Are My Flaky Hands Due To Eczema Or Psoriasis?

Are your hands itching or burning?

Eczema can be caused by a weakened skin barrier. It can be caused by genetic factors but can also be a reaction to irritants and allergies. The hands will likely be very itchy and red, whereas psoriasis - which is either a genetic issue or an overreaction from the immune system - tends to be thicker with an accompanying feeling of tightness.

Flaking skin on your hands can provide a clue

Eczema sufferers will find that their hands develop fine flakes on top of very dry, red or even cracked skin. They may also see tiny, fluid-filled blisters on the sides of their fingers. Psoriasis affecting the hands however, manifests as thicker, well-defined patches of silvery scales.

What other signs are there of eczema or psoriasis on the hands?

A pre-existing problem with hay fever could point to eczema
Pitting or yellow spots under the nail (https://www.drdropin.uk/blog/hand-eczema-not-improving-causes-triggers--when-to-seek-help) or silver scales also on the elbows, knees or scalp is more likely to be psoriasis. If you find that your joints are also sore in the morning, then you may be experiencing psoriatic arthritis.

Do I need to see a dermatologist for my hands?

With these conditions, it won’t simply be a case of buying an over-the-counter product. To define the condition will require an examination and possibly a skin biopsy; and because the skin on our hands is thicker than on the rest of the body, aggressive treatment is likely to be needed.

The first stage is always to protect the skin barrier by removing any products containing irritants. Beyond this, frequent application of fragrance-free emollients will help and we advise individuals to use gloves when carrying out any work which brings the hands into contact with fluids for any length of time, including water.

If eczema is diagnosed, a steroid cream such as clobetasol can help to reduce inflammation alongside a calcineurin inhibitor such as tacrolimus for long-term maintenance. The most recent breakthrough in topical treatment is delgocitinib, a non-steroidal cream for hand eczema.

With psoriasis, it often takes a high-potency steroid cream under occlusion, to penetrate the scales. This can be used simultaneously with vitamin D or coal tar preparations to slow down skin cell growth. If the psoriasis is in the folds of the hands, tacrolimus may also be used in this instance.

What if creams don’t work?

If topical creams and ointments just don’t cut it, dermatologists can use light therapy on the hands, which is usually highly effective. In severe cases, attention may also turn inwards, with immune modulating injections and oral retinoids being another option.