Article by Yi Shi
Hands are an essential part in performing our day-to-day activities. When the hands are cracking 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 condition, i.e., occupational dermatitis/eczema or occupational irritant hand dermatitis/eczema.
Specific occupations associated with higher rates of hand eczema include hairstylists, printers, cement workers, painters, mechanics, animal care takers, 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 eczema include one or more of the following:
–Redness (erythema)
–Dryness, peeling, 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 disorder with many possible triggers. It starts by irritants or allergens coming into contact with the skin which causes chain of events, i.e., cellular damage, inflammatory responses, and disturbance and dysfunction of skin barrier.
Irritants And Allergens
Irritants are agents that can exert toxic effects to skin cells after single or repeated exposure. Common skin irritants include detergents, greases, solvents, rubber, and food products. Mild irritants may require frequent exposure to cause the problem whereas highly irritating materials may cause hand eczema with the first exposure.
Allergens are small elements, which can infiltrate 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 provoke 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 passing into and out of the skin, thus shielding the deep layer of the skin against the external environment and preventing water loss.
Irritants or allergens provoke disturbance of stratum corneum by direct cell toxicity, lipid barrier removal, cell membrane damage, and break down of keratins (the key structural material making up the outer layer of the human skin). All types of hand eczema include a disturbance in the stratum corneum.
In addition to irritants and allergens, some host factors may impair the skin function and lower the repair ability of the skin, and thus contribute to the development of hand dermatitis. These conditions include susceptibility to allergy and other skin diseases such as atopic eczema, psoriasis, etc.
Cellular Damage Sets Off Inflammation
Despite variable irritants or allergens, the final common path of hand eczema is executed through the release of inflammatory mediators from keratinocytes, the major cell type in the epidermis (the top layer of the skin).
Keratinocytes are essential in the producing and releasing inflammatory mediators upon penetration of irritants through the stratum corneum. These inflammatory mediators augment immune and allergic responses and propagate hand eczema.
Prolonged Inflammation Impairs Skin Barrier Function
Hand dermatitis is often a recurrent condition owing to sustained inflammatory responses. Studies have shown that frequent exposure of irritants or allergens promotes continued inflammation which exposes the immune system to immunogenic peptides and result in continuing infiltration of inflammatory cells and prolonged production of inflammatory cytokines. Some inflammatory cytokines (i.e., TNF-a) are controlled in a self-stimulating fashion and thus engaged in the continuation of inflammatory response.
Prolonged inflammation can initiate the damage to deeper layers of skin and destabilize the skin barrier. When the skin barrier function is weakened, the penetration of irritants and allergens as well as the subsequent responses are enhanced. This, in turn, cascades into a vicious cycle of lifelong ailment, suffering dryness, fissuring and cracking.
Hand Dermatitis/Eczema Treatment
The goal of treating hand eczema is to prevent irritant exposure, avoid allergen, and relieve skin irritation-caused itchy blisters and painful cracks. It is well-known that the longer hand dermatitis is present, the more difficult it is to treat.
Treatment Failure And Persistent Inflammation
Admittedly, 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 unrealistic to avoid the exposure of all irritants or allergens. Third, inadequate and unsustainable control of stubborn inflammatory/immune responses.
Topical steroids are often used to control inflammation in the skin. Common side effects of long-term use of steroids include skin thinning, loss of pigment, allergic to the steroids, and prone to infection. Immunosuppressant and UV radiation therapy 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 retain moisture and prevent fissuring, may prolong or even exacerbate inflammation.
Natural Anti-inflammatory Remedies For Control Of Persistent Inflammation
Owing to fear of side-effects of steroids and dissatisfaction with standard treatment, dermatitis sufferers are looking for alternative therapies. Most commonly suggested approaches are natural anti-inflammatory remedies. In fact, many anti-inflammatory plant extracts, such as Astragalus, Scute, Coptis, Licorice, and Aloe vera, have shown therapeutic effects in treating inflammatory skin conditions including hand dermatitis.
Since inflammation triggers, propagates, and aggravates hand eczema, cooling inflammation is critical to heal hand eczema and prevent skin barrier dysfunction. Studies suggest that elimination of inflammatory mediators 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”.
Dr Yi Shi, founder of Innovative Drug Discovery http://www.3Rskincare.com is well recognized in inflammatory disease research. Dr Shi has conducted numerous research projects and published over 40 research articles in medical journals. For nearly a decade, Dr Shi has led collaborative efforts to develop natural anti-inflammatory products and 3R Skincare System for inflammatory skin conditions.
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Tags: Cracked, Cure, Fingers, Hands, There
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