Eczema on Hands: What Causes Hand Eczema and How to Treat It

Most eczema on the hands settles with two things: a plain, fragrance-free ointment applied after every hand wash, and a prescription cream matched to the severity of the flare. However, getting the right cream for hand eczema can be difficult because of the unique nature of the skin on your hands.

Your hands are really two kinds of skin. The palm is the thickest skin on your body, so a mild cream barely gets through. The back of your hand is about as thin as your forearm, and a strong steroid used there for too long can thin that skin further. So the right choice for treating eczema on the hands depends on which part of your hand is affected.

In this article, we cover what eczema on hands looks like, what sets it off, what treatment suits each part of the hand, and how to see a doctor about hand eczema in Canada.

An Overview of Eczema on Hands

Eczema on hands — also called hand eczema, or hand dermatitis — is an itchy, inflamed, and often cracked rash that flares and settles rather than clearing for good. Sometimes, it’s atopic dermatitis appearing on the hands, which is the same long-term condition most people simply call eczema. Just as often, it’s contact dermatitis, which is a reaction to something the skin has touched. Atopic and contact eczema look much the same on the hands and are difficult to tell apart.

Contact eczema is the most common occupational skin disease, accounting for up to 90% of cases (most of them on the hands). However, plenty of people develop hand eczema with no occupational trigger at all. A survey of just over 60,000 adults across Canada and five European countries found that 4.7% had long-lasting hand eczema in a given year, or roughly 1 in 20 people.

What makes eczema treatment on the hands difficult is knowing which cream will work. Your hands carry the thickest skin on your body (palms) and much thinner skin a few centimetres apart (knuckles). So the cream that settles a flare on your palm isn’t necessarily the cream that belongs on the back of your hand.

Identifying Eczema on Hands

Eczema on hands looks different depending on which part of the hand is involved. Eczema on back of hands and across the knuckles usually appears as dry, scaly skin with fine cracks running through it (deep cracks can mean a flare has been running for weeks rather than days). Eczema on palms of hands behaves differently, thickening the skin so that it later peels. On darker skin, eczema inflammation more often looks brown, violet or ashen grey than red.

Eczema blisters on hands have a name of their own — dyshidrotic eczema. This usually presents as crops of small, deep blisters along the palms and the sides of the fingers, which dry out and peel over a week or two (then often come back). Of the types of eczema on hands, dyshidrotic eczema is the most distinctive to look at, and it accounts for between 5% and 20% of cases.

A few other conditions can look similar to hand eczema:

• Palmoplantar psoriasis — thick, scaly plaques on the palms, often symmetrical, with the nails involved in up to 60% of cases. On appearance alone, psoriasis here can be indistinguishable from hand eczema.
• Tinea manuum — a fungal infection. The most common pattern is one hand and both feet, though both hands are affected in roughly a quarter of cases. On the palm, it shows as dry, even scaling rather than the cracked, inflamed look of eczema.
• Scabies — caused by scabies mites. Shows up as itching that’s noticeably worse at night, burrow marks in the finger webs, and usually somebody else in the house itching as well.

Telling these conditions apart by eye is difficult even for doctors, which is why it’s important to have a professional look at your hands rather than working through creams by trial and error.

What Causes Eczema on Hands

Eczema starts with two problems at once — the skin barrier stops holding moisture in and keeping irritants out, and the immune system in the skin overreacts to whatever gets through. Hands usually come into contact with more irritants than any other part of the body, which is why they flare so readily.

Hand eczema causes tend to fall into a few groups:

• Wet work and irritants. Soap, water, detergents, solvents and alcohol sanitiser each strip a little more of the natural protective barrier away. In some jobs, hands are washed twenty or more times a day. Irritant contact dermatitis from wet work is the single most common cause of occupational hand eczema.
• Things you’re allergic to. Nickel, fragrances, and preservatives are common culprits. So are the ingredients used to make rubber gloves, which means the gloves people wear to protect their hands can be what’s actually causing the rash.
• Your job. Hairdressers develop hand eczema at around 21 new cases per 100 people a year and nurses at 17, against about 5 in office work. Healthcare, hospitality, cleaning, food preparation and the trades all sit at the high end.
• Stress. Stress-related eczema on hands is a real pattern. However, it’s generally thought to work as an amplifier rather than a cause in its own right. Stress appears to interfere with how fast the skin barrier repairs itself. Managing stress may help, but it doesn’t replace treating the eczema itself.
• Cold weather. Hand eczema tends to be worse in winter. Cold air holds less moisture, indoor heating dries the skin further, and hand-washing goes up through cold and flu season, making winter eczema on hands is a familiar pattern.

How Hand Eczema Treatment Varies By Location

Skin thickness varies enormously across the hand. Palm skin measures around 173 micrometres thick, while the skin over your knuckles measures about 29 micrometres. 

This means the right cream for eczema on hands depends on where the eczema is sitting, because a cream strong enough to get through a palm is usually far too strong for the back of the hand.

Eczema on the palms

Mild eczema creams often do very little to treat flares on the palms, as the skin there is naturally thick and prevents absorption. 

A Canadian guideline for family doctors recommends a potent or super-potent steroid to bring a palm flare down, naming clobetasol propionate 0.05% ointment for a bad flare and betamethasone valerate 0.1% for a milder one. Betamethasone valerate is the active ingredient in Betaderm. 

These are short courses of steroid creams that require a prescription and are reviewed after a couple of weeks rather than repeated indefinitely.

Eczema on the backs of the hands

The skin on the back of the hands is naturally thin, and prone to thinning further under a topical steroid. A mild steroid in a short course is still the usual first move, but where flares keep returning, non-steroid prescription creams suit this skin better. 

Protopic and Elidel both work on hand eczema without thinning the skin, which makes them a good fit for sensitive areas like the backs of the hands, knuckles, and the face.

When creams aren’t enough

Alitretinoin is a tablet marketed in Canada for chronic hand eczema, meaning a flare that has run for three months or come back twice in a year. A doctor might suggest alitretinoin for severe eczema on hands that potent steroids haven’t cleared.

Management Routines That Stop Hand Eczema Coming Back

It’s often difficult to avoid the triggers for hand eczema, which is why flares tend to come back so often. 

A management routine that survives a busy day looks something like this:

• Moisturise after every hand wash, not twice a day. More often than most people expect, and regular moisturising means fewer flares and less need for steroid cream.
• Swap the soap. A gentle hand soap for eczema is easier on a damaged barrier than ordinary soap. On skin that hasn’t cracked, alcohol sanitiser is actually less irritating than soap and water.
• Glove up for wet work, and line the gloves. Waterproof gloves trap sweat, which can cause or worsen hand dermatitis by itself. A cotton liner is recommended once gloves are on for more than about ten minutes, and it should be swapped once it’s damp.
• Use the night to repair. Moisturiser under cotton gloves overnight is the one stretch of the day your hands aren’t being used for anything else.

When Eczema on Your Hands Needs a Doctor

Persistent hand eczema usually needs a treatment that’s only available via prescription. Book an appointment with a doctor if:

• A flare hasn’t settled after a week or two of moisturising and gentle care
• Cracks are deep enough to split open or bleed
• The skin is weeping, or crusting with a honey-coloured scab, which suggests infection
• Itching is disrupting your sleep
• You’ve been through repeated courses of steroid cream with no longer-term plan
• Your hands are getting in the way of your work
• You aren’t certain the rash is eczema at all

One urgent exception: a rapidly spreading crop of small, painful blisters, often with a fever, can mean a herpes infection has taken hold in eczema-affected skin. That needs same-day care rather than a routine appointment.

How to Get Treatment for Hand Eczema in Canada

In Canada, you can get treatment for eczema on hands by seeing your family doctor, going to a walk-in clinic, or speaking to an online doctor.

If you’re in British Columbia, an appointment with a Walk In doctor is covered by MSP, so getting a hand eczema flare looked at costs nothing and requires no in-person appointment.

Frequently Asked Questions About Eczema on Hands

What’s the best cream for eczema on hands? 

A plain, fragrance-free moisturiser is the base recommended for everyone, including for mild eczema on hands. Beyond that, the best cream for eczema on hands depends on where the flare sits. A palm and the back of a hand need different strengths, and working out which you need is something you can discuss with your doctor.

Can hand eczema be cured permanently? 

Hand eczema is managed rather than cured, which is true of eczema generally. Long stretches of clear skin are a realistic goal, and so is reducing how often flares arrive. Treating a flare early and keeping the routine going in between is what keeps those gaps long.

Can stress cause eczema on your hands? 

Stress-related eczema on hands is a real pattern, though stress amplifies an existing tendency rather than creating one. So stress management can help, but it works alongside treatment rather than instead of it. If your flares track your worst weeks, that’s worth mentioning to your doctor.

How do you treat severe hand eczema? 

Severe hand eczema usually requires a steroid-based cream to bring the flare down. Where that hasn’t worked, or flares keep returning, a doctor can look at options beyond creams, including tablets that are approved in Canada for chronic hand eczema. Persistent hand eczema is worth a proper assessment rather than another round of the same cream.

Looking for Help to Manage Hand Eczema?

Hand eczema is one of the more frustrating kinds of eczema to live with, because exposure to triggers is difficult to avoid. Best results come from finding the right hand eczema cream for where the flare actually sits, and an ongoing management routine that survives a normal day of washing and working.

Developing a management plan is the part worth getting help with from a doctor. Palms and the backs of the hands usually need different treatments, and the options that settle a stubborn flare all need a prescription in Canada.

If eczema on hands keeps coming back despite a decent routine, or you aren’t certain the rash is actually eczema, a doctor from Walk In can confirm what you’re dealing with and discuss your treatment options.

Speak to a Doctor Online About Eczema