{"id":3900,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/eczemahandandfoot\/"},"modified":"2024-10-11T09:47:20","modified_gmt":"2024-10-11T08:47:20","slug":"eczemahandandfoot","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/eczemahandandfoot\/","title":{"rendered":"Eczema, Hand and Foot"},"content":{"rendered":"\n<p>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.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>A good history helps to determine what the underlying cause may be.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><img decoding=\"async\" src=\"\/files\/sites\/2\/Dermatology-Eczema-Hand-Foot-31-03-20.jpg\" alt=\"Dermatology Eczema Hand and Foot\"><\/td><td><img decoding=\"async\" src=\"\/files\/sites\/2\/Dermatology-Eczema-Hand-Foot-31-03-20.png\" alt=\"Dermatology Eczema Hand Foot\"><\/td><td><img decoding=\"async\" src=\"\/files\/sites\/2\/Dermatology-Eczema-Hand-Foot-Pomphylox-31-03-20.png\" alt=\"Dermatology Eczema Hand Foot Pomphylox\"><\/td><\/tr><tr><td>Shoe contact dermatitis- <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=eczema%20shoe%20contact\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/td><td>Atopic hand dermatitis &#8211; <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=atopic%20hand%20dermatitis\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/td><td>Pomphylox &#8211; <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=pomphylox\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>R.C 24-04-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Dermatology Referral Criteria<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Poor response to continuing potent or very potent topical steroids.<\/li>\n\n\n\n<li>Recurrent secondary infection.<\/li>\n\n\n\n<li>Clinical history of occupational exacerbations where there is likely to be frequent exposure to detergents, fragrances and chemicals.<\/li>\n\n\n\n<li>Suspicion of contact allergy, which may be occupational or hobby related (for consideration of patch testing).<\/li>\n\n\n\n<li>Impact on quality of life at work or at home.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Therapeutic Tips<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Attention to good hand care includes the use of protective gloves, and avoidance of irritants such as soap, shampoos and detergents.<\/li>\n\n\n\n<li>Patients should be encouraged to use a suitable emollient as often as possible and to have emollients both at home and work.<\/li>\n\n\n\n<li>Prescribe adequate quantities of emollients, soap substitutes (+\/\u2212 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.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Management<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consider underlying cause or predisposing factors including atopy \/ profession \/ hobbies.<\/li>\n\n\n\n<li>Consider differential diagnoses such as: psoriasis, fungal infection, palmar plantar pustulosis<\/li>\n\n\n\n<li>Assess, swab and treat any secondary bacterial infection.<\/li>\n\n\n\n<li>Mycology skin scraping for tinea, particularly if unilateral changes or one hand and both feet affected.<\/li>\n\n\n\n<li>Avoid irritants.<\/li>\n\n\n\n<li>Soap substitute&nbsp; &#8211; lotion, cream or ointment &nbsp;depending on patient preference.<\/li>\n\n\n\n<li>Apply emollients frequently throughout the day and recommend ointment emollient under cotton gloves at night.<\/li>\n\n\n\n<li>Potent \/ very potent topical steroids (step down potency or frequency of application for continued maintenance if required)<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If weeping\/ severe blistering soak hands\/ feet in 1:10,000 solution of potassium permanganate for 10 mins (<strong>potassium permanganate<\/strong>&nbsp;<em>solution tablets 400mg&nbsp;<\/em>1 tablet dissolved in 4 litres of water). Warn patients nails may stain brown. Warn patients NOT TO DRINK&nbsp; the solution.<\/li>\n\n\n\n<li>Salicylic acid containing ointments can be useful in hyperkeratotic eczema.<\/li>\n\n\n\n<li>Fludroxycortide tape to fissures.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">For Patients<\/h4>\n\n\n\n<p><a href=\"http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=166&amp;itemtype=document\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=166&amp;itemtype=document<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=3776&amp;itemtype=document\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=3776&amp;itemtype=document<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">For Health Professionals<\/h4>\n\n\n\n<p><a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/eczema-hand-dermatitis\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.pcds.org.uk\/clinical-guidance\/eczema-hand-dermatitis<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.dermatology.nhs.scot\/dermatology-pathways\/pathways\/eczema-hand-and-foot\/\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.dermatology.nhs.scot\/dermatology-pathways\/pathways\/eczema-hand-and-foot\/<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[103],"class_list":["post-3900","page","type-page","status-publish","hentry","category-eczemahandandfoot"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/eczemahandandfoot\/\" rel=\"tag\">Eczema, Hand and Foot<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3900","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3900"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3900\/revisions"}],"predecessor-version":[{"id":21175,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3900\/revisions\/21175"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3900"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3900"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}