The importance of hand care
Hand skin preservation tips
Investigations for hand dermatitis
Treatment
Good hygiene practice and prevention of cross-infection are essential for healthcare workers in hospitals, clinics, aged care facilities, and private homes. Hand care is necessary because healthcare workers are prone to hand dermatitis mostly due to contact with irritants associated with frequent hand washing or cleaning using soap and water, aggressive disinfectants, and detergents. The use of surgical gloves may also cause dermatitis in some individuals.
Hand dermatitis is being seen increasingly in healthcare personnel involved in caring for patients during the COVID-19 pandemic due to the increased hand hygiene and glove requirements at work and after-work hours in the retail/entertainment environment; so-called 'COVID hand dermatitis'.
Exposure to irritants at home or during recreation may exacerbate the problem. Chemicals, extremes of temperature and humidity, mechanical injury (eg, rough surfaces and friction), plants, paints, some foods, and ultraviolet radiation may injure the skin.
The skin barrier may be disrupted by:
Disruption of the skin barrier manifests as frank eczema or irritant contact dermatitis. Damaged skin is itchy, sore, less supple, and susceptible to secondary bacterial infection and the development of allergies (contact allergic dermatitis).
Dermatitis is most likely in those with pre-existing sensitive skin or who have atopic dermatitis in other sites. [see Atopic hand dermatitis]
Staphylococcus aureus and Streptococcus pyogenes are the usual causes of a bacterial infection. Hand dermatitis and wet work also predispose to yeast infection, generally presenting as paronychia infected by Candida albicans or as intertrigo between the fingers (erosio interdigitalis blastomycetica), and can be confused with tinea manuum (fungal infection of the hand).
Evidence-based Cochrane reviews confirm alcohol-based hand rubs are superior to regular hand washing for reducing transmission of diseases in hospitals and healthcare services. They also cause less irritation compared with soap and water.
Gloves provide some barrier for the skin, but no single glove type will resist all chemicals indefinitely. Choosing the right glove design and construction will give the best protection, provided it also fits well. Similarly, protection against mechanical risk varies with different gloves providing different strengths of abrasion, blade cut, tear and puncture resistance.
Healthcare facilities often have a health and safety officer with knowledge about suitable gloves. Safety shops also offer advice and a wide choice.
If hand eczema is slow to improve, seek a referral to a dermatologist for patch tests. Patch tests help decide if a contact allergy is contributing to the hand dermatitis. About 60% of patients with chronic hand eczema have one or more positive contact allergens on patch testing, however the relevance of the positive reaction must be assessed in the clinical situation. Loss of barrier function due to irritant contact dermatitis increases the risk of developing a contact allergy.
Common occupational allergens in healthcare workers include nickel, perfume/fragrance, rubber antioxidants, antiseptics, antibacterial soap, and preservatives.
Latex allergy typically results in immediate redness and swelling of the hands when donning gloves. Diagnosis may be confirmed by prick tests and specific IgE tests.
Treatment of hand eczema includes:
