Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Eczema—other forms
The other main types of dermatitis are seborrhoeic, hand, pompholyx, discoid, venous, and asteatotic eczema.
Seborrhoeic dermatitis
Seborrhoeic dermatitis is a scaly eruption, usually affecting the scalp and eyebrows. Other patterns are recognized. The condition is usually less itchy than atopic eczema, but sometimes clinical distinction of these entities is difficult. Treatment is with mild topical corticosteroids and anti-yeast therapy ( Chapter 33 ).
Hand dermatitis
Hand dermatitis is a common, often recurrent condition that varies from being acute and vesicular to chronic, hyperkeratotic and fissured. The condition results from a variety of causes, and several factors are often involved. In children, hand dermatitis is mostly due to atopic eczema. An atopic predisposition often underlies adult hand dermatitis, especially if caused by repeated exposure to irritants.
Allergic causes need excluding, and most adults with hand dermatitis require patch testing (Capter 20). Fungal infection is ruled out by microscopy and culture, especially in unilateral hand dermatitis, and the feet are examined because tinea pedis can provoke a hand dermatitis as an ‘id’ phenomenon (p. 72). A core of patients are left who have an endogenous recurrent hand dermatitis often characterized by sago-like vesicles on the sides of the fingers, on the palms and sometimes on the soles.
Clinical presentation
Hand dermatitis often presents as a chronic eczema, but may appear as a vesicular eruption known as pompholyx eczema (below). Vesicles may be seen with atopic eczema or contact dermatitis but, in pompholyx, there is usually no associated disorder (below).
Management
Most hand eczema is at least partially irritant, so reducing irritant exposures (e.g. soaps, detergents and wet work) and increased use of emollients is always necessary. Advice for patients with hand dermatitis is given in Box 22.1 . Hand psoralen plus ultraviolet A (PUVA) may be appropriate in selected cases resistant to topical therapy. Alitretinoin (p. 30) has recently been licensed for severe chronic hand eczema refractory to potent topical corticosteroids.
Box 22.1
Hints on hand care for patients with hand dermatitis
Handwashing
Use warm water and unscented soap; avoid paper towels and hot air dryers; instead use a dry cotton towel.
Protection
Avoid wet work if possible, or otherwise wear cotton gloves under vinyl or nitrile gloves; wear gloves in cold weather and for dusty work.
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