Chronic Hand Dermatitis Case Report: Managing Severe Itching and Fissuring in a 55-Year-Old Female
Chronic hand dermatitis can significantly impact daily activities, sleep, and quality of life—especially when symptoms persist despite initial treatment. At Village Dermatology, we specialize in identifying triggers and optimizing treatment plans for inflammatory skin conditions. This case highlights the management of inadequately controlled hand dermatitis in a patient seen in Katy and Houston, Texas.
Patient Presentation
A 55-year-old female presented as a new patient with a 4-month history of a blistering, red, and intensely itchy rash affecting both hands. She reported prior evaluation by her primary care provider and treatment with triamcinolone, which did not provide sufficient relief.
The patient described severe itching, rated 10/10 on the itch numeric rating scale, and noted that the condition was contributing to increased anxiety and sleep disruption.
Clinical Examination
A focused dermatologic examination of the right and left hands was performed using dermoscopy. The patient appeared well-developed, well-nourished, alert, and in no acute distress.
On examination, there were erythematous eczematous patches with fissuring distributed across both hands, consistent with chronic hand dermatitis.
Assessment
Status: Inadequately controlled
Overall severity: Mild with severe pruritus
Treatment Plan
Given the persistence of symptoms and lack of response to mid-potency topical steroids, a more aggressive treatment plan was initiated:
Clobetasol 0.05% ointment, applied twice daily to affected areas on the hands (and feet if involved) for 2–3 weeks
Wet wrap therapy with occlusion using white cotton gloves at night to enhance medication penetration
Hydroxyzine 10 mg orally at bedtime to help relieve itching and improve sleep
Continued use of thick emollient moisturizers multiple times daily
Patient Counseling & Education
Extensive counseling was provided to address both symptom control and long-term management:
Skin Care Recommendations
Wash hands with lukewarm water and a mild, fragrance-free cleanser
Moisturize immediately after washing
Apply emollients 2–3 times daily
Avoid scented soaps, detergents, and fabric softeners
Keep fingernails short
Avoid excessive hand washing when possible
Expectations
The patient was counseled that hand dermatitis is often chronic and relapsing, and may worsen with:
Stress
Dry weather
Frequent hand washing
Harsh or scented products
Skin infections
Medication Counseling
Hydroxyzine may cause drowsiness; patient advised not to drive after taking it
Potential side effects reviewed, including dry mouth, blurry vision, and urinary retention
Risks of prolonged topical steroid use discussed, including skin thinning, discoloration, and visible blood vessels
Patient advised to avoid high-potency steroids on the face, groin, or skin folds
All questions were answered, and the patient demonstrated understanding of the treatment plan.
Follow-Up
Return visit scheduled in 2–3 weeks to assess response to treatment and adjust therapy if needed
Expert Hand Dermatitis Care in Katy & Houston
This case demonstrates the importance of escalation of therapy and patient education when managing chronic hand dermatitis. At Village Dermatology, we provide personalized treatment plans to help patients regain skin comfort and improve quality of life.
If you’re struggling with persistent hand rashes or severe itching, our dermatology team is here to help.
