Eczema, Hand and Foot

Hand and foot eczema is often multi-factorial. Causes include atopic eczema, irritant dermatitis or allergic contact dermatitis. It can be itchy and may be vesicular, bullous or hyperkeratotic. Fissures may be evident.

Pompholyx is a specific type of eczema that causes intensely itchy vesicles and/or blisters on the palms and sides of fingers and/or on the soles of the feet.

A good history helps to determine what the underlying cause may be.

R.C 18-05-23

Dermatology Referral Criteria

Poor response to continuing potent or very potent topical steroids.
Recurrent secondary infection.
Clinical history of occupational exacerbations where there is likely to be frequent exposure to detergents, fragrances and chemicals.
Suspicion of contact allergy, which may be occupational or hobby related (for consideration of patch testing).
Impact on quality of life at work or at home.

Therapeutic Tips

Attention to good hand care includes the use of protective gloves, and avoidance of irritants such as soap, shampoos and detergents.
Patients should be encouraged to use a suitable emollient as often as possible and to have emollients both at home and work.
Prescribe adequate quantities of emollients, soap substitutes (+/− antiseptics) Patients may need up to 500g emollient per week on a repeat prescription. Consider ointment based emollients (under cotton gloves if tolerated) in the evening. Remember to warn patients about potential fire hazard of emollients, especially if they smoke.

Management

Consider underlying cause or predisposing factors including atopy / profession / hobbies.
Consider differential diagnoses such as: psoriasis, fungal infection, palmar plantar pustulosis
Assess, swab and treat any secondary bacterial infection.
Mycology skin scraping for tinea, particularly if unilateral changes or one hand and both feet affected.
Avoid irritants.
Soap substitute – lotion, cream or ointment depending on patient preference.
Apply emollients frequently throughout the day and recommend ointment emollient under cotton gloves at night.
Potent / very potent topical steroids (step down potency or frequency of application for continued maintenance if required)

If weeping/ severe blistering soak hands/ feet in 1:10,000 solution of potassium permanganate for 10 mins (potassium permanganate solution tablets 400mg 1 tablet dissolved in 4 litres of water). Warn patients nails may stain brown. Warn patients NOT TO DRINK the solution.
Salicylic acid containing ointments can be useful in hyperkeratotic eczema.
Fludroxycortide tape to fissures.