Hands are an essential part in performing our day-to-day activities. When the hands are scaling and fissuring, it causes pain, embarrassment, and psychosocial distress.
Cracked/chapped hand, known as hand dermatitis or hand eczema, is a common skin condition affecting ~ 10% of the general population, mostly women. It is also the most common occupational skin disorder, i.e., occupational dermatitis/eczema or occupational irritant hand dermatitis/eczema.
Specific occupations associated with higher rates of hand eczema include hairdressers, printers, cement workers, painters, mechanics, animal handlers, food processors, florists, chefs, constructers, pharmaceutical factory workers, and laundry workers. The common features shared by these occupations are an excessive exposure to water, solvents, and/or micro trauma.
Symptoms Of Hand Dermatitis/Eczema
The main symptoms of hand dermatitis involve one or more of the following:
–Redness (erythema)
–Dryness, scaling, and flaking
–Cracking or fissuring
–Thickening of the skin (hyperkeratosis)
–Blistering and swelling
–Pain, irritation, burning, and/or itching
The condition may last few days, weeks, even months or years. It can come and go over the course of many years.
Causes Of Hand Dermatitis/Eczema
Hand eczema is a condition with many possible causes. It starts by irritants or allergens coming into contact with the skin which causes chain of events, i.e., cellular damage, inflammatory responses, and disruption and dysfunction of skin barrier.
Irritants And Allergens
Irritants are agents that can cause toxic effects to skin cells after single or repeated contact. Common skin irritants include detergents, greases, solvents, rubber, and food products. Weak irritants may require repeated exposure to cause the problem whereas highly irritating materials may trigger hand eczema with the first exposure.
Allergens are small elements, which can penetrate impermeable skin barrier and contact the living layers of the skin. Allergens can cause an allergy or skin sensitization. Metals, soaps, detergents, topical drugs, balsams, nickel, phenol, rubber, formaldehyde, and resin are the most frequent allergens.
Disruption Of Stratum Corneum
Irritants or allergens can cause disturbance of stratum corneum, the superficial layer of the skin made of dead, flat skin cells that shed about every 2 weeks. The cells of the stratum corneum are embedded in a lipid layer of ceramides, fatty acids, and cholesterol with 25% water content. The stratum corneum serves as an important barrier by keeping molecules from going into and out of the skin, thus protecting the deep layer of the skin against the exterior environment and preventing water loss.
Irritants or allergens provoke disturbance of stratum corneum by direct cell toxicity, lipid barrier removal, cell membrane damage, and destruction of keratins (the key structural material making up the outer layer of the human skin). All forms of hand dermatitis include a disruption in the stratum corneum.
In addition to irritants and allergens, some host factors may weaken the skin function and lower the repair capacity of the skin, and thus contribute to the development of hand dermatitis. These conditions include predisposition to allergy and other skin diseases for instance atopic dermatitis, psoriasis, etc.
Cellular Damage Sets Off Inflammation
Despite varying irritants or allergens, the final common path of hand eczema is implemented with the release of inflammatory mediators from keratinocytes, the major cell type in the epidermis (the top layer of the skin).
Keratinocytes are critical in the producing and releasing inflammatory cytokines upon entering of irritants through the stratum corneum. These inflammatory cytokines augment immune and allergic responses and propagate hand eczema.
Persistent Inflammation Impairs Skin Barrier Function
Hand dermatitis is often a recurrent condition owing to sustained inflammatory responses. Studies have shown that frequent contact of irritants or allergens promotes continued inflammation which exposes the immune system to immunogenic peptides and result in persistent recruitment of inflammatory cells and sustained production of inflammatory mediators. Some inflammatory mediators (i.e., TNF-a) are regulated in a self-stimulating fashion and thus involved in the continuation of inflammatory response.
Sustained inflammation can initiate the damage to deeper layers of skin and weaken the skin barrier. When the skin barrier function is weakened, the permeation of irritants and allergens as well as the subsequent responses are amplified. This, in turn, cascades into a vicious cycle of lifelong disorder, experiencing dryness, fissuring and cracking.
Hand Dermatitis/Eczema Treatment
The goal of treating hand dermatitis is to prevent irritant contact, avoid allergen, and relieve skin irritation-caused itchy blisters and sore cracks. It is well-known that the longer hand dermatitis is present, the more difficult it is to treat.
Treatment Failure And Sustained Inflammation
Undoubtedly, it is extremely difficult to treat hand eczema successfully. There are several possibilities: First, identifying a single substance is inefficient at best, and often impossible. Second, it is impractical to avoid the exposure of all irritants or allergens. Third, insufficient and unsustainable control of stubborn inflammatory/immune responses.
Topical steroids are frequently used to suppress inflammation in the skin. Common side effects of long-term use of steroids consist of skin thinning, loss of pigment, allergic to the steroids, and prone to infection. Immuno-suppressant and ultraviolet radiation treatment are prescribed for severe cases. None of these treatments, however, is suitable for long-term use.
Recent studies suggest that some additives in lotions and creams, commonly used to help the skin hold moisture and reduce cracking, may prolong or even aggravate inflammation.
Natural Anti-inflammatory Remedies For Control Of Sustained Inflammation
Due to fear of side-effects of steroids and dissatisfaction with conventional treatment, dermatitis sufferers are looking for alternative solutions. Most commonly recommended methods are natural anti-inflammatory remedies. In fact, many anti-inflammatory plant extracts, such as Astragalus, Scute, Coptis, Licorice, and Aloe vera, have shown beneficial effects in treating inflammatory skin disorders including hand dermatitis.
Since inflammation initiates, propagates, and aggravates hand eczema, control of inflammation is critical to heal hand eczema and avoid skin barrier dysfunction. Studies suggest that elimination of inflammatory substances help prevent disruption of stratum corneum and protect skin barrier function.
To learn and benefit from natural anti-inflammatory remedies, follow blog series "Nature’s Best Anti-inflammatory Herbs" and "Natural Cures For Chronic Inflammatory Conditions".