Help! My hand's a flake!

November 22, 2011 7:13 AM

I have eczema all over my dominant hand, which is making some day to day tasks difficult. What are some ways of getting around this?

(Background - I'm in the UK, and we can't just up and see a dermatologist - we have to be referred via a GP. As this is seen as a relatively minor complaint, it's unlikely. Nobody knows what causes it - the last time I had an attack this bad was ten years ago, when I lived in a different part of the country with different water content (water and cold seems to have an effect) and I haven't made any significant changes to my lifestyle that might be causing it again.)

I have pretty bad eczema all over the third finger and little finger on my right hand. I can type, and I can more or less hold a pen, but many other things are difficult. The increased sensitivity to temperature makes handling hot mugs difficult (I tend to hold mugs by the 'cup' rather than the handle as I am less likely to spill them this way) and I can't grip handles very easily. I can just about use a hand sewing needle, but my poor grip means I can't use, say, a crochet hook or fabric scissors very well. And the most frustrating thing is that it really hurts when I try and wash my hair in the shower - doing it one-handed doesn't work, and it's hard to stop my sore fingers from coming into contact with the hair - or use soap and shower gel. (I dye my hair but I'm not risking it at the moment). There is some cracking and bleeding so avoiding soap at all seems a bad idea as I don't want to risk infection.

I'm using a barrier cream (not sure of the name but it's an emollient containing liquid petroleum and urea) as well as some Palmer's Olive Butter that's on my desk, but it still itches and flakes and really hurts. I will be seeing my GP this week for somethign else and I may see if I can get some steroid cream, but in my experience this makes my skin feel brittle and tight.

Any ideas on how I can avoid irritation? During my last bad attack the skin got so sore that I couldn't actually move my fingers, and I want to avoid this!

posted by mippy to health & fitness (14 answers total)

I am right there with you - I have it on my thumb, index finger, and middle finger on my dominant hand. The steroid creams I've been prescribed seem only to work for a short time and then I get too acclimated to them.

The dermatologist I went to suggested a moisturizer called Cera Ve - not sure if it's available in the UK but it's helped me the most out of all the other stuff I've tried. I use it immediately after I've done anything that might irritate my skin, like washing my hands or long periods of "wet work". I've also started wearing gloves for a lot of daily tasks, so whenever I'm washing dishes or using irritating chemicals (bathroom cleaner seems to be particularly bad) the gloves go on. I've been wearing cold-weather gloves a lot more than I have in the past, too, since the cold seems to irritate my skin quite a bit.
posted by backseatpilot at 7:22 AM on November 22, 2011

I have hand eczema too -- going on 4 years now! Have tried every cream from the derm to no avail. A couple of things seem to help: gloves whenever possible; staying out of water (avoiding dishwashing, bathing the kids); frequent reapplication of over-the-counter hand cream; and, surprisingly, topical antifungal medication. I think the irritated state of my skin left it vulnerable to secondary infection. If you have itching and cracking you may have a fungal thing going on.

The hand cream I like the best I found at Whole Foods: Psorzema Creme from Dermae. It feels great and absorbs quickly, so I'm happy to put it on hourly. It claims to contain "Neem, burdock, vitamin A, vitamin E, and bearberry" and no "paragons, phthalates, sodium laurel sulfates, petrolatum, mineral oil". Sensitivity to sodium laurel sulfates in particular has been blamed for this kind of problem, so you may want to check your soap and shampoo.
posted by libraryhead at 7:33 AM on November 22, 2011 [2 favorites]

Gloves sound like a good idea to me - at minimum, a latex glove in the shower (assuming you're not allergic) and a cotton glove at night to maximize the benefit you get from moisturizing at night. And it sounds weird, but it seems to me like a fingerless knit glove over a latex or cotton glove would help with the hot cup issue (fingerless glove for insulation against the temperature, under-glove to protect your skin from fibers/irritation).

I've also had good luck with colloidal oatmeal body wash and lotion (Aveeno, for instance) when I'm having an eczema outbreak, but I don't tend to have outbreaks as bad as the one you're having.
posted by EvaDestruction at 7:34 AM on November 22, 2011

libraryhead - I switched to non-SLS shampoo a while ago, although thinking about it, one of the shampoos I am using at the moment might have it in. However, I'd been using the same drugstore shampoos for years before then and it never seemed to affect my hands (I switched because I was getting an itchy scalp).

We have a Whole Foods here, though it's a bit of a pain for me to get to - might be worth investigating.
posted by mippy at 7:39 AM on November 22, 2011

Mary Kay's Extra Emollient Night Cream. My MIL talked me into trying this several years ago. After trying every imaginable over the counter and prescribed product, I was shocked at how well it worked. The second thing I have used to control the eczema is a daily dose of an antihistamine (in my case Allegra), which has helped immensely.
posted by theBigRedKittyPurrs at 7:45 AM on November 22, 2011

I get eczema in patches over pretty much the whole of both hands, and have done since early childhood.

Barrier creams can help, but that's mostly in terms of keeping irritants (dust and so on) from getting in direct contact and making you itch.

Having tried pretty much every treatment there is over 40 years of living with the condition, I'm convinced that steroids are the way to go. Other things will seem to do the trick for a while, then they'll suddenly stop working. And eczema comes and goes in its own cycles. Cause and effect can become hard to determine.

First of all, when you're prescribed a topical steroid, you can ask for a cream or an ointment. A lot of doctors will prescribe a cream by default, but you can ask for whichever you prefer. Ointments are generally soft paraffin based, so they're more like vaseline. While a cream will be mostly absorbed, an ointment will coat the skin and stay there for longer, and will tend to resist washing better. Personally, I find that whatever there is in creams just makes me itch more, so I go with an ointment (Betnovate RD).

Secondly, and where most people go wrong, is that you have to continue treating a patch of eczema for a week or two after it clears up. Because even when the steroids clear the eczema on the surface, it persists deeper down, and will come straight back again. This is why so many people report a 'rebound' effect - they didn't treat it effectively the first time, and it came back.

Steroids need to be used in conjunction with something that keeps the skin from drying out. My doctor prescribes Diprobase, which is an emollient cream that comes in a huge pump dispenser. You use a thin application of steroid cream, then the Diprobase on top. You apply the Diprobase regularly in-between uses of the steroid.

If you want something cheap you can use to moisturise your hands, and that contains almost nothing that will irritate you, go to a chemist and buy a big tub or aqueous cream for a couple of quid. It's as good as anything.

My eczema flares up badly whenever I wash up without gloves, or if I wash my hands more than necessary for any other reason. Water, with or without soap, is the enemy of eczema.
posted by le morte de bea arthur at 7:45 AM on November 22, 2011 [1 favorite]

I'd also recommend eliminating dairy, coffee, wheat and citrus from your diet, if you can.
posted by essexjan at 8:31 AM on November 22, 2011

Anecdata: a colleague with chronic eczema recently gave up wheat for a few months (it was on a dare - she is a bread lover) and her eczema disappeared completely. It's back now, though, as she found too challenging to avoid wheat.
posted by lulu68 at 8:41 AM on November 22, 2011

This Borage oil cream is amazing. When I was researching options for a friend a few years ago, borage oil came up as a good possibility. I meant to investigate other ways of applying/consuming borage but this worked so well that it wasn't necessary. I love it because it's not greasy and doesn't make my hands oily or sweaty, and the borage definitely helps my winter eczema. FWIW I use the regular lotion, but they have a few different formulations.
posted by barnone at 9:00 AM on November 22, 2011

I think others have good suggestions for the eczema specifically, but going back to the option of getting a referral to the dermatologist -- I can see how eczema could be seen as a minor thing, maybe if it were a little patch that comes and goes and that you have successfully treated. However, two things stand out: first, yours has gotten significantly worse recently, and you haven't been able to successfully treat it. Second, it's impinging on your quality of life and interferring with your grip. If you continue to not be able to use your hand properly, you risk increasing muscle weakness, etc. that could lead to another type of injury.

So if I were you, I would go to the GP and yes, see what they say and what they can give you. But stress the change in the status of your eczema and the effect on quality of life, so that please can they start the referral process in the event that you don't start to get relief (i.e. turn the eczema at least back into a minor problem)....
posted by Tandem Affinity at 9:55 AM on November 22, 2011

The zyrtec I'm taking for other allergies actually keeps my eczema at bay as well.
posted by kbuxton at 10:36 AM on November 22, 2011

The magic words for getting referred sooner rather than later might "afraid for my safety when I'm driving because I can't always grip the steering wheel tightly" (if that's true).

Or maybe, "spilled hot coffee on myself because I couldn't continue gripping the cup." (if true*)

Also, "unable to function sufficiently at work, possibly looking at losing income." (if true)

Another option is "significant difficulty dressing myself." (Buttoning things, in particular, I'm sure, but also, if true.)

The doctor needs a way to document that this is not cosmetic, but is in fact, impacting your activities of living.

Also, I sent you a few PDF articles that I received from a Med Student I know.

*Standard ethical disclaimer.
posted by bilabial at 11:44 AM on November 22, 2011 [1 favorite]

Also, get an allergy test to see if it gives you any clues.

I get eczema from blue cheese. I love the stuff, but it looks like my allergy to mold extends to blue cheese. (No tummy issues, just a skin reaction.)
posted by wenat at 6:56 PM on November 22, 2011

The Whole Foods nearest me carries a line of products called California Baby. A guy I used to go out with has eczema, and he said that their Super Sensitive Shampoo & Body Wash helped calm his flare-ups. This page of testimonials recommends both the Super Sensitive Shampoo & Body Wash and the Calendula Cream for eczema.

Good luck. Skin flare-ups are miserable. I've been battling candidiasis, and I have to second le morte de bea arthur: Follow-through is the key. When you find something that works for you, keep using for a week or two after the visible signs of eczema clear up. I stopped using the over-the-counter lotion I'd been using, and as soon as I got stressed out again, the candida came right back.
posted by virago at 7:19 PM on November 23, 2011