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Eczema Guide
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Endogenous Hand and Foot Eczema
Irritant Contact Eczema
Lichen Simplex
Seborrhoeic Eczema
Venous Eczema


Endogenous Hand and Foot Eczema

Adult hand eczema is the most complicated type of eczema to diagnose because there are several different types and these often co-exist It is more debilitating than eczema on other body areas because we do so much with our hands. When assessing someone with hand eczema, the doctor needs to know what they do with their hands every day - at work, at home and in relation to hobbies- in order to decide if there are external or contact factors that could be important. For example, someone who develops hand eczema after retiring and notices that their hands get worse the day after doing a lot of gardening could have developed an allergy to plants. It can be very difficult to say whether a contact allergy is causing hand eczema, and so patch tests should be considered.

The skin on the soles of the feet is very similar to the palms, so eczema that affects one of these sites often affects the other. Several different patterns of endogenous (constitutional) hand and foot eczema are recognized, as detailed below.

Pompholyx (blistering) hand and foot eczema

This is an intensely itchy form of eczema with lots of fluid-fined blisters. These usually appear on the sides of the fingers or feet, and tend to be worse in hot weather. The cause is not known, but it may be related to increased sweating. The blisters are usually small at first, like tiny beads, but they can join together and sometimes reach the size of a fingernail. When there are many weepy blisters, it may be helpful to dry the skin by soaking in a mild antiseptic such as a dilute solution (1 in 10,000) of potassium permangonate. Strong steroid creams are usually needed to settle the inflammation and itch, or in severe cases, a short course of steroid tablets.

Hyperkeratotic (thick skin) hand and foot eczema

This type of eczema causes thick, hard areas of skin on the palms and soles of the feet. The centre of the palms and heels are commonly affected, and the thickened skin often has deep surface cracks or fissures. These are very uncomfortable when the skin moves, causing pain on walking and when doing tasks with the hands. It can be helpful to apply a hypoallergenic tape to close the cracks, and a special tape that contains a strong steroid can be obtained on prescription. Moisturizers with added ingredients, such as lactate and urea, can help to soften the brittle hard skin and reduce cracking. Weak, topical steroids are usually ineffective on the thick skin of the palms and soles, so stronger steroids are often prescribed. These can work better if applied for a few weeks under an occlusive dressing. 'Occlusion' or covering the skin makes' it moist and soft, which allows treatment to get through more easily (just think how soggy and soft the skin on your finger gets if it is covered with a sticking plaster for a day). Cling film can be used as a home-made occlusive dressing and kept in place over night with surgical tape and cotton gloves or socks. This helps to trap moisture in the skin and allows treatment to work more effectively.

Fingertip eczema

Some people are prone to get sore, cracked skin on the fleshy pulps and tips of their fingers. Sometimes the affected skin peels away, leaving delicate skin exposed. At other times the skin gets herder and sufferers complain that they've lost the feeling in their fingers. The fact that this site isso sensitive and important for doing fine tasks means that minor amounts of eczema here can be a great nuisance. There are different causes of fingertip eczema including allergic and irritant contact eczema. However, some adults get this problem without any obvious external cause. It may be aggravated by mild but repeated friction such as handling large quantities of paper. If you are affected, try to avoid the temptation to peel and pick away hard skin as this can cause more hard skin and cracks to develop. This is often a stubborn problem, but it can be helped by frequent use of a moisturizer, avoiding soaps or detergents, and using steroid ointments to settle any irritation.

Moisturizers with added ingredients, such as lactate and urea, can help to soften the brittle hard skin and reduce cracking. Weak, topical steroids are usually ineffective on the thick skin of the palms and soles, so stronger steroids are often prescribed. Clarins makes a skin care line of moisturizers for day and night use are available online. These can work better if applied for a few weeks under an occlusive dressing. 'Occlusion' or covering the skin makes' it moist and soft, which allows treatment to get through more easily (just think how soggy and soft the skin on your finger gets if it is covered with a sticking plaster for a day). Cling film can be used as a home-made occlusive dressing and kept in place over night with surgical tape and cotton gloves or socks. This helps to trap moisture in the skin and allows treatment to work more effectively.


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