Hand care is so important, so obvious, and yet so often neglected. Dry, cracked, painful hands and fingers are frequent wintertime skin concerns. Simply consider the limitation in movement and comfort this presents. Fortunately a little prevention and some good treatment help keep hands intact year round.

"HAND"le with care

Handle your hands with care! Hand eczema, atopic dermatitis, dishidrotic eczema, psoriasis, contact dermatitis (allergy), latex allergy and simple wear and tear lay the groundwork. Combined with cold, dry weather and lifestyle (like over exposure to harsh chemicals or water), and the skin is set to form tough to treat hand and finger splits.

I'm Drying...Drying...Drying...

Dehydration and irritation from over washing or frequent exposure to harsh detergents or disinfectants often affects health care workers. I remember when I was in medical school and going through my surgery rotations. The constant scrubbing with strong hand soaps several times a day literally tore up my hands. This is particularly true when cold dry weather and furnaces ace as environmental dehydrators.

Industrious Yet Notorious

Other industries are equally notorious for conditions, which contribute to forming dry, chapped hands. Bartenders, waiters and other food workers face irritation when handling lemons and limes, not to mention all that water exposure.

Hairstylists tend to find that chronic exposure to permanent wave and hair color solutions used in hairstyling contribute to hand dermatitis.

Cement workers and construction workers may come into contact with certain ingredients in the cement mix that can cause a contact dermatitis.

The list is endless, but understanding essentials of limiting water exposure as possible, wearing protective gloves (if necessary) and applying barrier emollients will help reduce the risk of routine flare-ups.

The H20 Has Got To Go

Cut down on water exposure. Ask your husband or kids to do the dishes. If you're in a job that requires frequent hand washing, keep your barrier cream with you and apply it! If you are considering bathing just a few times a week, let's face it life goes on. While it may have been the norm for dermatologists years ago to say don't bathe but once a week, reality dictates this isn't ideal. But, you can take some steps to protect your skin. As the water evaporates, it takes moisture out of the skin. This is why applying a barrier cream immediately after washing is so important.

When you do wash, try to use a mild soap such as Vanicream Cleansing Bar or Cetaphil Gentle Cleansing Bar Soap.

ARE YOU ACTIVE OR PASSIVE?

Your choice of moisturizers is highly dependent upon the status of your hands. Those bland moisturizers I spoke of above are what I would term passive treatment. This is equally important for crisis periods you may face. However, you can add products into your routine when your skin is in a quiet phase that can help to prevent flare-ups.

Active Is As Active Does

Active hand care products contain ingredients that work to soften the skin. Since thick scaly skin is often associated with many forms of hand dermatitis, exfoliation is typically the end result of many of these active agents.

Many, however, are humectants, holding many times their weight in water in the skin. Active hand creams are not what you want to rub into an open wound, you'll regret it once the stinging starts. But if you have thickened rough skin or are prone to finger splits, these are the types of products you want to include for preventative purposes.

Regular use of such an active hand cream on a maintenance basis can help keep the skin softer, and less likely to crack or peel. You may certainly alternate the various active hand creams or combine them in a regimen with passive hand care emollients. Alternating the use of the different products can work synergistically and potentially result in a better result.

Whatever you use, it is important to apply something immediately after washing your hands or doing the dishes. Consistency in your routine is particularly helpful for keeping your hands in great shape.

• Glycolic Acid: DERMAdoctor KP Duty Dermatologist Moisturizing Therapy For Dry Skin
• Lactic Acid: Priori Advanced AHA Hand & Body Revitalizing Lotion
• Urea: Carmol 10 Lotion or Carmol 20 Cream
• Combination Approach, Glycolic Acid, Urea and Green Tea: DERMAdoctor KP Duty Dermatologist Moisturizing Therapy For Dry Skin

Glycolic and Lactic acid help soften the skin mostly through exfoliation of the hard dry epidermis. Urea is a humectant, helping hydrate the skin. DERMAdoctor KP Duty Dermatologist Moisturizing Therapy For Dry Skin is a 2 in 1 treatment, softening the crustiest skin and helping improve symptoms of inflammation thanks to ECCG contained in the green tea.

Prescription options include LacHydrin (also a 12% lactic acid like AmLactin) and Carmol 30 and 40 (higher concentrations of urea).

Salicylic acid and hyaluronic acid are ingredients that may be incorporated into skin care products that can also help. Salicylic acid, aka beta hydroxy acid, helps exfoliate dry skin. Salicylic acid tends to be a companion ingredient in moisturizers rather than a main player.

Hyaluronic acid, aka cyclic hydroxy acid, (CHA), helps hold 1000 times its weight in water content within the skin. Hyaluronic acid is now a favored ingredient in a bevy of moisturizers.

Skin rejuvenation and moisturization can be achieved through the use of AHA containing hand creams. Here again, glycolic acid in DERMAdoctor KP Duty Dermatologist Moisturizing Therapy For Dry Skin or lactic acid in Priori Advanced AHA Hand & Body Revitalizing Lotion helps exfoliate and stimulate a small amount of fibroblast activity.

Vitamin C is also a member of the AHA family, although most think of it in a class of its own. Not only can Vitamin C work as an antioxidant, it helps stimulate fibroblast activity. Apply some Cellex-C High Potency Serum and get your active protection, rejuvenation and SPF in one.

PASSIVE BUT NOT A PUSHOVER

They may be bland, but they're not boring. Heavy bland moisturizers are what I refer to as passive protectants. These are formulated without acidic or medical softening ingredients, yet help keep skin hydrated and sealed.

These heavier passive creams are essential for putting a barrier between you and the environment. No barrier, no healing. Lotions simply won't do. They are incapable of healing thickened dry skin splits. Real estate agents will always stress location, location, location. But when it comes to problematic chapped hands, cracked cuticles or finger splits, it's protection, protection, protection.

The key to using a passive moisturizer is to apply it as frequently as possible. Apply your passive moisturizer every time you wash your hands, do dishes, etc. Keep a second moisturizer at work or in your purse to have readily available. When it comes to parched skin, healing is proportional to pampering.

Protective Passive Options:

• TheraSeal Hand Protection
• Vanicream Moisturizing Skin Cream, 4 oz
• CeraVe Moisturizing Cream
• AHAVA DERMUD Intensive Nourishing Hand Cream
• Nouriva Repair Moisturizing Cream

Finger Split First Aid

Most people don't think about their hand care until split fingertips, itching or tiny blisters affect them until they appear. With all the nerve endings located in the fingertips, split fingertips can be exquisitely painful. If you think a paper cut is bad, just amplify it a thousand fold in order to get the idea. Fissures (also called cracks or splits) may be nursed back to health by following this routine:

• Apply Polysporin First Aid Antibiotic Ointment into the splits twice a day. Do not use any topical antibiotic ointment that contains neomycin which is a notorious skin sensitizer and cause of contact dermatitis.
• Use DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone at least nightly, ideally twice a day. DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone contains a bevy of AHAs, salicylic acid and propylene glycol to quickly softens the hard, dry skin, allowing the fissures to heal. It also contains 1 percent hydrocortisone, oat beta glucan and green tea extract to help reduce itching and inflammation. The base establishes a protective barrier to prevent further environmental challenges. I think of DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone as a medicated dry oil; a little goes a long way and won't leave skin feeling greasy.
• Use a passive barrier cream de jour obsessively.
• Using Super Glue does NOT help heal fissures and may lead to an allergic contact dermatitis.

Blisters

Do you have blisters on your fingertips that look like tapioca seeds? This is a sign of dyshidrotic eczema. The bubbles are a sign of increased inflammation that means increased itching and often scaling, splitting, etc. Seeing those little blisters form means you are about to have a flare. Don't ignore them, call your dermatologist if you rely upon prescription therapy. If you have been lax on your maintenance hand care, start up right away.

Dry out blisters by compressing them with a damp cloth soaked with Domeboro Astringent Solution.

Keep in mind, however, you want to dry out the blisters without overly drying the skin. Removing the fluid from the blisters with the Domeboro and then hydrating the skin with a moisturizer is not contradictory. Stop using the Domeboro when the blisters are gone.

It is preferable not to pop blisters. But for the occasional painfully large blisters, you may want to pick the edge with a sterile needle to deflate them but not pull the top protective skin off. If you do pop a blister, keep it clean with hydrogen peroxide and Polysporin First Aid Antibiotic Ointment to prevent infection.

Underlying Causes

Skin diseases can either directly cause or flare dry, blistering, itchy, splitting hand dermatitis. Are you eczema or psoriasis prone? Protection and finger split therapy remain important, but treating the underlying problem is essential.

Eczema (atopic dermatitis) is often treated with topical steroids. These can range in strength from OTC Cortaid to potent prescription cortisones. For unresponsive eczema prescription agents Protopic or Elidel can rapidly clear nasty chronic cases.
Psoriasis treatments tend to be selected by severity of the condition. These may include topical tar products like Balnetar Therapeutic Tar Bath, or topical steroids ranging from OTC DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone or Balnetar Therapeutic Tar Bath, to rx options; Dovonex or Tazorac. Light therapy (PUVA) is reserved for difficult to treat hand eczema or psoriasis.

For those who prefer trying remedies from Nature, AHAVA Dead Sea Mineral Mud and AHAVA Bath Salts may provide some relief from excessive scaling or itching. Don't however, steer clear of the previous options. There is more to fear from secondary bacterial infection than from the treatment itself.

Fungal infections of the skin may occasionally mimic hand eczema or psoriasis. If superficial scaling, particularly on the palms as well as the fingertips, is present, ask your dermatologist about a simple painless skin scraping called a KOH. While most commonly thought of as a foot problem, (aka athlete's foot) fungi can indeed affect the hands (tinea manum). Fungal infections may be treated topically with products like DERMAdoctor Feet Accompli Ultimate Antifungal Pedicure Cream or with prescription oral antifungal agents.

No apparent reason for the problem? Ask your doctor about patch testing to rule out a contact dermatitis. This refers to developing an allergic reaction to something you come into contact with. Not only may a contact dermatitis be the primary culprit for the condition, sometimes it may complicate other skin conditions, especially eczema. Atopic individuals tend to have a higher rate of allergic contact dermatitis. Eliminating these flare factors from daily use quickly helps resolve the problem.

Working through problem hand concerns with your dermatologist and keeping hands protected, helps keep hands looking great and feeling great. Plan ahead now for cold winter weather before your hands become a nuisance. Advance planning makes all the difference for anyone with a known history of dry cracking hands.

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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