Eczema, Hand and Foot

Hand and foot eczema is often multi-factorial with irritant, allergic and atopic aetiologies.

Micro vesicles on lateral palm and sides of fingers.

Large blisters with exudation and crusting.

Chronic hyperkeratotic eczema.

• Consider underlying cause or predisposing factors
• Consider differential diagnoses such as: psoriasis, fungal infection, palmar plantar pustulosis
• Assess and treat any secondary bacterial infection
• Mycology skin scraping for tinea, particularly if unilateral
• Avoidance of irritants

Acute Eczema

• Soap substitute
• Apply emollients frequently throughout the day
• Potent / very potent topical steroids
• If weeping/ severe blistering soak hands/ feet in 1:10,000 solution of potassium permanganate for 10 mins (warn nails may stain )

Chronic Eczema

• Soap substitutes
• Apply emollients frequently throughout the day may need large quantities of cream and ointment.
• Potent / very potent topical steroid (step down potency or frequency of application for continued maintenance)
• Salicylic acid containing ointments can be useful in hyperkeratotic eczema
• Cotton gloves may be helpful

Dermatology Referral Criteria

• Poor response to continuing potent topical steroids.
• Recurrent secondary infection.
• Clinical history of occupational exacerbations.
• Suspicion of contact allergy