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Dry, Cracked Winter Hands

by Dr. Michael McKelvey

For many of us, winter means dry, chapped, cracking, and itchy hands. However, with the right preventative strategy and treatment for dry skin, you don’t have to be miserable this winter. 

Why are my hands so dry in winter?

When the normal skin barrier stops functioning properly and results in dry, red, scaling, and itchy skin, this is called dermatitis, and dry winter conditions, hot water, and cold can all make this worse. Dermatitis of the hands can have a profound impact on quality of life and can lead to difficulties in individuals performing everyday tasks at home and in the workplace. 

There are two main causes for hand dermatitis, eczema and allergic contact dermatitis.

  1. Eczema is the most common type of hand dermatitis. Eczema is inflammation of the skin due to a sensitivity of the skin to environmental exposures. The most common trigger for eczema is frequent hand washing, since wet-dry cycles pull moisture out of the skin and lead to impaired barrier function. Other irritant exposures that can lead to eczema reactions on the skin include contact with solvents, detergents, soaps, and acidic foods.

  2. Allergic contact dermatitis is also a frequent cause of hand dermatitis. It is caused by exposure to an allergen. Allergen exposure is thought to cause about 20% of hand dermatitis cases. Common allergens that cause hand dermatitis include nickel, preservatives, fragrance, rubber, and topical antibiotics.

Is Eczema or Allergic Contact Dermatitis Causing My Dry Winter Hands?

Unfortunately, there is little evidence that a detailed history and exam by an experienced physician can reliably tell the difference between hand dermatitis caused by eczema and an allergic reaction since the conditions present almost identically. To sort out the cause, allergy testing using a patch test is the most reliable way to identify an offending allergen. While we don’t always find an allergic trigger, a positive allergy test can potentially cure a patient of their hand dermatitis if they are able to avoid the offending agent.  

How to Manage Dry Winter Hands

Management of hand dermatitis requires irritant avoidance, preventative care, and appropriate medication when necessary. While none of us can completely avoid hand washing, minimizing excessive wet-dry cycles is often the first step in hand dermatitis management. 


When you do have to wash your hands, we recommend using a mild, soap free cleanser and immediately afterwards, while the skin is still damp, applying a thick moisturizing cream or ointment. This will lock hydration into the skin and prevent evaporation from drying the skin out. While counterintuitive, alcohol based hand sanitizers are actually milder on the skin than soap and water, and should be used in situations where they are an appropriate substitute for hand washing.   


To combat the inflammatory component of dermatitis, topical steroids are often prescribed.   Because of the thickness of the skin on the hands, we often need to use much stronger steroids than we would use on other parts of the body in order to penetrate the skin to the problem areas. If severe enough, systemic steroids can offer quick, but temporary, relief for hand dermatitis sufferers.  


Winter doesn’t have to mean suffering for the approximately 14.5 million Americans that suffer from hand dermatitis. Call the office or book an appointment today to get relief! 


Dr. McKelvey’s favorite products and steps for treating and preventing dry winter hands:

 

1. Cleanser:  My standby for a soap-free, mild hand cleanser is Cetaphil Gentle Skin Cleanser.   

2. Moisturizer:  After cleansing or any wet exposure, apply a moisturizer.

  • If you want a very light moisturizer without a greasy feel and quick to rub in, CeraVe Moisturizing Cream is great.

  • Eucerin Advanced care is also fairly light and contains urea to break down rough skin.

  • Neutrogena Norwegian Formula Hand Cream takes longer to rub in, but the high concentration of glycerin provides lasting hydration and is especially good for frequent hand washers.

  • La Roche-Posey Lipikar Balm is the thickest cream that I recommend and is great for severely chapped hands.

  • Finally, while it leaves a lasting, greasy feeling, Aquaphor Ointment is an old standby and offers high levels of moisture and protection.