Skin and Nail Disorders

In addition to the musculoskeletal disorders that affect our hands and wrists, a number of skin and nail problems are commonly seen, ranging from bacterial and fungal infections to allergic reactions and inflammation.

What are some of these problems?
Eczema is one of the most common problems encountered by primary care physicians. It refers to an inflammation of the hands and fingers. Eczema of the hands affects 1 in 20 Americans. It is twice as common in women as in men and can cause discomfort and embarrassment, often interfering with daily activities.

Contact dermatitis is also an inflammation of the skin that is caused by an allergic reaction to something you are in physical contact with, such as a watchband made of nickel or even certain fragrances. The most harmful exposures are to chemicals, but detergents, dust, and dry dirt often trigger the rash. Typically, the skin becomes irritated, itchy, and blistered as a result.

Topical steroids (cortisone-like drugs) are usually helpful in relieving symptoms, but unfortunately, the condition is often chronic (long lasting) and relapsing. You should avoid certain things that are likely to aggravate your symptoms (see table).

Fungal infection of the hands often looks and acts much like eczema. When the back of the hand is infected, it may look more like classic "ringworm." Antifungal creams and oral antifungal medication can be very useful in treating these conditions.

Fungal nail infections were at one point in time untreatable. Today, however, there are several oral antifungal medicines available, although they are expensive and must be taken for three or more months.

One of the more painful conditions, know as paronychia, involves a skin infection around the fingernail edges. Biting your nails or frequently getting them manicured can cause this type of bacterial infection. Topical and/or oral antibiotics or antifungal agents may be needed. Sometimes surgical drainage of the infected tissue is necessary.

Fortunately, new treatments are available for some of these problems. For example, Lamisil and Sporanox are prescription medications that are effective in the treatment of stubborn fingernail disease. If you are having skin problems, be sure to make an appointment to see your physician, who may recommend specific tests or treatment options, or even a referral to a dermatologist for consultation.

Clark H. Cobb, M.D.
Columbus, Georgia

Tips for Patients with Irritant Hand Dermatitis

  • Wear unlined rubber gloves when irritants are encountered. However, rubber gloves alone are not sufficient because the lining collects sweat, scales, and debris and can become more irritating than those objects to be avoided. Dermal white cotton gloves should be worn next to the skin under rubber gloves. Several pairs of cotton gloves should be purchased so they can be changed frequently. Try on rubber gloves over the white cotton gloves at the time of purchase to ensure a comfortable fit.
  • Wash hands as infrequently as possible. Ideally, soap should be avoided and hands washed in lukewarm water.
  • Shampooing must be done with rubber gloves or by someone else Avoid direct contact with household cleaners and detergents.
  • Wear cotton, plastic, or rubber gloves when doing housework.
  • Do not touch or do anything that causes burning or itching (such as wool; wet diapers; and handling fresh fruits, vegetables, and raw meat).

Photos and table reprinted from Habif TA. Clinical Dermatology: A Color Guide to Diagnosis and Therapy (3rd ed.) St. Louis, MO, Mosby, 1996.