Hands Contact Eczema: The Patterns and The Implicated Culprits

Hand eczema (HE), is a common chronic multifactorial inflammation of the skin of the hands and/or wristwith the prevalence of5.5-8.8 cases per 1000 person-years with one year prevalence 10% . Women have higher incidence rate compared to men but there is no difference of incidence after 30 years of age. Hand eczema is diagnosed by criteria and currently there is no gold standard for hand eczema diagnosis.

The most common hand eczema clinical findings arevaried from redness, macules, papules, vesicles, and oedema in acute stage, to crusts, scale, fissures, erosions and hyperkeratosis in chronic stage. Hand eczema (HE) cause by endogenous and exogenous substances. Atopic dermatitis is an endogenous cause of hand eczema.Mild irritant (e.g. water and soap) and toxic agents are the most common external cause.Allergic contact dermatitis is less common and reflects contact allergy to specific substances such as rubber, nickel, or perfumes. Current classification systems for hand eczema are based on clinical and etiologic factors such as hyperkeratotic eczema; recurrent vesicular hand eczema (pompholyx, dyshidrotic eczema); nummular eczema and pulpitis (chronic fingertip dermatitis). In some study,the morphology of hand eczema lesions is not related with its aetiology due to changes in morphology over time. 
Hand eczema (HE) cause by endogenous and exogenous substances. Atopic dermatitis is an endogenous cause of hand eczema.Mild irritant (e.g. water and soap) and toxic agents are the most common external cause.Allergic contact dermatitis is less common and reflects contact allergy to specific substances such as rubber, nickel, or perfumes. In one third of patients with ACD not as the main diagnosis, the patch test result are also positive. Further interpretation in positive patch test result is needed because it may not be relevant to current dermatitis
The classification of hand eczema are subjective to the dermatologists interpretation . Irritantcontact dermatitis (ICD) or allergic contact dermatitis (ACD) are diagnosed by exposure assessment and patch testing, meanwhile in atopic hand eczema (AHE), atopic dermatitis history is needed.