Hand eczema presents on the palms and soles, and may sometimes be difficult or impossible to differentiate from atopic dermatitis, allergic contact dermatitis, and psoriasis, which also commonly involve the hands. : 78   Even a biopsy of all these conditions may not result in a definitive diagnosis, as all three conditions may demonstrate spongiosis and crusting on the hands. : 78 Non-communicable inflammation of the skin of the hands is referred to as hand eczema. Hand eczema is widely prevalent and, as it is a very visible condition associated with severe itching or pain, has serious consequences for the affected person including a high psychological impact. Different disease patterns can be identified according to the course of the illness, appearance of symptoms, degree of severity, or catalysts. Prognosis is hard to predict for individual cases of chronic hand eczema and usually differs from patient to patient. Successful treatment depends on determining the causes of the condition, obtaining an accurate diagnosis, sustainable hand protection procedures and an early, extensive, and where appropriate internal treatment. Signs and symptoms
Normally, skin inflammation connected with hand eczema is accompanied by blister formation and pronounced itching, but solid calluses and painful tearing may also occur. The quality of life of the affected person is seriously diminished, especially in the case of chronic forms of the illness, and psychological impact is often very high. This impact is enhanced by the high visibility of the illness on the hands, which may lead to feelings of shame and fear of rejection.
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.