Managing Hand Eczema: Tips on Steroids, Moisturizers, and Handwashing

Q: Managing Hand Eczema: Tips on Steroids, Moisturizers, and Handwashing

Hello： 1. <br>After brief exposure to water, such as washing hands, you can carry petroleum jelly or hand cream with you for immediate application. <br>2. <br>Steroid ointments can be applied during acute flare-ups, while regular maintenance should be emphasized during chronic ph

Hand eczema & handwashing & corticosteroids & moisturizers

Hello, doctor: I have hand eczema, which I would consider mild (compared to what I found in Google image searches).
I have seen a dermatologist and used topical corticosteroids, occasionally applying hand cream and wearing cotton gloves.
After applying the medication, my symptoms improved, but it hasn't completely resolved, though it doesn't severely impact my daily life.
I initially thought it couldn't be cured, but after researching, I found that it might be possible to achieve complete resolution, although it may require over six months of maintenance.
Due to frequent activities like washing rice and dishes, it's challenging to reduce irritation in a short time.
However, I want to avoid the long-term side effects of corticosteroids, but in my situation, it seems I will end up using them for a longer duration.
I stopped using medication and have not returned for follow-up, thinking that I could just ask the doctor for medication if acute inflammation recurs.
Currently, I only have symptoms on the fingertips, which are not itchy, but the skin is dry and rough, with almost no fingerprints.
While the weather is still relatively mild, I would like to seek your advice.

After searching for information online, I found that related educational materials suggest "washing hands less" and "using less soap or hand wash." However, even if I reduce the frequency, I still end up washing my hands more than four or five times a day after using the restroom and three times before meals.
Moreover, I need to follow the "wet, rub, rinse, dry" five-step procedure, washing for at least 20 seconds.
Washing my hands ten times a day seems normal.

I would like your recommendations on the following:
1.
In light of this situation, how can I minimize damage? (Can I wash with just water? Are there any handwashing occasions that can be skipped?)
2.
Do I need to revise my understanding? (Should I continue using corticosteroids?)
3.
"Traditional hand creams provide oil and moisture to hydrate dry skin, but over time, the skin may become lazy and gradually lose its ability to produce oil and moisture on its own, making it more prone to dryness when not using hand cream." This advertisement sounds quite alarming...
Is it true?
#Common Sense Question (sorry, but I'm really unclear): Should I wash my hands before applying Vaseline or lanolin? (If so, that would mean washing my hands a lot...) (If I believe I don't need symptom treatment and only want to seek professional advice at the clinic, will the doctor find it difficult to deal with? Should I explain to the patient that this may take a considerable amount of time...)
Finally, thank you, doctor, for answering my questions! Thank you!

Fugui Shou, 10~19 year old female. Ask Date: 2015/10/12

Dr. Li Yufen reply Dermatology

Hello: 1.
After brief exposure to water, such as washing hands, you can carry petroleum jelly or hand cream with you for immediate application.
2.
Steroid ointments can be applied during acute flare-ups, while regular maintenance should be emphasized during chronic phases.
3.
There is no need to wash your hands again before applying petroleum jelly or lanolin.
Thank you!

Reply Date: 2015/10/12

More Info

Managing hand eczema can be challenging, especially when it comes to balancing effective treatment with the desire to avoid long-term use of steroids. Here are some strategies and insights based on your concerns:
1. Reducing Skin Damage:
- Handwashing: While hand hygiene is crucial, especially in the context of food preparation and personal hygiene, you can modify your approach to reduce irritation. Instead of using soap every time, consider rinsing your hands with water when they are not visibly soiled. For example, after using the restroom, if your hands are clean, a simple rinse may suffice.
- Choosing the Right Soap: If you must use soap, opt for a gentle, fragrance-free cleanser that is less likely to irritate your skin. Look for products labeled as "moisturizing" or "for sensitive skin."
- Moisturizing: Apply a thick moisturizer immediately after washing your hands to lock in moisture. This can help mitigate the drying effects of frequent washing. Consider using a heavy-duty cream or ointment, such as those containing ceramides or glycerin, which can help restore the skin barrier.

2. Steroid Use:
- Continued Use of Topical Steroids: It’s understandable to be cautious about long-term steroid use due to potential side effects. However, if your eczema flares up, a short course of topical steroids may be necessary to control inflammation. Discuss with your dermatologist the possibility of using a lower potency steroid or a non-steroidal anti-inflammatory cream as an alternative.

- Weaning Off Steroids: If you decide to stop using steroids, do so gradually under the guidance of your healthcare provider. This can help minimize rebound flare-ups.

3. Understanding Moisturizers:
- The concern that using moisturizers can lead to the skin becoming "lazy" is somewhat exaggerated. While it’s true that the skin can become reliant on external moisturizers, they are essential for managing eczema. The goal is to maintain skin hydration and barrier function, which is often compromised in eczema patients. Regular use of moisturizers is beneficial and should not be avoided.

4. Using Vaseline or Sheep Oil:
- When applying products like Vaseline or lanolin (sheep oil), it’s generally a good idea to wash your hands first to remove any irritants. However, if your hands are clean, you can apply these products directly without washing again. The key is to ensure that your skin is not contaminated with irritants before applying these occlusive agents.

5. Consulting with Healthcare Providers:
- Seeking professional advice is always encouraged, even if you feel your condition is stable. Dermatologists appreciate patients who are proactive about their skin health. A consultation can provide you with tailored advice and potentially new treatment options that you may not have considered.

In conclusion, managing hand eczema effectively involves a combination of proper hand hygiene, regular moisturizing, and judicious use of topical steroids. It’s essential to listen to your skin and adjust your routine based on how it responds. If you find that your symptoms persist or worsen, don’t hesitate to reach out to your dermatologist for further evaluation and management. Remember, the goal is to maintain skin health while minimizing discomfort and avoiding unnecessary treatments.

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