Itchy dermatitis of the hand

Hand dermatitis is an itchy condition often seen in primary care. Hand dermatitis encompasses irritant and contact hand dermatitis as well as atopic hand dermatitis. The stratum corneum layer of the skin is disrupted and inflamed in these conditions, which ultimately affects its barrier function. Barrier dysfunction can cause increased transepidermal water loss and lowers its threshold for inflammation. Importantly, contact dermatitis is a delayed type IV hypersensitivity reaction.

Identifying and managing hand dermatitis may be challenging in primary care as it is often chronic. In refractory cases specialist referral might be appropriate.

Establishing the history

It is helpful to know whether a rash to the hands has evolved and whether it has changed in appearance. Importantly, other areas of the body can be affected. Given that the rash is itchy in hand dermatitis, it would be useful to know whether there are any relieving or exacerbating factors. For example, there might be significant exposure to soap or latex gloves, the patient's occupation may require frequent hand washing or wet-work, or their hands might be regularly exposed to chemicals. Avoiding exposure to irritants, less frequent handwashing and applying emollients can all provide relief.