Third Time's the Charm for My Persistent Skin Condition
July 30, 2024 10:26 AM   Subscribe

I have dried, thick, flaky skin on the knuckle of my ring finger on both hands, and a less severe version on my left pinky. This has gone on for about eight years, getting better and worse but never healing. What might work for this condition?

I have actually posted twice about this in AMF before, here and here. Having followed people's advice to no avail, and time having passed with maybe new products on the market (he says, hopefully but skeptically), I thought I'd give it one last shot.

Yes I know I should see a dermatologist. I'm working on it--my health care provider, Kaiser, has made this difficult enough over the years to walk away intermittently, but I'm back on the war path and trying to get a dermatology appointment. Kaiser's strategy of rationing-via-frustration is incredible effective, but I'm going to break through it!

Folks here in the past have suggested it might be eczema or psoriasis, I don't know. Based on Mefite advice and my primary care physician's advice, here are the things I have used over the years, which have not healed or seriously improved the situation:
20% urea cream (made it worse and left a kind of ring of darkened skin around it)

Aveeno Daily Moisturizing with Oats (softens the skin while it is applied, so that I can almost see my knuckle-print again, but no lasting effect)

Vaseline Advanced Repair (softens it after I apply the lotion but doesn't have a lasting effect)

Aquaphor (softens it after I apply the lotion but doesn't have a lasting effect)

Eucerin Advanced Repair Hand Cream (softens it after I apply the lotion but doesn't have a lasting effect)

Eucerin UreaRepair Plus (softens it after I apply the lotion but doesn't have a lasting effect)

Bag Balm in the bottle (softens it after I apply the lotion but doesn't have a lasting effect)

Bag Balm in the tin (improves it but only after constant application for weeks, issue returns with a day or two)

Antifungal creme (heavily damaged the skin and left open and bleeding skin)

Clobestasol 0.05% steroid ointment (Prescribed, doesn't really do anything. If I apply more than the recommended 2x per day, damages the skin and leaves cracks and open wound type of thing)

Working Hands (no effect)

Cocoa butter (no effect)

Coconut/avocado oil lotion (no effect)

MG217 coal tar ointment (no effect)
All manner of changes to what I wash my hands with has had no impact.

I don't wear rings or do things that heavily dry out the tops of my hands or hang both hands out the car window or use hand sanitizer or anything. I'm a pottery hobbyist but there is no improvement to my condition when I don't do pottery; in the pandemic I did none for two years and it didn't heal.

One thing I haven't tried yet is a bleach bath, but it's on my list. Are there any thoughts as to what else I should be doing? You are not my dermatologist, but my dermatologist does not yet exist.
posted by kensington314 to Health & Fitness (19 answers total) 1 user marked this as a favorite
 
If it's psoriasis, it's autoimmune, and there are creams that will absolutely help but they're prescription-only. I have psoriasis (in my ears! it could be worse!) and prescription cream is the only thing that has ever affected it. Psoriasis can also end up having arthritis-like effects, so if you have joint pain, make a note of it and don't fail to tell your doctors about it.
posted by restless_nomad at 10:38 AM on July 30, 2024 [7 favorites]


I'm doubtful if anything that's not an RX will totally heal it at this point, and even then, if it's an autoimmune thing you're always going to be fighting it. Get thee to a doctor and find out what can be done.

Meanwhile, maybe Vit E and coconut oil would prove soothing.
posted by BlueHorse at 11:22 AM on July 30, 2024 [1 favorite]


Agree with the above advice regarding non-prescription products being unlikely to budge this, but did want to note for hope’s sake that I’ve had persistent eczema patches on my hands for years that were cleared up completely and durably once I finally went to the dermatologist for an rx.
posted by space snail at 11:29 AM on July 30, 2024 [1 favorite]


Best answer: I have what I would describe in exactly the same terms you use on the big joint of my right middle finger and the knuckle of my ring finger of the same hand.

I’ve had it for years and recently I put some over the counter Bacitracin on it which I had been using on a sore on my leg, and it improved markedly.

You mention being a potter, and I have often wondered whether it’s standard procedure to sterilize raw potting clay. I’ve never heard of anyone doing it, and it’s not clear to me the clay would be stable under that much heat, but if it’s not sterilized I don’t see how you’d avoid being exposed to a range of soil bacteria.

And this:
Antifungal creme (heavily damaged the skin and left open and bleeding skin)
makes me think the antifungal could have killed off competing fungi that were holding the bacteria in check and allowed them to run wild.

I also have restless_nomad's issue of something suspiciously similar in my ears, which I’m nerving myself up to try treating with the Bacitracin, but the notorious ototoxicity of many antibiotics is giving me pause.
posted by jamjam at 11:48 AM on July 30, 2024 [1 favorite]


Best answer: Have you tried hydrocortisone? That is available OTC and might help if it is psoriasis, but it's probably not a strong enough steroid to make a difference.

I think a bleach bath is worth trying. You could also try a Hypochlorous Acid Spray. This is just from my personal experience, based on the news that eczema may be caused by an imbalance of bacteria. It is very gentle. I'd try putting it on at night before going to bed. I get ridiculously itchy skin on my shins and when moisturizing didn't seem to make a dent, this usually does. IDK bodies are weird.

However, the "thickened" part makes me think of psoriasis too. I hope you can get in to see a dermatologist. Keep fighting that good fight. You might mention how long you've been dealing with this on the phone and maybe a receptionist can get you in sooner.

The only other thing I could think of is do you shove your hands in your pockets a lot? Maybe it's a callus of some sort. I get a weird one from my computer mouse of all things.
posted by purple_bird at 11:50 AM on July 30, 2024 [3 favorites]


I also have restless_nomad's issue of something suspiciously similar in my ears, which I’m nerving myself up to try treating with the Bacitracin

Can you memail if that works, because I have the same problem in my ears and in my eyebrows too?

OP - I read your original question and I'm also wondering if it's a callus as well.
posted by EmpressCallipygos at 12:47 PM on July 30, 2024


Are you certain that these are not warts or wart-adjacent? I had something I think was similar on a knuckle. At my doctor's suggestion, I went over it daily with an emery board to keep it smoothed down to skin level and eventually, it just went away and everything is back to normal.
posted by DrGail at 12:50 PM on July 30, 2024


Response by poster: Fairly certain it's not warts, in the sense that it doesn't look like any wart I've ever seen. Also the symmetry--same knuckle, both hands--makes me feel like maybe it's not warts?
posted by kensington314 at 12:59 PM on July 30, 2024 [1 favorite]


Best answer: I had a similar problem for years, mostly on my hands but also my ankles. Dermatologists told me it was psoriasis. Vanicream was the most effective daily product for me--sometimes combined with hydrocortisone cream when it got bad. A salicylic acid lotion would also help in short bursts. But nothing ever licked the problem.

The issue disappeared when I lost a significant amount of weight. If that hadn't been my solution, I probably would've investigated one of the fancy biologics.
posted by mullacc at 4:49 PM on July 30, 2024 [1 favorite]


I’ve had issues with atopic dermatitis my whole life—granted, with symptoms different from yours—but my dermatologist putting me on RINVOQ has been the most effective treatment for everything. Ask your dermatologist about it! (I am not a paid spokesperson, just someone happy to find an effective treatment after decades of trying different things.)
posted by ejs at 5:56 PM on July 30, 2024


Best answer: This is an example of 1, so not scientific.
Do what you can to see a derm. I had a spot on the outside of my heel that was weird for a long t8me, and slowly got worse. I ignored it *years* (something I’m not proud of). Finally went to a derm, we treated with an expensive medication for excema, to no avail. The lack of response led her to do a shave biopsy, and lo and behold- squamous cell cancer! Nothing “to be alarmed about” (her words), and hasn’t spread past the dermal layer. I’m using a chemotherapy cream, and just as was told, it’s getting worse before it gets better, but should ultimately clear up altogether.
tl;dr - see a dermatologist sooner than later.
posted by dbmcd at 7:17 PM on July 30, 2024 [2 favorites]


The only thing that has ever cleared my psoriasis is phototherapy. Unfortunately, that is only available at the derm’s office, or by buying a prescribed machine.

Topicals, even the strong ones, sometimes helped a bit but never cleared me.
posted by sevensnowflakes at 8:08 PM on July 30, 2024


I had something similar, finally went to a dermatology PA after years of messing around with other solutions, got diagnosed with psoriasis, got a Zoryve prescription, and problem solved. No more flaking, no more itching, no more messing around with a stable of ineffective solutions.

If you do end up getting Zoryve, go to GoodRx to get a manufacturer's coupon. It'll likely cover your full copay (which was $100/month in my case, ouch!) and you can get the cream for free, which is totally awesome.

In the meantime, what my dermatologist recommended for moisturizing my problematic hands was Vaseline or Aquaphor, but I see you've tried that already. Fingers crossed for Kaiser will give in and get you a derm soon. <3
posted by cnidaria at 12:25 AM on July 31, 2024


Oh, and Zoryve is a fairly-new topical cream to the market. It's allegedly leaps and bounds better than the old options, but I've never tried the old options (other than straight-up steroid creams like clobetasol, which are hard on you in other ways, and didn't really work for me and which I see from your list didn't work for you either) so I can't really comment from personal experience, but that's what I hear from my dermatologist at least.
posted by cnidaria at 12:27 AM on July 31, 2024


Oh, and one more thing: if you have red deep fissures, my dermatologist would start with a week of 2x daily muciprocin to kill the staph bacteria, and then progress to Zoryve after that, with Aquaphor for any needed additional moisturizing.

Maybe your PCP can prescribe the Zoryve and possibly the muciprocin (if you have the red fissures, otherwise it's not necessary), if the dermatologist wait is too onerous?
posted by cnidaria at 12:34 AM on July 31, 2024


If it’s not psoriasis, try AmLactin.
posted by Violet Hour at 5:10 AM on July 31, 2024


I have one patch of this, right hand middle finger top knuckle, which I have probably had for at least 15-20 years. I call it eczema because my husband has psoriasis (the full rheumatologist-care kind) and this thing never looks/feels anything like his plaques ever have. Mine has very little discoloration, for one thing, unless it's extra irritated.

You've tried a lot to treat it, but I find mine often flares in response to non-deliberate contact with stuff and/or rough handling so - at least until you can get in to that derm or a rheumatologist - you may need to also focus on protection. As you likely well know by now, it's a challenge to keep a (dry) band-aid on it for more than an hour, so you may want to try a skin barrier cream as a protectant. I use diaper rash cream, but probably a better option is what's often called "liquid glove" - it's got some dimethicone in it which diaper rash cream doesn't, and it's not smeary like zinc oxide. But if you've already got some Desitin in a medicine cabinet, you might try it for a few days.

I'm not good at wearing nitrile/latex finger cots, but if I'm doing something where I might be knocking my hands around a lot (yardwork, setting up camping, or just being out and about in cold/dry weather) I don't mind this mesh tube bandage as a bit of padding and protection.
posted by Lyn Never at 6:51 AM on July 31, 2024


Best answer: Epidemiologist here with some professional experience in dermatology. This is almost certainly eczema (I would suggest atopic dermatitis, AD) or psoriasis.

The correct answer is, indeed, visit a physician and probably two or three over time because diagnosis is weird and strange when it comes to conditions inthis immunologically-related family. The broader orrect answer is that these families of conditions currently have no cure and, frustratingly, there is a too-heavy emphasis (or reliance) on trials and error.

On the antifungal aspect: like many topical medications, most (all?) topical antifungal agents themselves are irritants as time and other exposure factors increase. This is why it's helpful to avoid opting for over-the-counter (OTC) drugs without at least a decent diagnosis. You may be putting your body through unneccessary "treatment" that won't address relevant root causes, all the while accepting the side effects. I suggest this is true for OTC steroids like hydrocortisone because, as the duration of treatment increases so too does the likelihood of systemic side effects, drug interactions, and so on. Steroids shouldn't be used for a long time, and that's a very flexible metric (you probably won't cause yourself any harm by testing out an OTC hydrocortisone), but if you try one and your skin heals or your symptoms lessen that is very useful information to share with a doctor.

Hang in there! I also have savage AD on my hands and it's been this way for 15ish years. Useful adjuncts to my approach have included using lower volumes of "non-biological" laundry detergent (i.e. the kind that does not include enzymatic ingredients) that I try to ensure is well rinsed out of clothes and bed linens. Fragrance substances left behind on clothing in particular are often irritated as irritants that provoke, prolong, and worsen flares of AD. Handwashing for me is always with a product intended for use by medical/lab people who necessarily have to wash their hands dozens if not hundreds of times per day (if you can get Nursem, try it--ditto the gentle Aveeno body washes, and various gentle versions of CeraVe, Cetaphil, and similar store brands). Sometimes the practical work is trying to keep the irritation that's there at a minimum, and that's by being gentler and kinder to the skin on your hands generally. I switched to using dishwashing gloves, for instance, about two years ago and I wish I'd started that practice sooner. I've recently followed by using gloves when I lift heavy things, open taped-shut boxes, work in the yard, etc.
posted by late afternoon dreaming hotel at 7:32 AM on July 31, 2024 [3 favorites]


I was thinking about pottery some more--those two fingers on your left hand, do they rub against the wheel when you're centering your clay?

You might try some finger cots on those joints (cut off the tip), waterproof bandaids or just a nitrile glove whenever you do pottery for the next month or so. See what happens!
posted by purple_bird at 1:36 PM on July 31, 2024


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