German skin and allergy aid e. V. Skin allergy news 4

Skin diseaseChronic hand eczema is an inflammatory disease of the skin that is largely confined to the hands. The number of people affected is high: about 10 percent of the population in Germany suffer from it. Initially, the skin on the hands is characterized by severe dryness. Subsequently, itchy blisters may form that ooze and crust over, or the skin may begin to flake, tending to become horny and painful to tear.

Many of the patients can only use their hands in pain and are thus enormously restricted: in manual work, but also in everyday life, when reaching, touching or being touched. Recurring or persistent hand eczema significantly affects the quality of life. In addition, make the practice of particularly skin-damaging professions (e.g., medicine and nursing) more difficult. B. Hairdresser, bricklayer, healing and nursing professions) almost impossible. There is a threat of job changes, retraining or even occupational disability. Chronic hand eczema is one of the most common occupational diseases leading to occupational disability.

Although chronic hand eczema can cause massive discomfort, in many cases it remains undiagnosed for a long time. The reason: There is no uniform clinical picture of hand eczema. Thus, one person suffers mainly from itchy blisters, the other struggles with dry and cracked hands, inflamed fingers, palms or cracked fingertips. Manifestations and manifestations as well as the course of the disease vary greatly from patient to patient. It is important to recognize the onset of hand eczema at an early stage and to take immediate measures to alleviate the symptoms and improve skin regeneration, as well as to protect the hands from further contact with harmful substances. Thus, it is possible to gradually achieve a subsiding of the eczema.

Causes and triggers

There are various factors that can promote and cause the occurrence of hand eczema. Hand eczema develops z. B. repeated contact with chemical, biological or physical substances (so called irritants), which are harmful to the skin. In some patients, the eczema is an expression of an allergic reaction. There is also a hereditary predisposition to sensitive skin with a tendency to eczema. Allergic reactions play a role.

Stresses on the skin that favor the development of hand eczema:

– frequent contact with water and moisture accumulation, z. B. under rubber gloves ➞ swelling of the skin, damage to the skin barrier – contact with soaps and solvents ➞ washing out of skin lipids, increased skin dryness, damage to the skin barrier – chemical irritants, z. B. Acids, alkalis ➞ Damage to the skin barrier – Mechanical irritation ➞ Abrasion of the outermost skin layer, z. B. in manual occupations, damage to the skin barrier

hereditary predisposition to:

– sensitive, dry skin – atopy, especially neurodermatitis

possible triggers:

– incorrect skin cleansing and care, z. B. with soaps, aggressive syndets – acids and alkaline chemicals – organic and inorganic oils – solvents – UV rays – plant substances, e. B. Toxicumach – contact allergens, z. B. Nickel, chromium, cobalt compounds, resins, preservatives, dyes, fragrances, latex, plant extracts

Very often it is a concatenation of several factors: the hand eczema develops due to a combination of skin-damaging influences, e.g. B. in the occupational environment, exposure to pollutants or allergens, an individual predisposition to the disease and increased permeability of the skin barrier. The list of possible causes and triggering factors clearly indicates that some people z. B. are particularly at risk of developing hand eczema due to their occupation (see table).

Hand eczema due to occupation

In some occupations, the skin is subjected to extreme stress, so it is hardly surprising that skin diseases have been at the top of the list of all occupational diseases for many years now. Particularly stressful are activities in which highly irritating substances are handled and the skin is attacked by frequent washing, damp work and mechanical irritation.

Where the skin is exposed to harmful influences, i.e. primarily on the backs of the hands and fingers, the palms of the hands and forearms, there is a high risk that the natural skin protection will weaken and chronic hand eczema will develop.

Occupations with high risk for hand eczema

In most cases, the skin damage is not immediately obvious, but the skin is still able to regenerate. However, repeated irritations cause the damage to accumulate more and more. The skin's own repair mechanisms reach their limits. If a certain threshold of irritation is exceeded, eczema develops.

In some cases of occupational chronic hand eczema, allergic contact allergies play a major role, in addition to skin-damaging influences and irritants. In these cases, the immune system reacts to invading foreign substances with defensive measures that lead to inflammation with reddening of the skin and small, itchy pustules. Both forms of hand eczema cannot always be clearly separated.

Hereditary eczema susceptibility

Hand eczema is remarkably common in patients who already suffer from atopic dermatitis or an allergic disease such as hay fever, allergic asthma or food allergy. These patients have a genetic predisposition to hypersensitivity reactions of the immune system. Such a predisposition is medically called atopy.

Attack on the skin barrier

The fact that mechanical irritations, chemical substances or allergens can endanger skin health to such an extent is due to the fact that the skin barrier is either already disturbed or is increasingly attacked by repeated exposure. In healthy skin, a stable network of skin cells and lipids ensures that no harmful foreign substances can penetrate the skin. Moisture can be stored. The skin is protected from drying out. In many cases of occupational hand eczema, the skin barrier z. B. Damaged by wet work or frequent hand washing. Also, if protective gloves made of rubber or similar materials are worn over a longer period of time so that the hands sweat, this attacks the skin barrier. The consequences: Irritants can penetrate more easily, the susceptibility to inflammation increases (see graphic).

Importance of the skin barrier

– Stable composite of horny cells and lipids – Hardly any loss of moisture – Protection from external influences

– Poor cross-linking of horny cells – Lack of horny lipids – Loss of moisture, dry skin – Less protection against external influences

In patients with atopic dermatitis, the structure of the skin is also genetically altered in such a way that the barrier function is reduced. As a result, the skin is very sensitive, prone to dryness, and thus more susceptible to eczema.

Diagnosis and treatment

If hand eczema is suspected, the dermatologist should be consulted immediately. In order to be able to adapt the therapy and skin protection measures specifically to the individual course of the disease, the physician will ask questions about skin stress during the diagnostic interview and will want to know how often the hands come into contact with water and irritants. Allergy tests can be used to determine a possible contact allergy as the cause.

If a connection between the skin disease and the occupational activity can be established, it is useful in many cases to initiate the so-called dermatologist procedure. The accident insurance institution responsible for the employer, usually an employers' liability insurance association, is informed about the disease so that the further procedure for occupational skin protection and treatment can be coordinated.

Deutsche haut und allergiehilfe e. v. haut allergie aktuell 4

The goal of the dermatologist procedure is to detect occupational skin diseases early and allow those affected to keep their jobs.

Dermatology procedure

If there is a possibility of occupational hand eczema, the dermatologist can initiate the dermatology procedure in consultation with the patient. The employers' liability insurance association then supports the affected person, takes over u. a. costs for skin protection and special skin care products, arranges individual and workplace-related preventive measures, offers participation in skin protection seminars and finances, if necessary. Retraining.

Step therapy

Since hand eczema is caused and maintained by contact and exposure to skin-damaging substances, the first measure is to avoid all triggering factors. The next step is treatment to alleviate symptoms. This includes skin protection, skin care and, if necessary, anti-inflammatory therapy. The individual therapy steps are adapted in stages to the course of the disease, the duration of the disease and the acute severity (see Fig.). The basis is formed by skin protection measures including avoidance of possible trigger factors as well as consistent and regular skin care. The more successfully the first treatment steps are implemented, the better the duration and severity of the disease can be mitigated and the use of anti-inflammatory drugs can be reduced or eliminated. avoid.

– Use systemic therapy to influence the immune system (e.g. B. The comprehensive skin protection program with appropriate cleaning. Care of the hands should start however not only in the case of beginning disease signs. It is much better not to let it get that far in the first place.

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