Eczema, Hand and Foot

Presentation

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.

Management
  • 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
Referral

Dermatology Referral Criteria

  • Poor response to continuing potent topical steroids.
  • Recurrent secondary infection.
  • Clinical history of occupational exacerbations.
  • Suspicion of contact allergy
Therapeutic Tips
  • Attention to good hand care includes the use of protective gloves, and avoidance of irritants such as soap, shampoos and detergents.
  • Prescribe adequate quantities of emollients, soap substitutes (+/− antiseptics) and bath additives , may need up to 500g emollient per week on a repeat prescription. Consider ointment based emollients in the evening
Patient Information