The most common cause of eczematous changes on the palms may occur in those with genetic tendencies towards atopic eczema, or those who have contact with irritant substances such as soap and detergents, cutting oils or vegetable juices. Up to 10 per cent of the population may be affected. It is particularly common in those who work with irritant substances, such as cleaners, caterers, hairdressers and healthcare workers, requiring frequent hand washing. Symptoms include itching, inflammatory changes, flaking skin, fissures, vesicles and blisters. The main approach to treatment is to reduce/stop exposure to the irritant substances. If necessary, recommend cotton-lined protective gloves, especially during 'wet work.' Prolonged use of gloves may aggravate the situation. Frequent application of emollients helps and ointments are more effective than creams. A topical corticosteroid for a month may be necessary to get the condition under control, but skin atrophy may follow continued use. Maintenance therapy two to three times a week is sometimes required. Severe cases may need to see a specialist who may prescribe topical calcineurin inhibitors, phototherapy, oral retinoids or immunosuppressive agents.
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