Eczema palms

Palm eczema is a common, often chronic disease that has many causal and contributing factors.

Eczema palms can be attributed to categories such as irritant eczema; exfoliative eczema; atopic eczema; eczema of fingertips; allergic eczema; hyperkeratotic eczema; coin-like eczema; dyshidrotic eczema; simple chronic lichen and "id" - a reaction. Each of these types is considered separately. Irritant eczema of the palms is the most common type, followed by atopic eczema of the palms. Allergic contact dermatitis is the cause of palmar eczema in about 10-25% of cases.

[1], [2], [3], [4]

Causes and pathogenesis of eczema of the palms

Women are sick more often than men. Occupational risk factors include contact with chemical irritants, work in a humid environment, chronic friction and work with sensitizing (allergenic) chemicals.

[5], [6], [7], [8], [9]

Exogenous factors of eczema of the palms

Irritants include chemicals (such as solvents, detergents, alkalis and acids), friction, cold air and low humidity. Allergens can have work related and non-related sources of allergenic exposure. Immediate type I allergy may include reactions to latex and food proteins, and a more common delayed type IV allergy may include reactions to rubber additives, nickel, medicines (bactracine, neomycin and hydrocortisone) and common chemical ingredients in personal care products (such as preservatives, flavors, sunscreens and other additives). A certain role can also play food allergens. In infections, there may be "icb-reactions, including eczema of the palms, as a reaction to a distant foci of fungal or bacterial infection.

[10], [11], [12]

Endogenous factors of eczema of the palms

Atopic diathesis (hay fever, asthma, atopic eczema) is often a predisposing factor and may contribute to susceptibility to the disease and the chronization of the process, despite appropriate treatment and precautions.

[13]

Symptoms of palmar eczema

Care should be taken to examine all skin in search of diagnostic keys and disease-promoting factors, as well as to exclude other dermatoses (eg, psoriasis). This state is variable; acute, subacute and chronic eczematous changes are observed. Although the association between the clinical picture and the etiology can not be established with sufficient degree of reliability, some of the signs may be useful: xerosis, erythema, burning on the back and inner surfaces of the palms make suspect the irritants. Coin-like eczema, the back surfaces of the palms and fingers indicate the possibility of allergy, irritation or atopy; sometimes the culprit is contact urticaria (type I allergy). Abundant, recurring, intensely itching vesicles on the lateral surfaces of the fingers and palms may indicate dyshidrotic eczema. When eczema of the fingertips (dryness, splitting, soreness, lack of itching), think about the presence of an irritant, an endogenous factor (atopy in winter) or frictional eczema. In the presence of erythema, flaking, itching in the base of the fingers can be assumed atopy.

If it is possible to determine with what irritants or allergens the patient contacted and eliminate this contact at the very beginning of the disease, the prognosis of a full recovery will be good. Continuous or prolonged contact with irritants and allergens can lead to a chronic process. Abstinence from contact with provoking factors and appropriate care often improve the condition, but in some patients the disease does not go away completely.

Treatment of eczema of the palms

Treatment of palmar eczema involves the identification of irritant factors that should be avoided. Such factors can be frequent hand washing and the effects of water, soaps, detergents and solvents. Injury due to chronic friction is also an irritating factor that can lead to chronic recurrent dermatitis. Take protective measures (for example, vinyl gloves to work with water or chemicals). Assign topical corticosteroids of average strength of action (group II-IV) twice a day. Ointments are preferable to creams. It is possible to apply occlusion under a polyethylene film. If dermatitis is not severe, abstinence from the appointment of very strong corticosteroids (group I). Topical corticosteroids for dermatitis of the hands are more effective if they are prescribed not continuously, but with interruptions.

In case of severe dermatitis, a topical corticosteroid with a very high pharmacological efficacy is used after moist compresses with Burov's solution twice a day for the first 3-5 days of treatment, after which a medium strength corticosteroid is given twice a day for several weeks. You can designate a hand bath with Balneotar oil. Two or three caps of oil are dissolved in a bowl of water and immerse hands for 15-30 minutes. The procedure is carried out 2 times a day. After it, a topical corticosteroid is used.

Systemic steroids (prednisone 0.75-1 mg / kg / day with a gradual dose reduction for 3 weeks) may sometimes be needed to control severe and acute inflammation. The condition of most patients improves if irritants are eliminated, topical corticosteroids are treated and regular and often using emollients. If there is a suspicion of allergies (swelling of the palms, vesicles, itching and especially if the back of the palms is injured or the eczema of the fingertips takes place), a patch test should be carried out to determine the allergens causing or supporting the disease. In the material for testing, it is necessary to include allergens corresponding to the professional occupations of the patient. In case of chronic torpid disease the patient should be under the control of a dermatologist. Other treatments for palmar eczema include the use of psoralen topically in combination with ultraviolet irradiation treatment of band A and surface short-focus X-ray therapy. In cases of disability, low doses of methotrexate (5-15 mg weekly) or daily low doses of cyclosporine are administered weekly.