Hand dermatitis: practical management and current concepts.

Abstract

hand dermatitis (HD) is a common clinical challenge, its management a clinical art. The vexing problem of etiologies is simplified by classifying causative factors as either exogenous or endogenous. Most patients respond to avoidance of irritants combined with appropriate topical corticoids and lubrication. While certain aspects of treatment must be individualized, many of the protective and lubricating measures are routine. Patient compliance with these routine, and necessarily involved, measures is greatly improved by using printed instruction forms. A minority of patients with HD will challenge the most skilled clinician. At present, technics for determining the role of endogenous versus exogenous factors are not satisfactory. Even repeated and involved patch testing combined with prolonged observation may leave a nagging uncertainty . . . is there an overlooked allergen responsible for this chronic dermatitis? The chronic, endogenous, palmar, vesicular dermatoses represent a stubborn therapeutic problem. Potent corticoids under occlusion, while often effective, tend to produce atrophy. Intralesional corticoids are practical only for small areas. Systemic corticoids, while producing dramatic relief, only postpone the problem, since their side effects preclude long-term usage. At times psoralens and ultraviolet A (PUVA) therapy provides effective control. With perceptive persistence, most chronic HD can be effectively controlled. It is worth the effort, for often it means restoring a social and economic outcast to a useful and happy life.