Transcript
Announcer:
Welcome to DermConsult on ReachMD. On this episode, we’ll hear from Dr. Matthew Zirwas, an American Board of Dermatology certified physician and the Founder of Bexley Dermatology Research in Ohio. He’ll be sharing insights on different types and causes of hand eczema, which he spoke about at the 2026 Maui Derm NP and PA meeting. Here’s Dr. Zirwas now.
Dr. Zirwas:
The way that I describe hand eczema is, for all intents and purposes, every single case of hand eczema you should assume has a component of irritant dermatitis. Now, why do I say that? Because first, as a dermatologist, if somebody comes in with widespread eczema over lots of their body and I say, “Tell me about your normal daily routine,” and they say, "Oh, six showers a day," you would immediately say, "Well, that is your problem. You should not be getting six showers a day. That is removing too much of the natural oil and damaging your skin." Right? Well, how often do people on average wash their hands? Four, five, six times a day.
And so there's almost always a component of irritant dermatitis. Sometimes it's just irritant dermatitis. Sometimes it's irritant dermatitis complicating allergic contact dermatitis or atopic dermatitis. And the biggest clues that I try and give people are, number one, itch versus irritated. If you ask patients, "Is it more itchy or more irritated?" they can usually give you an answer. And that's actually pretty helpful in determining if it's just irritant contact derm or if there's another component of allergic or atopic.
The second thing, for me, is distribution. And so as a general rule of thumb—and this is by far not 100 percent accurate, but a general rule of thumb—if it's primarily only on the dorsal aspect of the hand on the back of the hand and the fingers, that's more likely to be irritant. If it is just on the palms with no real spread onto the back of the hands, that's more likely to be atopic. And if it's both back of the hand and front of the hand relatively equally, that's more likely to be allergic contact dermatitis. And the reason is the palm is very resistant to irritant contact derm. The back of the hand is not. That's normal skin. So if you're washing your hands 20 times a day, there’s a very good chance you'll get a rash on the back of your hands but not on the fronts. Atopic dermatitis very commonly causes chronic vesicular hand eczema. It can be back of the hand as well, right? But often atopic dermatitis will be only the palms. With allergic contact dermatitis, what are the key things that cause allergic contact dermatitis of the hands? Soaps, moisturizers, and gloves, and all of those go on both the palms and the back of the hands, and so you tend to get both the dorsal hand and the palm involved.
Those are the key clues that I would give people, and the idea of what makes it unique is that it's such a frequent overlap between multiple causes of dermatitis.
Announcer:
That was Dr. Matthew Zirwas discussing how we can recognize different types of hand eczema. 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!
