Dr. Aleta Simmons, Assistant Professor of Dermatology, and coordinator of the Skin of Color Clinic in the Department of Dermatology at Vanderbilt discusses hand dermatitis, a condition common to healthcare workers who frequently wash their hands.
Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, I am speaking we are speaking with Dr. Aleta Simmons, Assistant Professor of Dermatology, who also helps to run and coordinate the Skin of Color Clinic here at Vanderbilt University Medical Center. Dr. Simmons, thanks so much for being with us today.
Dr. Aleta Simmons: Thank you for having me.
Shaina Farfel: As we are approaching winter when a lot of us struggle with dry, itchy and irritated skin and for our medical professionals who are washing their hands constantly throughout the day and probably even more so during the pandemic and for whom this can become an even greater challenge, I wanted to focus on a skin condition known as hand dermatitis that we see a lot in the occupational setting. Can you tell me, what is hand dermatitis and what causes it?
Dr. Aleta Simmons: When people typically come in with hand dermatitis, they usually have signs of dry, scaly, or chapped skin on the hands. They may see redness or even dark brown areas of irritated skin. It is often particularly itchy. Patients may have blisters or even fissures in the skin. It typically effects the palms or the fingers or the fingertips or a combination of those. Patients may also say, those cracks are bleeding, or they find that they have weeping, and usually in adults it is caused by an exposure to a chemical or something that they are handling with their hands at their job. Often times, people who have a history of atopic dermatitis or what we commonly call eczema, they can be more prone to develop hand dermatitis as well. To keep it plain, an itchy rash, it maybe red or scaly or both, that appears on the hands that causes patients a lot of itching.
Shaina Farfel: You touched on this a bit, but any other populations that maybe at increased risk for this condition specifically?
Dr. Aleta Simmons: Definitely. In terms of occupations, people who work with cleaning material. The staff at our hospital that do janitorial work, cement workers, and people who work with paper can also often get dermatitis to that or we also call dermatitis like eczema or rash. People who work in factories, they are often wearing gloves for long periods of time. People who wash their hands frequently, like you said before, the wet-to-dry cycle washing the hands and drying the hands often leads to irritation because our skin has a barrier, and once you break that barrier down with dryness and cracking in the skin, things that we handle can often get into the skin, we become sensitive to it and are more likely to develop a rash from it. We also cannot leave out kids. One example is children that like to play with slime and if they already have a history of eczema, the things in the slim can often cause them a rash.
Shaina Farfel: We talked about signs and symptoms a little bit. I did not know if you wanted to expand on that at all in terms of what folks may see that may guide them to know to come and be seen in the clinic and things to look out for.
Dr. Aleta Simmons: Typically, people will try things at home before they present to the clinic. By the time we see them, they have had hand dermatitis for a while and now it is affecting their day-to-day life. Patients say, I can no longer work comfortably. I am miserable. What can I do? At that point, we have to take a history in terms of what are they exposed to at work, what do they do at home, what are their hobbies. Bakers, those that work or people who do it often at home, can sometimes get a hand dermatitis too. We really need to know what patients are doing in their jobs and outside of their jobs because that is going to be key to treating them. Patients often come in and say, I am a babysitter, I watch kids frequently or I work in a daycare. We want to know, are you using wipes, how often are you washing your hands. Those types of questions are very important. When patients usually present to us, we are doing some investigative work to find out what they may be in contact with in order to stop one, the irritation and the itching in the skin, calm down the inflammation to try to get their hands to heal.
Shaina Farfel: Once you do that investigation and history, what are some of the recommended treatments for the condition?
Dr. Aleta Simmons: One great start for patients is doing patch testing. We need to see what the patient is allergic to and this entails using allergens or common things that people are allergic to in terms of what they are using based on their history and also getting information from their employer about what types of chemicals they are exposed to at work. We use that to place patches of those allergens on the patient's back and this is done over a course of a week where we see the patient three times to place the patches, look at the patches mid-week on a Wednesday and then look at them again on a Friday in order to see if they have had an allergic reaction to anything. Once we find out if a patient is allergic to a substance, we then can go into a database for contact allergens and give patients a list of things that they can use that do not have those chemicals or other items in them that should not cause them a rash. Also, patients that work at factories or even bakeries, they do paper or woodwork, we need to know what types of gloves can be accessible to them at their jobs. Because often times we will have people wear cotton gloves, the cotton gloves will absorb any moister from sweating or heat that they may work with and then put another type of glove over that in order to protect them from the chemicals they are using. Because the type of glove may matter because some chemicals can seep through particular types of gloves depending on what they are allergic to or what they use at work. Another thing that is really important is barrier repair. As I said in eczema, the skin barrier has been injured, so we need to try to support it and help it heal. Moisturization, white petrolatum, a moisturizer such as Vanicream that does not have too many allergens in it is going to be helpful for that barrier repair. Then, we need to treat the inflammation, so we use topical steroids or even nonsteroidal medications to get the inflammation down. If those things do not work, we may have to do other treatments like phototherapy or oral medications.
Shaina Farfel: For some of our workers who maybe most at risk for this condition, what are some recommendations in terms of prevention prior to symptom onset?
Dr. Aleta Simmons: Patients with atopic dermatitis may want to meet with their doctors even as early as teenage years to think about what they may want to do for a career because this may impact their life as they are more susceptible to developing hand dermatitis. That is the biggest part of prevention, but some patients may not think about that. They are already in a profession that they love, and they have developed hand dermatitis. It is important that they work with their dermatologist to come up with a plan to treat their dermatitis and to also prevent it from recurring.
Shaina Farfel: Well, Dr. Simmons, thank you so much for sharing your expertise with us today. I think we have a lot of employees, certainly cooks, hospital workers, and daycare providers, who I think could probably benefit a lot from this information and we truly appreciate your time today. Thanks again.