Cracking and patch inflammation on back of hands

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Dear Friend,
My wife has a painful condition on the back of her hands. It generally manifests itself in the evening. It is red, blotchy .. the area between the fingers is rough as compared to her delicate skin. The skin splits around the knuckles, fine cracks that are red. Throbbing, burning pain... A light cotton glove relieves some of the pain. Never on the palms. She has multiple food allergies (corn, wheat, rye, barley, soy (occ. ok), oranges, potatos, more) but her diet is very well-managed and she eats exceptionally well.  Her skin is othewise in good health, she exercises 5x/week 30-60min, sleeps well. She works as a librarian (director) with the usual satisfactions and stresses. She washes her hands a lot, uses no antibiotic soaps. She claims that her skin feels dry everywhere, though it does not appear that way to me. She does not drink, smoke .. has a single decaf in the AM. We heat with a wood stove, humidity generally not above 25% except in the bedroom at night. She uses time-proven moisturizers, perhaps twice a day ("Kiss My Face"). She is an organic food enthusiast, her regular doc is a lady ND, and she won't use topical steroids. A last thought: the patches of red are scattered across the back of the hands and fingers, it is surficial, the patches are gently swollen, the cracks look like they are just below the threshold of bleeding. She wears non-latex, non-powdered gloves if she's doing dishes. 32 years old. Thanks very much. Harry

[Alan Rockoff, MD]

It sounds as though your wife has eczema.  Eating well and moisturizing are helpful, but will not solve this problem alone, which is aggravated by winter weather and low humidity.  The treatment for eczema is the use of topical anti-inflammatory creams.  Most but not all of these are steroids.  Steroids circulate in the bloodstream, produced by the adrenal glands.  The amount absorbed through the skin of the hands is too small to change the level of circulating steroids.  In other words, steroid creams are not bad and dangerous.

There are now non-steroid treatments as well.  These include Protopic and Elidel.  Her doctor might consider prescribing one of these options.

Take care.

Dr. Rockoff

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