Eczema has ruined my hands - is there any way to fix this? (Photo)

Question

I have had eczema since childhood. It's the worst on my hands. I layer moisturisers and my corticosteroid creams at night and wear cotton gloves, which helps a lot with inflammation and broken skin, but I still have bumpiness and rough texture all over my hands. Is there any way to fix this? (My facial eczema never behaves this way, when I flare up I apply corticosteroid creams and it gets better in a few hours to days.)

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Managing chronic hand eczema can indeed be challenging, but there are several strategies you might consider to improve the texture and appearance of your skin. Since you are already using moisturizers and corticosteroid creams with some success, here are additional options that might help:

Moisturizers: Continue using thick, emollient-rich moisturizers regularly throughout the day. Look for products containing ceramides or hyaluronic acid, which can help restore the skin barrier.

Avoid Triggers: Identify and avoid any potential irritants or allergens that could be exacerbating your eczema. Common triggers include harsh soaps, detergents, and latex gloves. Opt for mild, fragrance-free products and consider using vinyl or nitrile gloves for protection during wet work.

Prescription Treatments: Discuss with your dermatologist the possibility of using calcineurin inhibitors (like tacrolimus or pimecrolimus) or phosphodiesterase-4 inhibitors (such as crisaborole) as alternatives to corticosteroids, particularly for long-term management.

Phototherapy: Ultraviolet (UV) light therapy can be effective for hand eczema that is difficult to control with topical treatments alone. This should be done under the guidance of a dermatologist.

Systemic Treatments: In more severe cases, systemic treatments such as oral corticosteroids, immunosuppressants, or newer biologic agents might be considered.

Lifestyle Adjustments: Keeping your hands well-protected in cold weather and using a humidifier at home can help maintain skin hydration.

It's essential to continue working closely with your dermatologist to tailor a treatment plan specific to your needs. Regular follow-up appointments can ensure that your regimen is adjusted as necessary for optimal results.

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