Even in Houston, many of my patients experience winter hands. They're fine in the summer, but when winter arrives it's a different story. That's when the skin on their hands and fingertips starts to peel. And sometimes even crack. Some of my patients have used the term "winter hands" for this dry skin, and I think that's a good description. When we turn on the heat in our homes, it removes moisture from the air. That leads to dry skin. The outdoor elements don't help either. The cold temperatures and the wind all act to damage our skin barrier. And then there's probably the biggest dry skin trigger of all: handwashing. For those of us who are germaphobes, cold and flu season can lead to more handwashing than usual. Soaps remove the natural oils in our skin, while hot water damages our skin barrier. But while dry skin on our hands can be a nuisance, it's far more of an issue when it leads to hand eczema. Hand eczema can be a definite problem.
Dry skin represents an impaired skin barrier. When it isn't treated, it can worsen and lead to inflamed skin. The red, flaking (and sometimes oozing and cracked) skin that results is known as hand eczema. Hand eczema can be very itchy and even painful. And hand eczema often requires treatment with prescription medicated ointments.
Hand eczema can cause red, flaking, and even oozing and cracked, patches
How can you prevent hand eczema? Take a few cues from your nurse.
Nurses and physicians have some of the highest rates of hand eczema, because they may wash their hands 30 times or more during the course of a workday. And they're usually using harsh, fragranced soaps in the workplace. New parents are another group that often develops hand eczema. All of those diaper changes, and all of that handwashing, really impacts the hands. Florists also have a high rate of hand eczema, because they're constantly doing wet work. That constant exposure to water contributes to damage of the skin barrier.
How do these groups prevent hand eczema? 1. Wash with lukewarm water, not too hot and not too cold. And wash with soaps that are truly hypoallergenic. It can be difficult to choose soaps that are truly hypoallergenic--just because the label uses that term, it doesn't mean that the product is less likely to cause allergic reactions. The term is not regulated by the FDA, so it's a marketing term--and I've seen products that are labeled "hypoallergenic" that are anything but. Other terms that aren't regulated include "for sensitive skin" or "gentle enough for babies." While some products that are labeled with these terms are truly good for those with sensitive skin, others simply are not.
For persons with hand eczema, I recommend products that are truly less allergenic, which means they contain less of the common triggers of allergic skin reactions. That means products that don't contain fragrance additives, formaldehyde preservatives, or methylisothiazolinone. This handout lists some options. 2. Carry hand cream with you. I do. I carry a tube of hand cream in my pocket. Whenever I wash my hands, I pat dry partially. Then, while my skin is still damp, I apply a layer of hand cream. 3. There's actually a technique that I recommend for drying hands that are inflamed. Use a towel to pat dry partially. Do not rub or scrub the skin dry. Apply moisturizing cream while the skin is still partially damp, because this locks in moisture. 4. Note that I said hand cream, not hand lotion. Lotions contain a higher percentage of water. That means they're just not as effective when it comes to locking moisture into the skin. 5. Before I go to bed, I use a moisturizing ointment on my hands. These are far more greasy, but are more moisturizing. For my patients with hand eczema, I'll even recommend using the ointment under white cotton gloves, worn overnight. 6. Baby your hands. If you're going to be in contact with harsh cleansers, such as dishwashing soap, use gloves. Actually, use two sets of gloves. Many people with inflamed skin will notice that sweat makes their symptoms worse. That's why I recommend white cotton gloves against your skin, to protect against sweating, with thick rubber gloves worn over that to protect against water and harsh cleansers. Most of us don't pay much attention to our hands. But my patients with hand eczema have described it as hands that are covered with paper cuts: very painful, and very limiting. That's why taking these few extra steps to treat dry skin can be so important. For more information on hand care, and allergic reactions of the hands, see this handout.
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