Problems with the skin on the hands are very common, accounting for 90% of all occupational skin diseases. Hand dermatitis has a prevalence of 5–10% in the population with an incidence of around 5% per year. Psoriasis, tinea infections and atopic eczema including pompholyx mainly affect the hands (Table 31.1). Endogenous dermatitis, allergic contact dermatitis and irritant contact dermatitis need to be differentiated by detailed history, examination and investigations such as patch testing (see Chapter 30).

Hand Eczema

Patients with chronic hand eczema tend to have prolonged sick leave, increased health costs and decreased quality of life. Each year 60% of people with hand eczema visit their GP and up to 20% visit a specialist. Twenty-five per cent of chronic hand eczema is caused by allergic contact dermatitis.

Poor prognosis for hand eczema is associated with atopy (especially respiratory), contact allergy, older age, increased severity and longer duration (>1 year) of eczema. Other factors are patient exposure to wet work, increased frequency of hand washing and wearing gloves for long periods of time (>4–6 hours/day).

Thirty per cent of nurses develop hand eczema. Senior nurses with atopy, multiple hand washes during the day and wearing gloves for prolonged periods of time are particularly at risk. This is mainly a result of irritant contact dermatitis; however, allergic contact dermatitis needs to be excluded with patch testing.

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