Transcript
Announcer:
You’re listening to DermConsult on ReachMD. On this episode, Dr. Christopher Bunick joins us to talk about the various subtypes of chronic hand eczema. Dr. Bunick is an Associate Professor of Dermatology at Yale University School of Medicine in New Haven, Connecticut. Let’s hear from him now.
Dr. Bunick:
When it comes to chronic hand eczema, what defines chronic? Well, there's actually a very strict definition. Chronic hand eczema is hand eczema that persists for at least three months or has two or more episodes in a 12-month period. That's the official definition.
Now, when it comes to chronic hand eczema, chronic hand eczema is an umbrella term or a bucket, and within it are several subtypes. Sometimes, they're divided into what are called etiologic subtypes and morphologic or clinical subtypes. And ultimately, what that means is we have a group of these so-called etiologic subtypes—this would include irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis, and protein contact urticaria. And then on the clinical or morphologic side, we have things like vesicular hand dermatitis, where people get these tiny fluid-filled bubbles on their hands, nummular hand eczema, pulpitis, where you get inflammation, fissures, and scaling on the fingertips, and then, the last entity would be hyperkeratotic hand eczema, where you got thick, hard scale. That's one of the hardest subtypes of chronic hand eczema to treat.
At its core, chronic hand eczema involves skin barrier disruption. It involves it in two ways. It involves, clearly, the physical breakdown of the barrier, and what that does is it increases sensitivity to irritants as well as potentially infectious agents. Especially in our pediatric population, when you get hand eczema or chronic hand eczema, you can oftentimes get staphylococcal bacterial infection or what we call impetiginization of the eczema. So we have microbiome dysbiosis or disturbance. And then lastly, we have the immune system that gets ramped up, so we have inflammation. And that can drive a number of the things we see clinically, which is the redness and the scaling. Also, one of the under-recognized symptoms or signs of chronic hand eczema is actually swelling. So you can get swelling and painful fissures, and this really drives the quality-of-life problems that we see.
Announcer:
That was Dr. Christopher Bunick discussing chronic hand eczema subtypes. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
