Eczema, a word of Greek origin, can be translated into Turkish as “boiling”. In eczema, the skin resembles the bubbling of boiling water. In some regions, small water-filled bubbles in eczema are likened to small air bubbles formed in a dough that is fermented, and the disease is also called “yeast”. Eczema located on the hands is a very common skin disease in the society. It presents with dryness, redness, dandruff, blisters and watering on the hands. It can develop after the hands of people who are prone to develop a skin reaction are exposed to various issues. Skin irritation may develop after contact with water, dry air, soap, detergent, chemical matters, rubber gloves, personal care items. Even harmless baby artifacts, even water, can cause the disease to progress.
Types according to the causes of hand eczema
According to the causes of the disease, it can be examined in two most important clusters, internal and external. Intrinsic eczema is called atopic eczema (which is genetically related to allergic predisposition), kneehydrotic eczema (often in the form of pinhead-sized water bubbles), numular eczema (occurs in the size of a coin). Extrinsic ones are skin responses triggered by contact allergen. Depending on external causes, it can occur in hand eczema, allergic contact eczema or irritation contact eczema. Photosensitive eczema (eczema that develops due to sensitivity to light) can develop due to both internal and external causes. In addition, apart from these two reasons, neurodermatitis that develops only by scratching can also cause hand eczema.
Who is it seen in? Who is in the increased risk cluster?
Although the disease can be seen all over the world, it can be seen more frequently especially in individuals who are hereditary prone to skin reaction. A history of hay fever, asthma and food allergy can be detected in these individuals. Cleanliness can be encountered more frequently in people who deal heavily with dishes, in professions such as bakery personnel, hairdressers and brick workers, who are exposed to irritation and allergic elements due to their work, in occupational clusters such as dental technician, doctor, nurse, and those who deal with cement and paint work. The hobbies of the person are as valuable as his profession. The materials that individuals who deal with painting, model, gardening etc. come into contact with during their hobbies should also be questioned. It may also develop due to cortisone creams used for treatment in some individuals.
Eczema clinical picture and stages
In the acute (onset) phase of eczema, numerous water-filled blisters on a red and swollen base and their rapid opening, watering and crusting occur. In the subacute period (developing after the acute period), numerous dandruff and crusting are observed in a slightly reddened area. The dandruff is in the form of small rings, especially at the edges. In the chronic (advanced) period, the skin thickens, dandruff is evident on it, clefts may develop. Depending on the cause of the disease, it may progress in different periods and itching may occur at any time.
The elements that we use and encounter in our daily lives can be a cause or exacerbation of the disease. Some drugs and sun rays can trigger the disease, especially in eczema that develops due to sensitivity to light. Occupationally, contact with oily artifacts and metallic liquids and cooling materials can cause irritation.
How does eczema affect quality of life?
Itching can significantly affect patients’ quality of life. In addition to negatively affecting daily life, it can cause problems in children’s school lives and adults’ business lives.
How is eczema diagnosed?
For a definitive diagnosis, a detailed history is taken from the patient by the physician. In order to evaluate the responsible elements in the story, a patch test is performed.
Irritation contact eczema can be easily diagnosed by knowing what factors cause it and how often it causes it on your skin.
The diagnosis of allergic contact eczema is made by patch tests performed in the section of skin and venereal diseases. Standard prepared allergen issues and suspected items from materials that patients come into contact with are adhered to your back in small patches. It opens two days later, the doctor and nurse look at your back and decide which issue is the reaction. The same area is reassessed 24-48 hours later to finalize the irritation and allergic response and evaluate possible prolonged allergic responses. In addition, the diseases considered in the differential diagnosis are investigated by history, physical examination and various methods.
What research systems are recommended for differential diagnosis?
In order to exclude fungal diseases that are located in the hand, microscopic and microbiological examinations can be used to search for fungi after the scraping method. Pathological evaluation can be made by taking a biopsy to exclude various skin diseases, if necessary. Laboratory and radiological examinations can be performed for conditions accompanying internal diseases.
What are the ways of treatment?
-The basis of treatment is to avoid contact with the agent by revealing the cause. It can be difficult at times to stay away completely.
Prolonged contact with water and soap causes the loss of the natural protective layer of the skin. Moisturizing and barrier creams recommended by your doctor can help in this regard. Barrier creams and foams can physically prevent agents from entering the skin. However, it can be disturbing if the content is oily and creates a thick layer.
-People with a long-term disease may require treatment for several months. Topical steroid creams are used to improve itching and redness, and to beautify the skin. Topical steroid creams should be used as recommended by the physician in order to see their full effect and not develop side effects. If the watering is excessive in the disease, wet dressing application with the drugs recommended by the doctor, and if the thickness is evident, treatments that dissolve the skin may be on the agenda.
– If the disease is very severe, steroids can be given by mouth, vein and muscle applications other than the skin.
If there is no response to these treatments, other treatment options such as pimecrolimus, cyclosporine, methotrexate and phototherapy can be applied.
– If there is a secondary infection to the disease, appropriate treatment should be done.
Before starting the treatment, the physician should be informed about pregnancy, breastfeeding, internal diseases, and drugs used systematically for different reasons.
What are the preventive measures?
Reducing contact with irritation and allergy-causing situations is one of the most valuable measures. For this, the following warnings should be heeded.
-It is the use of auxiliary supplements for cleaning, dishwashing, child care, or the use of dishwashers and washing machines.
-The use of short-term prophylactic gloves is valuable. It should not be forgotten that the use of gloves for a long time can increase sweating. It will be appropriate to wear cotton gloves inside the gloves.
– If the doctor recommends, barrier and moisturizing creams should be applied.
Wearing gloves for a short period of time during shampooing will reduce the negative effects of weak irritants on the skin.
-During applications for toilet cleaning, the contact of your hands with detergent should be cut off.
It is recommended to wash hands with non-perfumed soap.
-Direct hand contact with items such as tomatoes, oranges and lemons should be avoided.
Avoiding and protecting possible allergens during hair dyeing is valuable.
– It is better to wash hands with warm water instead of hot or cold water.
-Removing the rings while working will reduce the irritant elements that may remain under the rings.
– If you have hobbies such as painting, flower models, etc., the issues you use during these processes should be questioned.
– If an occupational eczema is considered, a short-term job change may be on the agenda with the recommendation of the physicians, if there is a permanent problem.