ABSTRACT
This chapter reviews the epidemiology, clinical features, occupational aspects, and long-term outcomes of hand dermatitis. The clinical differential diagnosis of hyperkeratotic hand dermatitis includes palmoplantar psoriasis, tinea manus, palmoplantar keratoderma, and allergic and/or irritant contact dermatitis, as well as frictional dermatitis from mechanical trauma. In a study of hand dermatitis in North America, 7–11% of patients with allergic contact dermatitis had an associated occupational exposure. Topical pimecrolimus and tacrolimus, ascomycin-derived agents that inhibit inflammatory cytokine production by T-lymphocytes and mast cells, have been studied in the treatment of atopic dermatitis and allergic contact dermatitis. Some clinicians categorize hand dermatitis as either endogenous/intrinsic or exogenous/extrinsic. Treatment with psoralen plus UVA irradiation, both oral and topical, has been investigated in the treatment of various types of hand dermatitis. Cyclosporine works primarily by suppressing T-lymphocyte activation, making it useful for the treatment of many inflammatory skin conditions, such as atopic dermatitis and severe chronic hand dermatitis.
