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Dry, Scaly Skin Of Thumb
The thumb is one of the most specialized parts of our hand that provides grip and makes possible most complex and complicated movements with great ease. Dryness and chapping of thumb, is a form of fingertip eczema that can occasionally merge with palm eczema. The cracks may sometimes break down into painful, bleeding fissures.
Wear and tear eczema
Patterns of Eczema
Eczema is an inflammatory skin reaction characterized by itching, redness, scaling and clustered red bumps and blisters in its acute phase, and by dryness, patches of thickened skin and fissures in its chronic phases. Eczema of thumb develops in two characteristic patterns which include the following:
- Cumulative irritant dermatitis or Wear and Tear reaction - This involves most or all of the fingers, mainly those of the dominant hand, particularly the thumb and forefinger. It worsens in winter and improves on holiday. Eczematous reaction develops as a result of repeated damaging insults to the skin. The irritants include friction, mild trauma, low humidity, heat, cold, solvents, degreasing agents (soap and detergents) and the desiccant effects of powder, soil or water. Scratching, rubbing, and at times overzealous application of certain medicaments could lead to its persistence. Certain hobbies, as for example car maintenance or gardening and accidental exposure to strong caustics may also aggravate this problem.
- Contact dermatitis (both irritant and allergic) - This pattern involves the thumb, forefinger and third finger of one hand, and is usually occupational in origin. It may be either an irritant reaction (as in newspaper delivery employees) or allergic (to colophony in polish or to tulip bulbs). The dominant hand is mostly involved, but an allergy to onions, garlic and other kitchen products can affect both hands. Patch tests are beneficial in these instances. Hairdressers; medical, dental, and veterinary personnel; cleaners; agriculturists and horticulturists; homemakers and caterers; printers and painters; metal workers; construction workers and fishermen are more at risk of this skin problem.
Cold, dry weather.
Occlusion of thumb.
The temperature of the chemical irritant (Hot detergents are stronger irritants than detergents in cold weather).
Food substances that can cause contact allergy of hands include wheat bran, potato, eggs, peanut butter, fish, fresh pear, kiwi fruit, apple and plum. Thumb eczema may begin as dryness and chapping, and can progress into redness, scaling and fissures. This problem can be cured in the following ways:
1. Avoid the cause
Wash hands with soap or soap substitutes for a very brief period and immediately apply a hand cream. Old remedies, such as a tablespoon of emulsifying ointment mixed in a cup of warm water, are beneficial. Wearing hand gloves, is the best solution for eczema of occupational origin. Use rubber or polyvinyl chloride gloves for household work. Avoid those with holes, and wear the cotton variety beneath rubber gloves, if your hands sweat a lot. Wear thin leather gloves for gardening in cold, dry climate.
2. Moisturize frequently
The chapped skin is damaged, with reduced barrier function, and is prone to recurrent infections. To restore the lipid film that has been ripped off, a thin smear of emollients has to be rubbed gently into the skin, at frequent intervals. For the thumb with fissures, greasy emulsifying ointments are better, else mild aqueous base hand creams that readily sink into the skin, can be used.
If the thumb has developed fissures with infection in the crevices, then antibiotic tablets, along with steroid-antibiotic ointments can be applied. Mild low potency steroids, such as 1% hydrocortisone ointment promotes speedy healing. For unresponsive eczema, the steroid to be applied at bedtime, and polyethene gloves can be worn, sealed at the wrist with a sticky tape (occlusion therapy). In severe eczema, injections of steroids are given directly underneath the skin. Other treatment options include tar paste, salicylic acid, PUVA therapy, etretinate and cyclosporine.