronic hand eczema?

• In the acute phase, hand eczema typically presents as erythema, edema, exudation, and blister formation. Unlike the exudative features of acute eczema, chronic hand eczema exhibits chronic manifestations, often including erythematous papules, desquamation, thickening, and fissures on the skin of the hands.
• Lesions are usually bilateral and may involve the fingers, palms, or back of the hands separately, or the entire hand. Many patients also experience changes in their nails.
• Patients often suffer from varying degrees of itching, burning, or tingling sensations, which can severely impact daily life, work, and sleep.

What serious consequences can chronic hand eczema cause?

• First, eczema itself can cause discomfort such as itching and pain, affecting daily life, study, and work.
• Second, due to its location on the hands, it may impair aesthetics and negatively impact the patient's social interactions.

CAUSES

What are the causes of chronic hand eczema?

The pathogenesis is complex and is currently considered to result from the interaction of genetic and environmental factors.

• First, patients often have a susceptibility to hand eczema, which can be understood as having this "constitution," with poor epidermal barrier function and compromised epidermal integrity.
• Second, exposure to wet work and irritants is considered a trigger for chronic hand eczema, such as frequent contact with water, the use of detergents like soap, or exposure to building materials and soil. Wet work does not refer to the folk concept of "excessive dampness" but rather to occupations where repeated hand washing leads to severe loss of skin lipids, and exposure to irritating detergents, which may also act as allergens for highly sensitive individuals.
• Additionally, some patients may develop hand eczema due to allergic reactions to certain substances.

Who is prone to chronic hand eczema?

• People frequently engaged in wet work are more susceptible, such as healthcare workers, hairdressers, food processing workers, and homemakers.
• Furthermore, those regularly exposed to irritants, such as detergents, chemicals, aromatic plants, construction materials, dust, or soil, are also at higher risk.

Is chronic hand eczema contagious?

No.

Is chronic hand eczema hereditary?

Current research suggests that individuals with chronic hand eczema have genetic predispositions linked to loss-of-function mutations in the filaggrin gene, which may be inherited.

DIAGNOSIS

How is chronic hand eczema diagnosed?

An experienced dermatologist can diagnose it by reviewing the patient's medical history, symptoms, occupation, exposure history, and observing the rash.

Supplementary mycological tests can rule out fungal infections, while patch testing helps identify potential allergens. A skin biopsy may be performed if necessary to exclude other conditions.

Why are these tests needed for chronic hand eczema?

• To rule out fungal infections (tinea manuum), mycological tests are often conducted. These include microscopic examination and fungal culture, which involve scraping scales from the lesion edges—a painless, non-invasive procedure.
• Fungal microscopy allows doctors to directly observe fungal elements under a microscope, with results available in about 20 minutes.
• Fungal culture identifies specific fungal species but takes longer (2–3 weeks).
• Patch testing helps detect potential allergens. Patients must stop oral antihistamines for at least 3 days beforehand. This non-invasive test involves applying patches to the back for 48 hours, with results read 24 hours after removal. Avoid water contact and sweating during this period.
• A skin biopsy may be required to exclude other conditions. This invasive procedure involves surgically removing a small skin sample for pathology, followed by sutures and wound care until stitch removal.

What conditions are easily confused with chronic hand eczema?

• Tinea manuum (hand fungus): Worsens in summer and improves in winter, presenting as ring-shaped or semicircular red patches without oozing, usually affecting one hand. Fungal tests are typically positive. In contrast, eczema worsens in winter, shows polymorphic rashes (redness, papules, oozing, lichenification), often symmetrically affects both hands, and yields negative fungal tests.
• Palmoplantar pustulosis: Features recurrent sterile pustules on palms/soles, usually without occupational triggers. A biopsy confirms diagnosis. Chronic hand eczema rarely presents with pustules but often links to wet work or allergen exposure.

TREATMENT

Is treatment necessary for chronic hand eczema?

Treatment is recommended for chronic hand eczema, as failure to actively treat or incorrect treatment may lead to disease progression and persistence.

What are the treatment methods for chronic hand eczema?

• First, patient education is essential:
  • Detailed understanding of the patient's occupation and exposure history to specific substances is required. Avoid contact with suspected triggers and irritants, including water, detergents, soil, construction materials, etc.
  • Minimize water contact in daily life, avoid hot water washing, and reduce the use of soap.
• Daily skin protection should be strengthened:
  • Wear gloves when performing wet work or handling irritants. Keep hand cream readily available and apply it multiple times a day, especially after washing hands.
• For topical medications, mild to moderate cases are typically treated with first-line corticosteroid creams (commonly referred to as steroid creams), such as Eloson or Halometasone. Initially, apply 1–2 times daily, then gradually reduce usage as the rash improves and stabilizes. Frequent use of moisturizers is also recommended. For patients resistant to corticosteroid creams, topical calcineurin inhibitors like tacrolimus or pimecrolimus may be prescribed.
  • For severe or refractory cases, oral corticosteroids or immunosuppressants like methotrexate may be added.
  • For severe or refractory hand eczema patients who have contraindications to oral corticosteroids or refuse them, localized narrow-band UVB phototherapy or oral/topical psoralen plus UVA therapy is recommended. The phototherapy regimen involves 2–3 sessions per week for at least 12 weeks.

How long does it usually take to treat chronic hand eczema?

Chronic hand eczema often has a prolonged course and is prone to recurrence, so treatment generally requires long-term maintenance.

What are the common side effects of medications for chronic hand eczema?

Topical corticosteroid creams are relatively safe when used properly and maintained for maximum efficacy.

Adverse effects usually occur with long-term or improper use and may include skin thinning, telangiectasia, hyperpigmentation, and increased risk of infection.

• Topical calcineurin inhibitors are also widely used, but their main side effects include redness and burning sensations during initial treatment. Long-term use may slightly increase the risk of lymphoma (limited evidence).
• Oral medications may have more side effects, such as:
  • Potential gastrointestinal irritation;
  • Possible impact on liver and kidney function, requiring regular monitoring;
  • Immunosuppressants like corticosteroids may increase infection risks. Therefore, the decision to use oral medications and their administration should be evaluated and guided by a dermatologist.
• Phototherapy is generally an adjunctive treatment and may cause skin redness, peeling, or blisters. Long-term use may contribute to photoaging and, rarely, skin cancer (limited evidence).

Can chronic hand eczema be completely cured?

Chronic hand eczema is difficult to cure completely, as it tends to have a long course and frequent recurrences.

Is chronic hand eczema prone to recurrence?

Chronic hand eczema is prone to recurrence due to genetic predisposition and environmental factors such as prolonged wet work or repeated exposure to irritants, leading to frequent flare-ups in many patients.

DIET & LIFESTYLE

What should patients with chronic hand eczema pay attention to in their diet?

Avoid spicy, irritating foods, alcohol, and tobacco as much as possible. Reduce seafood intake when itching is severe.

What should patients with chronic hand eczema pay attention to in daily life?

• First, carefully identify potential triggers of eczema in daily life. For example, frequent exposure to wet work, detergents, or various chemical and physical irritants should be avoided. If contact is unavoidable, wear protective gloves.
• Second, maintain proper hand skin care. Wash hands less frequently, minimize water exposure, and reduce the use of soap.
• Additionally, apply hand cream or moisturizing ointment multiple times a day, especially after washing hands.

PREVENTION

How to Prevent Chronic Hand Eczema?

• Healthcare workers, hairdressers, homemakers, and other workers frequently exposed to wet conditions or irritating substances should wear gloves while working.
• Enhance skin moisturization by applying hand cream multiple times to form a protective layer on the skin surface, reducing the likelihood of hand eczema.