My name is Dr. Chet Tharpe and I am a board certified allergy specialist in South Carolina. This video blog is in response to a hand dermatitis post I read recently on the Eczema and Allergy Support Group on Facebook. Hopefully my thoughts will help you or your loved ones if you are suffering from hand dermatitis as it can be one of the most troublesome forms of eczema since we are constantly using our hands. The repetitive use can make it difficult for flares to heal and it’s not uncommon for patients to deal with flares for several weeks to months prior to showing up in clinic to get the issue addressed. Now remember, I am not your physician so please do not take my thoughts about this case as medical advice. They are only things to consider from my standpoint as a specialist regarding this particular scenario.
To summarize the post, the lady was having a flare of hand eczema with severely red, cracked and irritated hands. She was not only washing her hands and using sanitizers more as we hopefully all are due to COVID, but was also the caregiver for an elderly loved one and so her hand washing was at an all-time high. She reported that the constant trauma was obviously irritating them but that some of her lotions/creams were also starting to cause burning as well. She was looking for advice on how to best address this as her hand-washing will not be slowing down any-time soon and she felt her hands were only getting worse. This is a very tough situation that is unfortunately all too common in the allergy world.
So, to dive in and make one recommendation right out of the gate, it would be to take care of this fire/active hand dermatitis flare that’s smoldering on her hands. That fire is inflammation and it really needs to be calmed down now by some sort of anti-inflammatory prescription medicated cream that you will need to get from your medical provider. In my practice, it would be some sort of high potency topical steroid, or maybe another non-steroidal prescription on the market. So the prescription cream would be like the extinguisher to the fire. It would likely only be needed for a few days to a week. Once the flare begins to calm down, you can back off of the medicated cream. If you have the right prescription cream, by day 3 or day 4 of use, there should be a dramatic improvement. If not, that should trigger a call to your physician to re-group and evaluate why the topical isn’t working and what else could be causing the flare to persist.
As you will hear from me often. I don’t like medication, but in this situation, calming the flare down, and getting those cracks to start closing up is going to be key because if not, this is probably going to keep festering for a while.
Obviously because of the circumstancesthe frequent hand washing will need to continue along with sanitizer use. I definitely recommend limiting the use of sanitizer as much as possible as the alcohol and various ingredients will likely be very irritating. That being said, there’s nothing wrong with continuing to use sanitizers if that’s what needs to be done in your situation. When washing your hands, use lukewarm or cool water which should be less irritating. If you are sanitizing, make sure the sanitizer has completely dried after use. The key is what do you do immediately, within the first few minutes, after washing your hands and applying the sanitizers. And that key is being extremely persistent with applying moisturizers each and every time after you wash or sanitize. You cannot compromise on this, especially during a flare.
Regarding the type of topical moisturizer, use the one that’s easiest and most comfortable to you. Typically something light like a soothing lotion with oil in it which should be good for repetitive use. I think in this scenario, the person was using shea butter that they reported was not irritating. I’d say stick with it if you don’t mind applying it but often shea butter preparations are a little heavy and using them several times throughout the day can wear on you. In my experience, you will often do better and be more consistent with heavy moisturizers if you are only using them a few times a day and lighter moisturizers if you need to use them several times per day. The key is consistency. You can not miss one application after washing or sanitizing.
I would try to avoid anything that seems to amplify the burning when applied. That burning may be due to alcohol or other ingredients getting into those cracks and may be harmless at first. However, those cracks and breaks in the skin cause your immune system to be more exposed. You can definitely develop a contact allergy to any of the ingredients in these moisturizers through that impaired skin barrier as your skin is just not doing its normal job of protecting you from unfamiliar exposures. Thus, this is another reason to use medicated creams to try to heal the flare and close these skin breaks as fast as you can. The medicated creams by amplifying the healing process can possibly prevent the development of a contact allergy.
To summarize, the medicated topical will be key to calming this fire down. You can likely set up a telemedicine consult with your physician to discuss which would be best and will likely need it for only a few days if it is doing it’s job. And then it’s persistence during and after the flare with moisturizers, each and every time you wash or sanitize your hands.
I hope this has helped you in your respective situation and also hope it will stimulate a productive discussion with your physician. If you liked this video, please leave me a comment and subscribe to my e-mail list where I can keep you updated on new videos and educational opportunities through ChetTharpeMD.com. Thanks for your support! Great days are ahead!