TL;DR: Key Takeaways
- 4 main patterns: irritant, atopic, dyshidrotic (pompholyx), hyperkeratotic.
- Symmetric on both hands → almost always eczema, not fungal.
- Deep blisters on palms and fingersides → dyshidrotic eczema.
- Barrier care + short courses of topical steroid clear most cases.
Quick answer
Hand eczema shows as dry, red, cracked, itchy skin on the backs of the hands, sides of the fingers, or palms. It's almost always symmetric — that's the biggest clue it isn't fungal. The four main patterns are irritant contact (backs of hands from soap and wet work), atopic (finger creases and wrists), dyshidrotic or pompholyx (deep tapioca-like blisters on palms and fingersides), and hyperkeratotic (thick painful palms from wear and tear). Barrier care plus a short prescription steroid course clears most cases.
The four hand-eczema patterns
| Pattern | Where | Look | Trigger |
|---|---|---|---|
| Irritant contact | Backs of hands, finger webs | Red, cracked, chapped | Wet work, soap, sanitiser |
| Atopic (endogenous) | Finger creases, wrists | Dry, itchy, lichenified | Inherited barrier defect |
| Dyshidrotic (pompholyx) | Palms, sides of fingers | Small deep 'tapioca' blisters, intense itch | Sweat, stress, nickel, tinea |
| Hyperkeratotic | Central palms, fingertip pads | Thick yellow scale, painful fissures | Chronic friction, older adults |
Hand eczema vs fungal infection — the one-hand rule
The single best distinguishing test: look at both hands. Hand eczema is symmetric — both hands look similar. Tinea manuum, the fungal look-alike, is almost always one hand only, often paired with fungal infection of both feet ("one hand, two feet" syndrome). Fungal patches also have a well-defined, slightly raised, scaly advancing edge; eczema borders are fuzzy.
What actually works
- Wash hands with lukewarm water and a fragrance-free syndet cleanser — not bar soap
- Pat dry (don't rub) and apply a thick fragrance-free emollient after every wash
- Wear cotton-lined nitrile or rubber gloves for wet or chemical work; change every 20 min
- Prescription topical steroid (moderate potency) for active plaques — short courses only
- Dyshidrotic flares: cool wet wraps + potent topical steroid for 1–2 weeks
- Track flares: photograph both hands weekly to see whether the plan is working
See a dermatologist if:
- Not clearing after 4 weeks of consistent barrier + emollient care
- Cracks are bleeding, weeping, or affecting your work
- Recurrent flares that break through treatment — patch testing may be needed
- Signs of secondary infection: yellow crust, pus, spreading redness
Why one check is rarely enough
A single scan tells you about one spot, on one day. But skin changes are about patterns over time — a new mole appearing, a slow shift in shape, size or colour, or a patch that simply isn't healing. Monitoring the same spots side-by-side, week after week, surfaces the subtle changes a one-off check will always miss — and gives you a clear record to show a clinician if something needs a closer look.
(ScanSkinAI is a screening and monitoring tool, not a diagnosis. Always see a clinician for anything that is changing, bleeding, or worrying you.)
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Frequently Asked Questions
Dry, red-to-pink patches on the backs of the hands, sides of the fingers, or palms. Skin looks cracked, scaly, and rough. Severe flares blister, weep, or split — especially over the knuckles and finger creases. On darker skin, patches look greyish, violet, or hyperpigmented rather than red.
Most commonly on the backs of the hands, the sides of the fingers, and the finger web spaces. Palm involvement suggests dyshidrotic eczema (tiny deep blisters) or wear-and-tear hyperkeratotic eczema. Fingertip cracks alone often mean fingertip dermatitis from friction or contact irritants.
Hand eczema is symmetric (both hands, mirror image) and doesn't have a raised advancing edge. Tinea manuum (fungal) is usually one hand, with a clear scaly advancing border. If you have athlete's foot too, one-hand-two-feet fungal is likely.
Frequent wet work, soap, detergents, hand sanitiser, nickel jewellery, rubber gloves, fragranced hand creams, and stress. Healthcare workers, hairdressers, cleaners, and parents of young children have the highest rates.
Barrier-first approach: wash with lukewarm water and a fragrance-free syndet cleanser, apply a thick fragrance-free emollient after every hand wash, use cotton-lined gloves for wet work, and apply prescription topical steroid to active plaques for short courses. See a dermatologist if it isn't clearing in 4 weeks or affects your work.