The next time you reach for an antibacterial wipe to clean something in your home, imagine what it would be like doing it with sore, cracked hands.
Because wipes are a common cause of hand eczema – also known as dermatitis – a condition that’s become so common in recent years it’s been described by some as a shadow pandemic.
Symptoms often begin slowly, with red inflamed skin on your palms and around the webbing of your thumb, but then scaly patches and cuts or fissures may develop along the fingers and across the palm. It can make life a misery for those affected – as I know myself, as I’ve suffered from it too.
It was winter 2002 and as I carefully shampooed my baby’s head, I looked down at my chapped hands with painful cuts that caused me to wince with pain.
I’d suffered hay fever for a long time, an allergic condition that can also leave skin more prone to sensitivity and irritation.
The two often go hand in hand as both are driven by an overactive immune system.
Symptoms for hand eczema often begin slowly, with red inflamed skin on your palms and around the webbing of your thumb, but then scaly patches and cuts or fissures may develop along the fingers and across the palm
Dr Justine Hextall realised she had developed irritant hand eczema when her chapped hands with painful cuts were causing her to wince with pain as she shampooed her baby’s head
But it wasn’t until I began the endless ‘wet work’ of a new mother that the vulnerability of my sensitive skin began to show, too: I had developed irritant hand eczema.
While not the same, as you come into contact with an allergen your skin angrily flares, my skin barrier – the outermost layer – was sensitive to the constant washing and handling of baby wipes.
Luckily, I am a dermatologist so understood how to mitigate this new problem – but so many do not.
I have seen people with hands so sore with severe eczema that they were infected, crusting and weeping – as a result they’ve been at an increased risk of developing contact allergies, too.
Some have even had to stop work permanently – hairdressers are particularly vulnerable.
The pandemic saw a real rise in cases of hand eczema. People were not only washing their hands more than normal, they were using astringent alcohol-based hand sanitisers; healthcare workers were also wearing disposable gloves most of the day.
(Unfortunately, there is clear evidence that when hands become damp under moisture-trapping gloves, the skin barrier becomes damaged, and in people prone to eczema this has been shown to disrupt the skin microbiome, allowing for example Staphylococcus aureus, a bacterium that drives the urge to itch to flourish.)
This can create a cycle of more bacterial overgrowth, more barrier breakdown, more inflammation.
Once the barrier is compromised – whether from existing sensitivity or from the process itself – there’s an increased risk of developing new allergic reactions that never previously caused a problem.
Hand washing is also an issue. Our skin barrier is naturally acidic, with a pH around 4.5-5.5 – however most soaps have a more alkaline pH of around 9-10.
Increased skin pH can disrupt enzymes that build and maintain fats and oils in the skin, leading to moisture loss, dryness and irritation.
Soaps are effective at removing many viruses as the washing process physically removes debris and unwanted pathogens.
The soap also binds to fats and grease (that’s how it helps clean dirty hands) which has the added benefit of inactivating some viruses; it does this by disrupting their outer membrane which is formed largely of fats.
However, soap and (particularly) hot water will also wash away vital fats in the hand’s skin cells and proteins in the skin, significantly damaging the protective outer skin barrier. Once that is damaged it is a little like a breached dam.
This disrupted skin barrier can no longer hold as much moisture or protect us as efficiently from skin irritants such as alcohol gels – or even infection from viruses and bacteria.
Even more damaging to hands than soap and hot water can be household cleaning products such as disinfectant wipes
And unless steps are taken to calm, hydrate and repair the skin barrier, you can end up with significant hand eczema.
Even more damaging to hands than soap and hot water can be household cleaning products such as disinfectant wipes.
Harsh active ingredients such as N-alkyl dimethyl benzyl ammonium chloride, a disinfectant found in wipes and hand sanitisers, are very damaging – in one 2017 study, published in the journal Dermatitis, 32 per cent of the 615 patients referred for patch testing for suspected allergic skin reactions tested positive to this ingredient.
In higher concentrations the Environmental Protection Agency even describes it as corrosive to the skin.
There are also other well-known allergens such as methylisothiazolinone, deemed so allergenic that it has been banned from use in leave-on skin products and facial wipes by the EU since 2017 – as it was felt there was no safe concentration. But it can still be used in rinse-off products such as shampoo and household cleaning wipes, which fall outside of cosmetic regulation.
Contact allergic hand eczema is more common in ‘wet work’ professions such as hairdressers, healthcare workers, mechanics, construction workers and cleaners.
Hairdressers are one of the most at risk, as not only do they frequently immerse their hands in water with shampoo detergents, but they are also exposed to high-risk chemicals for allergy including hair dye, bleaching agents and perming solutions.
So what is my advice as a consultant dermatologist?
Certainly do not stop hand washing – but alter what you wash your hands with.
Look for a handwash that contains emollients (moisturising ingredients); ‘humectant’ ingredients, meaning they help to hold moisture in the skin (eg glycerin); or ceramides, important fats that act like mortar, holding the skin cells firmly together.
Afterwards, pat your hands dry – then apply moisturisers: it is important to consider the key oils/fats that are integral to the skin barrier, so look for ceramide-rich creams, or those containing shea butter, for example, as it’s been shown to boost hydration and reduce moisture loss.
Another option is allantoin, a naturally occurring mild humectant which comes from comfrey and chamomile amongst other plants and has anti-inflammatory properties and helps soothe and repair skin.
Next choose a humectant – which draws moisture (from the air or lower layers of the skin), to the top layer of the skin – such as glycerin, hyaluronic acid, panthenol and urea.
I recommend Avene’s Xerocalm balm, Eucerin’s 5 per cent repair hand cream and CeraVe’s moisturising cream. For easy absorption and minimal stickiness, I like Neutrogena’s hand cream.
Applying a rich hand cream under cotton gloves at night is also something I’d recommend – small studies support this, noting fabric gloves actually enhance the efficacy of moisturiser, reduce the severity of hand eczema and also appear to maintain the natural microbiome.
If you’re handling skin-damaging cleaning products do the same thing, but put rubber gloves on top; many patients have found this transformative.
It’s also vital to know what hand eczema you’re dealing with.
Atopic eczema (meaning inherited or having a genetic predisposition) is systemic so likely to be in both hands. Irritant hand eczema also usually involves both.
However, eczema in just one hand could be an infection – or a contact allergy: for instance a chef holding garlic in one hand whilst chopping could be allergic to the garlic, or a golfer could be allergic to the rubber in the glove they wear on a golfing hand.
This kind of eczema needs prompt treatment and may require a prescription from your GP or dermatologist. Traditionally we use topical steroids to control the acute flare-up and often then calcineurin inhibitors such as tacrolimus, which work by inhibiting the enzyme calcineurin which drives the inflammatory response.
This is often used as a maintenance treatment to prevent further flare-ups and reduce the need for topical steroids which long-term can cause skin thinning.
And for skin fissures, tape impregnated with steroids and left on for 12 hours a day is helpful, but these are only available from a doctor.
Despite the worry about using steroids long term, all these prescription topical creams can be safe and effective, and there is some evidence to use them intermittently for longer periods to prevent recurrence. However, suitable skincare must be used alongside, to optimise barrier function and give longer-term, sustainable results.
For most people hand eczema will calm down, yet around 9-16 per cent of those will have it in some form all the time.
But there is hope for them, too.
The most significant recent development is delgocitinib (brand name Anzupgo), a cream created specifically for this condition.
This was approved by the MHRA in November 2024 and is now available on the NHS following NICE approval.
It’s a type of JAK inhibitor – these drugs are already used to treat auto-immune conditions such as rheumatoid arthritis and vitiligo and work by blocking the janus kinase enzymes from telling the immune system to cause inflammation.
And delgocitinib has the added benefit of supporting skin barrier function.
In large clinical trials patients using this twice-daily achieved clear or almost-clear skin after 16 weeks; this is roughly two to three times the rate of those using a cream that didn’t include the active treatment.
It held up over the long term, too: 52 weeks after the trial ended, almost half of patients had clear skin and most flares resolved after restarting treatment.
But prevention really is key, as is treating flare-ups promptly to prevent complications.
And if previous treatments have been used with appropriate skincare without benefit, do have a discussion with your GP or skin specialist as newer treatments may be available.
I know, first hand, how distressing hand eczema can be – but, thankfully, there is now much that can be done about it.
