Contact allergies in certain types of employment are especially problematic, particularly if the work involves the handling of allergenic materials, e.g. masonry work or hairdressing. People allergic to Balsam of Peru may experience a flare-up of hand eczema if they use or consume products that use it as an ingredient.Severe and chronic eczema qualifies as one of the most frequent occupational illnesses. Patients should therefore be referred to an occupational-dermatological specialist as soon as possible. Patients with a history of neurodermitis, hay fever, or allergic asthma often develop hand eczema. These sicknesses reflect the individuals particular susceptibility or genetic predisposition to react over-sensitively to various environmental influences. This is described as atopy or atopy diathesis. Atopic diathesis is frequently accompanied by genetically conditioned problems with the skins protective barriers, which causes a weakening of the skins resistance against irritating substances and moisture, as well as easier penetration by allergens, which may lead to the development of contact allergies. Differences according to prevailing signs of skin illness (morphology)
The clinical appearance of various subtypes of hand eczema differs. The term dyshidrotic hand eczema is used to describe formations that mainly exhibit pronounced, itching blister formations, while callus and tear formations typically indicate hyperkeratotic fissured hand eczema. Differences according to degree of severity and course
Independent of the triggering cause or the prevailing signs of skin illness, the selection and planning of treatment options is important, since different types of illness also differ in terms of their degree of severity and the course of the illness.
Besides skin care, hand protection, and external (topical) applications with preparations containing effective ingredients or light therapy, an internal (systemic) therapy may be considered. Avoidance of catalysts, basic procedures, and skin protection
Of primary importance is the strict removal and avoidance of catalysts for the development of chronic hand eczema, such as skin-irritating damage, excessive contact with water, or proven allergenic substances. Treatment of every type of hand eczema and degree of severity must include sustainable replenishment of the natural oils and moisture contained in the skin with creams and salves free of fragrances and preservatives; this is an essential basic step. In addition, protection procedures developed especially for the individuals skin stresses must be applied, e.g. use of cotton or hypoallergenic plastic gloves. Depending on the individuals own needs, these procedures should continue after the hand eczema heals, since they will also have a preventive effect. External treatment
External treatment should be oriented primarily according to the prevailing signs of illness. In the case of blister forming, drying treatments such as hand baths containing synthetic tannins or oily-moist preparations may hinder itching. If callus development exhibiting tear formation is present, the focus should be on softening the skin with preparations containing urea or salicylic acid. In order to reduce inflammation, creams and salves containing cortisone are often very effective. Topical corticosteroids are a standard treatment for hand eczema, but their efficacy in comparison to UV phototherapy is not clear.