Treatment Options for Hand Dermatitis for Daily Hand Users
For individuals who use their hands daily, a comprehensive treatment approach for dermatitis should include regular moisturizing, appropriate cleansers, topical anti-inflammatory agents, and protective measures to maintain skin barrier function while allowing continued hand use. 1
First-Line Treatment: Moisturizers and Skin Protection
Moisturizing Regimen
- Use moisturizers packaged in tubes (not jars) to prevent contamination 1, 2
- Apply moisturizer immediately after washing hands while skin is still slightly damp 1, 2
- Carry pocket-sized moisturizers for frequent reapplication throughout the day 1
- Apply two fingertip units of moisturizer to cover both hands adequately 1
- Choose products free of fragrances, dyes, and potential allergens 1, 2
Nighttime Intensive Treatment
- Implement "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to damp skin 1, 2
- Apply a thick layer of moisturizer at night followed by cotton or loose plastic gloves to create an occlusive barrier 1, 2
- Continue this nightly treatment for up to 2 weeks for significant improvement 1
Anti-Inflammatory Treatments
Topical Corticosteroids
- Apply topical corticosteroids for flares of dermatitis 1
- For mild to moderate cases: hydrocortisone butyrate 0.1% cream is effective and well-tolerated 3, 4
- For more severe cases: clobetasol propionate 0.05% foam shows good efficacy 5
- Apply corticosteroids before wearing gloves if hands must be covered for work 1
- Important: Consider potential topical steroid-induced damage to skin barrier with prolonged use 1, 6
Topical Calcineurin Inhibitors
- Tacrolimus 0.1% or pimecrolimus can be used as alternatives to corticosteroids, especially on sensitive areas 1, 7, 5
- These are particularly useful for long-term management as they don't cause skin atrophy 7, 8
- May cause temporary burning/itching sensation upon application 5
Hand Hygiene and Protection
Cleansing Recommendations
- Wash hands with lukewarm or cool water (avoid hot water) 1
- Use soap-free cleansers or synthetic detergents with added moisturizers 1
- Pat dry gently instead of rubbing 1
- If using alcohol-based sanitizers, choose those with added moisturizers 1
Glove Recommendations
- For those with allergic contact dermatitis to gloves: use accelerator-free gloves (rubber-free neoprene or nitrile) 1
- Apply water-based moisturizer before wearing gloves 1
- Consider cotton glove liners under work gloves to reduce irritation 1
- Avoid wearing gloves on wet hands or immediately after using sanitizers 1
Advanced Treatments for Severe Cases
Phototherapy
- Consider ultraviolet light therapy (narrow-band UVB or PUVA) for recalcitrant cases 1, 5
- This treatment requires referral to a dermatologist 1
Systemic Treatments
- For severe, unresponsive cases, systemic options include:
Identifying and Managing Triggers
Common Irritant Avoidance
- Identify and avoid irritants such as:
When to Seek Specialist Care
- For recalcitrant hand dermatitis that doesn't respond to first-line treatments 1
- If allergic contact dermatitis is suspected (patch testing recommended) 1
- When occupational modification may be necessary 1
Special Considerations for Daily Hand Users
- Apply moisturizer before and after work shifts 1
- Consider barrier creams for specific work environments 1
- Rotate tasks when possible to reduce continuous irritant exposure 1
- Use tools or equipment to minimize direct hand contact with irritants when feasible 1
By following this treatment approach, most individuals with hand dermatitis can achieve significant improvement while continuing to use their hands daily for work and other activities.