Hand and foot eczema, hyperkeratotic-rhagadiformes L24.9

Non-prejudicial description for a chronic eczema of different aetiology on hands and feet.

Causes may include cumulative toxic hand eczema/foot eczema, contact allergic eczema, atopic eczema and psoriasis palmaris et plantaris. S.a.u. occupational dermatoses.

Hyperkeratotic-rhagadiform hand and foot eczema is a chronic or chronically recurrent eczema that can affect hands, fingers, interdigital spaces and the back of the hand in equal measure. It has a variegated appearance with itching, extensive redness, scattered fine vesicles, papules and hyperkeratotic plaques as well as mostly diffuse coarse lamellar scaling. The eczematous changes are blurred on the flexor side of the wrist (important DD for psoriasis palmaris) and can spread to the flexor side of the forearm. Erosions and rhagades are also observed.

An atopic diathesis (atopic hand/foot eczema), a contact sensitization (occupational disease if applicable), a psoriasis palmaris/plantaris and a tinea palmaris/plantaris must be clarified. If these diseases are excluded, the descriptive diagnosis "hyperkeratotic-rhagadiform hand/foot eczema" can be named as a diagnosis of exclusion.

If necessary, avoid the triggering noxious agent. Initially medium to strong glucocorticoid in a fatty base such as 0.1% mometasone ointment (e.g. Ecural Fatty Ointment) or 0.05% clobetasol ointment (e.g. Dermoxin Ointment) possibly under an occlusive dressing for 12 hours. Possibly 2-10% salicylic acid-containing ointments. Consecutive ointments containing tar R229. Avoidance of mechanical skin stress. Local PUVA bath therapy (see below eczema) can be tried. Alitretinoin was specifically approved in Germany in 2008 for the treatment of severe chronic hand eczema that does not respond to potent topical corticosteroids.

1. Schwensen JF et al (2014) The combined diagnosis of allergic and irritant contact dermatitis in a retrospective cohort of 1000 consecutive patients with occupational contact dermatitis. Contact dermatitis 71:356-363