Hand eczema: a common diagnosis in everyday practice

Abstract

Hand eczema is one of the most common dermatoses at the doctor’s office during visits. There is some evidence that the prevalence rates reach almost 15% of the population. This disease greatly affects patients’ quality of life, work activities and other areas of life. The eczema pathogenesis is quite complex and is built up of genetic factors, environmental effects and various irritating agents. Disturbances of skin barrier also plays a significant role in the development of the disease. For example, patients with atopic dermatitis often suffer from hand eczema. Excessive hand hygiene (frequent washing and use of alcohol-based products) also increases the risk of developing this unpleasant dermatosis. Clinical features distinguish acute from chronic eczema. Acute eczema manifests as erythema, oedema, and vesicular rashes. The chronic course is characterized by skin thickening, peeling, erosion and cracks. Exacerbations occur 2 or more times per year. Hand eczema can be divided into irritant, which develops in response to contact with physical, mechanical, and chemical irritants, and allergic, which is provoked by contact with an allergen that induces type IV immune response. It is also common to distinguish protein contact dermatitis, which refers to a subtype of allergic eczema. Traditionally, moisturizers and topical corticosteroids are used for the treatment of hand eczema. Among topical corticosteroids, methylprednisolone aceponate (Advantan®) is especially worth noting. In addition to the pronounced therapeutic effect, the option to use it once a day is an undoubted advantage over many other drugs. This fact has a positive effect on therapy adherence. This topical corticosteroid is well tolerated and highly effective for the treatment of eczematous dermatitis, which is confirmed by many-year experience in using it.