There are many different causes of hand and foot dermatitis, but the most common cause is irritant contact dermatitis. The dermatitis may start abruptly after a severe insult, or build up with repeated minor irritation. Once the rash gets started the skins normal barrier to irritants is disrupted, and the rash can be easily perpetuated by lesser irritant
Another common form of dermatitis on the hands and feet is dyshidrotic eczema. This is a common recurrent rash that consists of patches of slightly red, very itchy, bumpy skin that appears to have small bubbles within it that gradually come to the surface. These areas then become dry, crack, tender, and gradually heal. Unfortunately, attacks tend to be recurrent, often in the same areas coming/going over months to years intermittently. There is also no known cause, and it has not been associated with any foods or medications. It is often worse during times of stress or hot weather. Occasional cases can be triggered by foot fungus.
Treatment consists of many steps, all of which should be followed carefully. Even if the rash resolves the skin does not return to normal for many weeks, and therefore maintenance therapy should be continued.
1. Wash hands as little as possible and use a soap free cleanser such as Cetaphil or Cereve
2. Keep moisturizer by each sink, and on your person. Apply to hands every time you wash your hands, and several other times during the day. The thicker and greasier the moisturizer the better it will work, but the less pleasant it is to use. Find the thickest type moisturizer that you are willing to use. You may also find that you can use a thicker, greasier moisturizer at bedtime.
3. Any time that your hands could come into contact with irritants wear protective gloves. This- is best done with a thin, white, cotton glove underneath a pair of vinyl gloves. This keeps the hands dry and avoids the irritation of the glove itself on the skin. Have extra pairs of cotton gloves on hand so that you can change to a dry pair when needed.
4. Apply topical steroid (triamcinolone, fluocinonide, clobetasol) 2 times a day whenever itchy, red or inflamed for up to 2 weeks straight at a time.
5. For more chronic cases of hand dermatitis, where treatment will be required daily, steroid free medications such as Elidel and Protopic can be used.
6. Oral antihistamines can be used for severe itching. Generally, we recommend non drowsy formulas such as Allegra, Zyrtec or Claritin during the day and Benadryl or Rx antihistamines at night.
After the rash resolves continue steps 1 through 3 above. Save the topical steroid for flare ups. The earliest signs of recurrence are usually dryness followed by itching, and then redness, scaling and cracking.