Why do I need to care for my hands?
Our hands come into daily contact with many substances such as soap, detergent, shampoo, household cleaning chemicals, water and food. These can take away the protective oils that keep the skin moist, leading to chapping, dryness, and irritation. Frequent contact with water is one of the commonest causes. Once the skin on the hands is irritated and damaged, it is prone to further damage and a vicious circle is set up leading to hand dermatitis, or making existing dermatitis worse.
Will taking good care of my hands cure my skin condition?
No, but taking good care of your hands will help repair the skin and reduce damage. Once hand dermatitis has cleared, then good hand care will reduce the chance of it coming back. The skin stays vulnerable for several months after hand dermatitis looks better, so it is important to keep up a good hand care routine.
What are emollients (moisturisers) and how do they work?
Emollients are mixtures of oil (creams), or paraffin (ointments), and water. They smooth and hydrate the skin. These effects don’t last long so they need to be reapplied frequently, several times a day. There are many different types of emollients, and so it is important to find ones that suit you and are practical for your daily routine.
CAUTION: This leaflet mentions ‘emollients’ (moisturisers). When paraffin-containing emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that a naked flame or cigarette smoking could cause these to catch fire. To reduce the fire risk, patients using paraffin-containing skincare or haircare products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly, preferably daily.
How should I apply emollients (moisturisers)?
You should apply your emollients whenever the skin feels dry and after every hand wash. This usually means keeping a supply at your work or school. They can be bought in small tubes to take to work as well as larger pots for use at home. Good times to apply emollients are after a shower or bath, when relaxing watching television and just before going to sleep. Cotton gloves can be worn at night after applying the emollient to stop the bedclothes getting greasy.
Steroids are usually applied either 20 minutes before emollients, or 20 minutes afterwards (there is no evidence currently suggesting one order is better than the other). Steroid ointments moisturise the skin better than steroid creams, but some people prefer the feel of a cream. Steroids should not be used to moisturise dry skin – they should be used on active areas of dermatitis.
What are the side effects of emollients?
It is uncommon for emollients to cause side effects. If the hands are cracked and sore, they can occasionally sting when put on. Greasy emollients can also warm the skin which can sometimes make itching worse. Fortunately this does not mean you have an allergy and the stinging usually settles as the dermatitis improves. Only very rarely do people become allergic to the ingredients in an emollient. Paraffin-based emollients rarely cause allergy, and are the best choice if you are worried.
Is there anything I should do or avoid whilst applying emollients?
Pure petroleum emollients are flammable and should never be used near a naked flame. Your hands may be slippery after applying a greasy emollient, so allow time for them to soak in before driving or operating machinery. If you are doing paperwork you may prefer to use a less greasy cream or gel emollient. Pots of emollient should not be shared with other people.
How should I wash my hands?
Use warm water and a soap substitute (these can be bought without prescription and some double up as moisturisers). If your hands are dirty, use a non-perfumed soap applied sparingly then rinse thoroughly. Remove rings before washing your hands to avoid getting soap and moisture trapped underneath.
After washing, dry your hands carefully with a clean towel, especially between the fingers, then apply your emollient.
Is there anything I can do to avoid or reduce the frequency of flares?
Avoid skin contact with detergents, cleaning chemicals and laundry detergent as they will all irritate your skin. Always wear gloves when in contact with these chemicals. Try not to get your hands greasy when cooking then they won’t need to be cleaned with detergent.
Use washing machines and dishwashers when possible. Ask other family members for help with housework and gardening to give your hands a chance to rest.
Foods can irritate the surface of the skin. Do not peel or chop potatoes, tomatoes, citrus fruits, garlic or chillies with your bare hands.
Don’t get liquid soap or shampoo on your hands. Use disposable gloves when you wash your hair or children’s hair. Do not apply hair lotion, hair cream or especially hair dye with your bare hands.
Rings should not be worn for work or housework until the skin has been clear for three months. Keep the inside of rings clean by brushing under running water.
Wear gloves for messy tasks involving contact with engine oil and grease. Do not use harsh cleaners or wire wool on the skin of your hands as they are very irritating to the skin. Fibreglass, plasterboard and cement are also highly irritant.
Avoid any skin contact with paint, glues and solvents such as white spirit, turpentine, thinners and trichloroethylene.
Health care workers should use alcohol hand rubs instead of hand washing for infection control. If hands are not visibly dirty or soiled with blood or other body fluids, alcohol rubs can be used for decontamination. Always follow the infection control and hand hygiene guidelines in your own workplace. Alcohol rubs can sometimes sting but this is not a sign of allergy. It tells you that the soap you have already used has damaged the skin. Alcohol rubs are actually less irritating to the skin than soap and water.
When should I wear gloves?
Use protective gloves for wet work and when handling chemicals or potentially infectious material. Wear gloves for as short a time as possible, ideally not more than 20 minutes because sweating can make dermatitis worse. Make sure that your gloves are clean, dry and do not have holes. Use PVC gloves if possible as these are unlikely to cause allergies. Use cotton lined gloves or separate cotton inner gloves to reduce sweating.
Clean the inside of gloves by turning them inside out and rinsing with warm water several times a week. Replace worn out gloves regularly, especially when used industrially. Remove and replace gloves if they get wet inside.
Wear warm fabric gloves in cold weather to protect skin against the drying effects of cold air.
Where can I find more information?
Please see the patient information leaflet on contact dermatitis on the British Association of Dermatologists website.
For details of source materials please contact the Clinical Standards Unit (firstname.lastname@example.org).
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists; individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED JANUARY 2016
REVIEW DATE JANUARY 2019