Cumulative-toxic hand eczema

Last Updated: 2022-03-11

Author(s): Anzengruber, Navarini

ICD11: EK02.0

Toxic contact dermatitis (chronic), toxic contact dermatitis (acute), irritant contact dermatitis, cumulative toxic hand eczema, cumulative toxic hand eczema, toxic dermatitis, 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 have eczema. Toxic-irritant eczema is more common than contact-allergic eczema.

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

Frequently are:

  • Water (moisture), which also irritates and is a common cofactor in other contact toxins
  • Alkaline / 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
  • Sharp, erythematous, limited to the site of exposure, areal, scaly and pruritic erythema, papules and plaques
  • Seldom any satellite foci
  • Due to the symptoms, there may also be secondary phenomena such as excoriations or erosions in the sense of scratching effects, and then impetiginisation again
  • Well-considered anamnesis, e.g. does it get better during holidays? Then suggestive of connection with work activity.
  • Clinical appearance
  • Epicutaneous test if differential diagnosis of allergic contact dermatitis is suspected
  • Smears for mycosis incl. candida, as well as bacteria (impetiginisation) if clinical suspicion occurs
  • Objectify atopic diathesis incl. IgE, sx1, fx5 if there are indications

Almost always the hands are affected. Sometimes also feet, rarely other parts of the body.

Chronification is a great danger. Hand eczema is difficult to treat after a long persistence and can lead to permanent incapacity to work.

Good work equipment including gloves is very important and should be propagated and enforced by insurers and employers. See also the website 2haende.ch

See complications. It makes sense to check for occupational disease.

  • Avoidance of the triggering noxious agent: Cessat causa, cessat effectus
  • Omission of work may be helpful

 

Topical therapy

  • Gloves for work if context.
  • Add adequate re-lubrication with Excipial Repair 2x a day and Protect 3x a day
  • For palmar hyperhidrosis aluminium chlorohydrate.
  • For acute dermatitis, use a watery cream or lotion, while for subacute or chronic eczema, a greasy ointment base is targeted
    • Mometasone fuorat cream / lotion / ointment once a day
    • Clobetasol cream / ointment 1x daily

Phototherapy

  • UVBnb or bath PUVA

Systemic therapy

  • Alitretinoin 10-30mg p.o. 1x daily. if chronic
  • Prednisolone p.o. 25-100 mg 1x daily for 5 days if necessary in the acute stage
  • Levocetirizine p.o. 5 mg 1x daily or desloratadine p.o. 5 mg 1x tgl. or fexofenadine p.o. 180 mg 1x daily
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