Fingertip dermatitis

What is fingertip dermatitis?

Fingertip dermatitis is a type of hand dermatitis in which eczematous changes affect the fingertip extending from the palmar aspect of the distal crease to the distal ventral aspect of the digit.

Occupational hand dermatitis on fingertip

Hand dermatitis on distal fingers

Hand dermatitis on fingers

Who gets fingertip dermatitis?

Fingertip dermatitis can affect both sexes, all age groups, and all races.

Risk factors include:

• Pre-existing dermatoses such as atopic dermatitis and psoriasis
• Work and hobbies.

What causes fingertip dermatitis?

• Irritant contact dermatitis
  
  • Occupational and household exposure particularly to wet work
  • Thumb sucking in young children
• Allergic contact dermatitis
  
  • Acrylates — artificial nails (wearer, manicurist), dentistry
  • Food and plants — diallyl disulphide in garlic cloves, Tulipalin A in tulips and alstroemerias (Peruvian lily), bulbs in gardeners
  • Topical medications — eg, occupational exposure to the topical anaesthetics proparacaine and tetracaine
• Protein contact dermatitis
  • Fish and meat contact — repetitive exposure such as in abattoirs and fish-processing plants

What are the clinical features of fingertip dermatitis? 

The pattern of involvement will vary depending on the cause. It may involve just the thumb and index finger of one or both hands. For example, the thumb, index and middle finger of the non-dominant hand is typically affected when chopping garlic cloves, or the same fingers of the dominant hand in florists.

Symptoms of fingertip dermatitis may include itch, stinging, burning, or a slight numbness.

Acute fingertip dermatitis

• Red papules and plaques
• Bleeding
• Swelling
• Blistering

Chronic fingertip dermatitis

• Dryness and scale
• Chapping and fissuring
• Lichenification

What are the complications of fingertip dermatitis?

• Secondary bacterial infection involving staphylococci or streptococci cause additional redness, pain, oozing, and crusting
• Nail dystrophy 

Nail dystrophy secondary to fingertip dermatitis

How is fingertip dermatitis diagnosed?

Fingertip dermatitis is a clinical diagnosis based on history and skin examination. The cause of the dermatitis however may be harder to determine and investigations may include patch testing for allergic contact dermatitis and skin prick testing for protein contact dermatitis.

What is the differential diagnosis for fingertip dermatitis?

• Endogenous dermatitis
• Psoriasis
• Tinea manuum

What is the treatment for fingertip dermatitis?

General measures

• Avoid irritants and allergens
• Use protective gloves at work and in the home
• Soap-free cleansers are less irritating than liquid soaps and bar soaps
• Emollients and moisturisers should be applied frequently especially after hand washing
• Zinc-based ointments may be soothing for fissured areas

Specific measures

• Topical steroids
• Topical calcineurin inhibitors (eg, pimecrolimus, tacrolimus)
• Topical calcipotriol may be used off-label
• Physical therapies such as UVB phototherapy and Grenz ray therapy

What is the outcome for fingertip dermatitis?

Fingertip dermatitis is often a chronic condition and requires long-term attention to avoid recurrence.