What causes skin peeling on hands?

Causes of Skin Peeling on Hands

Skin peeling on hands is most commonly caused by irritant contact dermatitis from frequent hand washing, exposure to detergents and soaps, or environmental factors like low humidity, though allergic contact dermatitis to specific products (fragrances, preservatives, antiseptics) should also be considered. 1

Primary Mechanisms of Hand Peeling

Irritant Contact Dermatitis (Most Common)

Frequent and repeated use of hand-hygiene products, particularly soaps and detergents, is the primary cause of chronic irritant contact dermatitis and subsequent skin peeling. 1

• Detergents damage the skin barrier by causing denaturation of stratum corneum proteins, changes in intercellular lipids, decreased corneocyte cohesion, and decreased water-binding capacity 1
• Affected persons typically experience dryness, burning sensation, rough-feeling skin, erythema, scaling, and fissures 1
• Approximately 25% of healthcare workers report hand dermatitis symptoms, with up to 85% reporting a history of skin problems 1

Key Irritant Triggers

• Frequent hand washing with hot water significantly increases risk 1
• Washing hands with dish detergent or other harsh irritants 1
• Use of disinfectant wipes to clean hands 1
• Alcohol-based hand sanitizers can cause dryness and irritation, though they are among the safest antiseptics available 1
• Working with known irritants such as bleach 1

Environmental and Behavioral Factors

• Low relative humidity (most common in winter months) contributes significantly to hand dermatitis 1
• Using very hot or very cold water for hand washing 1
• Failure to use supplementary hand lotion or cream 1
• Quality of paper towels used for drying 1
• Applying gloves when hands are still wet from washing or sanitizer 1

Allergic Contact Dermatitis (Less Common but Important)

Allergic reactions to products applied to the skin present as delayed-type reactions (allergic contact dermatitis) and can cause peeling, though this is less common than irritant dermatitis. 1

Common Allergens

• Fragrances and preservatives are the most common causes of contact allergies 1
• Antiseptic agents including iodophors, chlorhexidine, PCMX, triclosan 1
• Ingredients in liquid soaps, hand lotions, or creams 1
• Latex proteins from glove use 1

Relative Frequency of Allergen-Induced Dermatitis

Irritant contact dermatitis from iodophors is most commonly reported, followed by chlorhexidine, PCMX, triclosan, and alcohol-based products in decreasing order of frequency. 1

Occupational and Atopic Factors

• Childhood eczema and atopic dermatitis are major predisposing factors for hand dermatitis 2, 3
• Occupational exposure to chemicals and wet work significantly increases risk 2, 3
• Shear forces from wearing or removing gloves contribute to hand dermatitis 1
• Skin damaged by repeated detergent exposure becomes more susceptible to irritation by alcohol-based preparations 1

Clinical Pitfalls to Avoid

• Do not assume the clinical picture alone can distinguish between irritant and allergic causes - patch testing is necessary for definitive diagnosis 1, 4
• The prognosis of hand eczema is poor, with approximately 60% of cases becoming chronic 4
• Atopic predisposition is seriously underestimated as the main risk factor for both irritant and allergic contact dermatitis 4
• Hand dermatitis is often multifactorial, with endogenous, irritant, and allergic etiologies coexisting 1

When to Investigate Further

• New hand dermatitis or suspected contact allergy should be considered for patch testing 1
• Individuals with recalcitrant hand dermatitis should seek dermatology consultation 1, 5
• Children with eczematous eruptions should be patch tested, particularly those with hand and eyelid eczema 1