What causes itchy hands and how can they be treated?

Itchy Hands: Causes and Treatment

Most Common Cause

Itchy hands are most commonly caused by irritant contact dermatitis (ICD) from frequent hand washing, exposure to detergents and soaps, or use of alcohol-based hand sanitizers, which strip away protective lipids and disrupt the skin barrier. 1, 2

Primary Causes

Irritant Contact Dermatitis (80% of cases)

• Frequent hand washing with hot water and harsh soaps causes lipid depletion in the stratum corneum, leading to barrier disruption and inflammation 1, 3
• Detergents and soaps denature stratum corneum proteins, alter intercellular lipids, and decrease water-binding capacity 3
• Alcohol-based hand sanitizers dissolve protective lipids, though they are safer than detergents for causing dermatitis 1, 3
• Hot water (above 40°C) causes lipid fluidization and increased skin permeability 1
• Low humidity environments significantly contribute to hand dryness and itching 3

Allergic Contact Dermatitis (20% of cases)

• Preservatives and fragrances in hand hygiene products are common allergens 1, 3
• Rubber accelerators in nitrile gloves cause allergic reactions despite being latex-free 1
• Antimicrobial ingredients including chlorhexidine, triclosan, and iodophors can trigger allergies 1, 3
• Patch testing is necessary for definitive diagnosis, as clinical appearance alone cannot distinguish allergic from irritant causes 3

Other Contributing Factors

• Pre-existing atopic dermatitis increases susceptibility to hand eczema 1, 4
• Occupational exposures (healthcare workers have 30% prevalence of hand dermatitis) 1
• Failure to moisturize after hand washing exacerbates symptoms 3

Treatment Algorithm

Step 1: Immediate Protective Measures

Modify hand hygiene practices:

• Wash hands with lukewarm or cool water (never hot) for at least 20 seconds 1, 2
• Use soaps without fragrances, dyes, preservatives, or allergenic surfactants 1, 2
• Choose synthetic detergents with added moisturizers 1
• Pat dry gently rather than rubbing 1, 2
• Never wash hands immediately before or after using alcohol-based sanitizer (increases dermatitis risk) 1
• Avoid disinfectant wipes for hand cleaning 1, 2

For alcohol-based hand sanitizers:

• Use products with at least 60% alcohol and added moisturizers 1, 2
• Choose formulations without fragrances or preservatives 1

Step 2: Aggressive Moisturization

Apply moisturizer immediately after every hand washing:

• Use two fingertip units of moisturizer per hand for adequate coverage 1, 2
• Choose fragrance-free products in tubes (not jars) to prevent contamination 1, 2
• Select moisturizers with petrolatum or mineral oil as base ingredients 2
• Reapply frequently throughout the day using pocket-sized containers 2

For severe dryness, use "soak and smear" technique:

• Soak hands in plain water for 20 minutes 2
• Immediately apply moisturizer to damp skin 2
• Perform nightly for up to 2 weeks 2

Step 3: Topical Anti-inflammatory Treatment

When conservative measures fail after 1-2 weeks:

• Apply topical corticosteroid (hydrocortisone 0.5-1% for mild cases, stronger potency for moderate-severe) 2, 5
• Use 3-4 times daily on affected areas 5
• Caution: Prolonged topical steroid use can damage the skin barrier further 1, 2
• Consider tacrolimus 0.1% as steroid-sparing alternative (may cause transient burning/itching) 2

Step 4: Advanced Therapies for Recalcitrant Cases (After 6 Weeks)

If symptoms persist despite above measures:

• Phototherapy (PUVA or narrow-band UVB) may improve symptoms 2, 6
• Oral alitretinoin 30 mg daily is highly effective (RR 2.75 for symptom control vs placebo, NNTB 4) but causes headaches 6
• Oral cyclosporin 3 mg/kg/day probably improves symptoms compared to topical steroids alone 6
• Newer agents including dupilumab, ruxolitinib, and JAK inhibitors show promise 7, 8

Critical Pitfalls to Avoid

• Never apply gloves to wet hands from washing or sanitizer (traps irritants) 1, 2
• Never use dish detergent or household disinfectants on hands 1
• Never use superglue to seal fissures (causes further inflammation) 1, 2
• Never occlude hands with gloves for prolonged periods without underlying moisturizer 1, 2
• Never pick at scaling skin (worsens barrier disruption) 1

When to Refer to Dermatology

• New or worsening hand dermatitis despite 6 weeks of appropriate treatment 2, 3
• Suspected allergic contact dermatitis requiring patch testing 2, 3
• Change in baseline dermatitis pattern suggesting new allergen exposure 1, 2
• Recalcitrant cases requiring phototherapy or systemic immunosuppression 2

Special Occupational Considerations

For healthcare workers and frequent hand washers:

• Use water-based moisturizers under gloves (oil-based products break down latex/rubber) 2
• Consider cotton glove liners under nitrile gloves for allergic reactions 2
• Switch to accelerator-free gloves if rubber allergy suspected 2
• Apply moisturizer before and after each glove use 2