Cumulative-toxic hand eczema

Toxic contact dermatitis (chronic), toxic contact dermatitis (acute), irritant contact dermatitis, cumulative toxic hand eczema, toxic dermatitis

Inflammation of the skin triggered by a primarily skin-damaging agent. Characteristically, the skin lesions remain strictly confined to the site of exposure.

Very common. Up to 10% of the working population has eczema. Toxic-irritant eczema is more common than contact-allergic eczema.

• Acute irritant-toxic contact dermatitis
• Chronic cumulative-toxic contact dermatitis

Frequent triggers include:

• Water (moisture), also a common cofactor
• Alkaline or acidic solutions
• Organic solvents (xylene, benzene, petrol)
• Fat solvents (acetone, carbon tetrachloride)
• Detergents
• Toxic plant or animal components
• Phototoxic substances
• UV rays
• X-rays
• Thermal stimuli

• Sharply demarcated erythema, limited to site of exposure
• Scaly, pruritic plaques and papules
• Rare satellite lesions
• Possible secondary changes: excoriations, erosions, impetiginisation
   

• Thorough anamnesis (e.g. improvement during holidays suggests occupational link)
• Clinical appearance
• Patch testing if allergic contact dermatitis is suspected
• Fungal and bacterial smears if indicated
• Work-up for atopic diathesis if appropriate (e.g. IgE, sx1, fx5)
   

Almost always affects the hands. Feet sometimes involved, other body sites rarely.

Chronicity is a major risk. Longstanding hand eczema can become treatment-resistant and may lead to permanent work incapacity.

Good work protection (e.g. gloves) is crucial and should be enforced by insurers and employers. See also: 2haende.ch

Depends on chronicity. Consider evaluation as occupational disease.

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