The pain had started after Rosie bumped her toe on a chair Standing at her shop counter, pharmacist Rosie Beaton was overwhelmed by a throbbing pain in one of her toes. 'I was used to aching feet from standing all day every day, but this pain was something off the scale,' says Rosie, 35, who lives in Glasgow with her husband Drew, 39, an accountant at the University of Glasgow. 'I had to apply ice packs to my foot in my breaks three times a day, and after a few days it was so swollen I couldn't get my shoe on - I had to wear trainers.' The pain had started after Rosie bumped her toe on a chair twice in the space of a week back in 2010.
'I had big red lumps on the front of my right foot and the side of my ankle, but I just soldiered on as I thought it would eventually die down,' recalls Rosie. She eventually visited her GP, who said she had a soft tissue injury and prescribed a painkiller. But this made no difference and the pain spread to Rosie's hip. 'My left hand was also very weak and painful. I had to use two hands to lift the handbrake on the car,' she recalls. 'I started to think my hip and hand problems might be related to my foot. I wondered if it might be arthritis, as my mum had osteoarthritis in her 50s.'
Rosie's suspicion was right - after two more painful months, her GP sent her for an X-ray, which showed erosion in one of the joints in her foot. But she was taken aback when her doctor suggested it might be linked to the small patch of scaly red skin on her elbow. 'I'd had psoriasis on my arm for years, and just controlled it with creams,' she says. 'I couldn't think why it was relevant. Then my GP said he thought I had psoriatic arthritis - which I'd never heard of.' Share An estimated 1.8 million people are affected by psoriasis, a condition causing itchy, flaky, red plaques on the skin. But few are aware that between 15 and 30 per cent of them will develop psoriatic arthritis - severe pain and inflammation around the joints, similar to rheumatoid arthritis.
It can affect the fingers and toes, neck, lower back, knees and ankles and in severe cases can destroy joints. And that's not the only potential complication. Dr Justine Hextall, a consultant dermatologist at the Western Sussex Hospital NHS Trust, says: 'Psoriasis is far more than just a scaly skin condition. Often patients don't realise that it can affect the whole body.
After two months her GP sent her for an X-ray, which showed erosion in one of the joints in her foot 'As well as psoriatic arthritis, patients are also at increased risk of heart disease, stroke and type 2 diabetes. We think this is mainly because it can create widespread inflammation in the body, although we don't know the exact mechanisms involved.' Scientists still don't know for sure why psoriasis can lead to arthritis. With psoriasis, it's thought that the immune system over-reacts and produces inflammatory chemicals, leading to skin cells shedding and growing too quickly. The extra skin cells build up to form raised plaques on the skin. Rheumatoid arthritis, on the other hand, occurs when the immune system mistakenly attacks body tissue, leading to inflammation around the joints. The triggers for psoriatic arthritis are thought to include a mixture of genes - 40 per cent of sufferers have a relative with the condition - and environmental triggers including injury, as happened with Rosie, infection and stress.
The problem is that psoriatic arthritis is often missed by doctors. That's because some patients either have no psoriasis skin patches at all or they are very mild - or they get psoriatic arthritis before they develop psoriasis on their skin. Some patients never get the skin symptoms at all. So by the time patients are diagnosed their joints may already be badly damaged. 'Patients usually haven't heard of psoriatic arthritis yet it can be just as serious and disabling as rheumatoid arthritis,' says Dr Stefan Siebert, a senior lecturer in rheumatology at the University of Glasgow.
The proportion of psoriasis patients who aren't happy with their treatment 'Some dermatologists and GPs don't make the link or pick it up either - there is a large undiagnosed group of patients out there.' The condition can also be misdiagnosed as other types of arthritis, he adds. 'This means patients can get the wrong or inadequate treatment and suffer joint deformity.' Although the symptoms of psoriatic arthritis vary, Dr Siebert says there are certain features that should ring alarm bells with doctors. These include patients with psoriasis who develop joint pain, swelling or stiffness, recurrent Achilles tendon problems, heel pain caused by inflammation of the plantar fascia ligament ('plantar fasciitis') and tennis elbow - pain around the outside of the elbow caused by overusing muscles.
'This is because in psoriatic arthritis the arthritis is not limited to joints but also affects tendons,' explains Dr Siebert. 'People with psoriatic arthritis are also more likely to have other problems including high blood pressure, diabetes, obesity and fatty liver disease.
The relationship between these problems is still unclear and an area of active research,' he adds. Psoriatic arthritis is more difficult to diagnose than rheumatoid arthritis. 'It is diagnosed by taking a careful history and eliminating other types of arthritis such as rheumatoid and osteoarthritis,' explains Dr Siebert. 'Although blood tests can be helpful, at least half of all people with psoriatic arthritis have normal blood tests.'
He says it's vital to raise awareness of the condition. 'Doctors should definitely be asking patients with joint pain if they have ever had psoriasis and those with psoriasis if they have joint pain. Early diagnosis and treatment with drugs is important to prevent future joint damage, as psoriatic arthritis like rheumatoid arthritis generally gets worse over time.' Her doctor suggested it might be linked to the small patch of scaly red skin on her elbow Once properly diagnosed, psoriatic arthritis and its symptoms can be treated with common anti-inflammatory medications. Disease modifying anti rheumatic drugs (DMARDs) such as methotrexate can help by suppressing the joint inflammation.
If those don't work then a newer form of DMARDS, called biologics, that target proteins involved in inflammation, may be given either as an infusion or injection. The newest treatment on the market for psoriatic arthritis is an injection called Stelara (ustekinumab), which targets a different protein implicated in psoriasis and psoriatic arthritis. However, although this been approved for use in Scotland, the National Institute for Health and Care Excellence (NICE) has not approved it in England. Yet all of these treatments work best the sooner they are started and Carla Renton, spokeswoman for the Psoriasis Association charity, says members report long delays in getting a diagnosis of psoriatic arthritis. 'Part of the problem is that the symptoms can be missed or mistaken for other conditions including gout, inflammatory back pain, general aches and pains, and rheumatoid arthritis.' She adds that people with psoriasis often get stuck on repeat prescriptions and don't get reviewed. This lack of follow-up care fits with Rosie's experience.
'I hadn't seen my GP in years about my psoriasis, because it was so mild I was put on repeat prescriptions for creams,' she says. 'If I'd had an annual review, my psoriatic arthritis may have been picked up earlier and my joint damage prevented.'
Following diagnosis, Rosie was treated with methotrexate and her symptoms are now better controlled. Recently though she's had an MRI scan that suggests she may now have long-term damage to her spine. 'Luckily, I haven't ended up on crutches or in a wheelchair but I know others with the condition who have, so I worry about my future,' she says. 'I already feel like a 70-year-old some days. 'I'm watching my diet and trying to keep fit because having psoriasis means I'm at higher risk of heart disease and diabetes, too.' Rosie believes anyone with psoriasis should be asked if they also have joint pain.
'It was never mentioned to me - but all the time a skin condition was attacking my joints.'
Why Do Palms Itch? Itching of the palms often occur for the same reason that itching occurs elsewhere on the body. Itch receptors when stimulate sends impulses back to the brain. The brain processes these signals and it is perceived as itching at the site from where it originates – in this case the palm or palms. The sensation of itching compels us to scratch the area. It is believed the act of scratching removes the irritant at the site, or makes us aware of something irritating the skin in order to take action to prevent further itchiness.
Red Itchy Patch Of Skin
It seems that itch receptors are stimulated by the chemicals that are released by the body when it comes into contact with irritants or allergens. It may be different from pain which is initiated with tissue damage although there may be some degree of overlap – triggers of itching may also cause pain in some cases. At one time it was thought that itching was a low-intensity version of pain. However, it is now apparent that the itch sensation arises in specialized sensory neurons (nerve cells).
Itch Triggers The hands are prone to irritation and injury as it makes direct contact with objects in our environment throughout the day. In fact the palms, like the soles, have thicker skin to contend with the repeated use, insults and injuries that it may face.
It also has a higher concentration of specialized tactile receptors like Meissner’s corpuscles that are sensitive to light touch. With these two factors in mind, it is therefore not surprising that the palms will itch with even slight triggers and be more likely to make contact with irritants and allergens. Irritants are substances that will trigger an itch in any person although the sensitivity of individuals toward the irritant varies.
Allergens will only trigger an itch in people who have immune-hypersensitivity (allergy) to specific harmless substances. Apart from substances that will trigger itching (like poison ivy) or allergens (like pollen), sometimes the most unexpected everyday substances can be triggers for itching. For example, water can be an irritant that can lead to itching, as can your body’s own perspiration. Causes of Itching Palms Trauma Injury to the skin can occur through a number of different ways. Most of the time we expect there to be discomfort, soreness, burning or pain along with redness, swelling and heat. These are typical features of inflammation.
However, sometimes minor trauma may be perceived as itching without overt pain and discomfort. Dry Skin Dryness of the skin is one of the main causes of itching yet it is easily treated and prevented. Although skin can maintain its own moisture levels, it is prone to drying when there is constant friction, dehydrating agents applied to it like antibacterial soaps and with exposure to dry environments. Dry skin known as xeroderma may also occur as a symptoms of various skin diseases.
Palmar Hyperhidrosis is the medical term for excessive sweating of the palms. It is a common condition often associated with abnormal nervous stimulation of the sweat glands in the skin. The persistent moisture of the palms can cause irritation of the skin along with peeling. Itching may be a symptoms especially when the sweating eases and the skin becomes very dry. Contact Dermatitis Dermatitis means skin inflammation.
There are many different types of dermatitis. Contact dermatitis is among the more common type. It occurs when the skin comes into contact with a substance that either irritates it or triggers an allergic reaction. Contact with water, soap, detergents, certain lotions, latex, animal hair and so on are some of the substances that can be a problem. Atopic Dermatitis Atopic dermatitis is commonly referred to as eczema, although eczema can refer to any type of dermatitis. It is a skin condition associated with a predisposition to allergies.
Often the condition starts early in life and may be linked to allergic rhinitis and asthma. The rash appears as excessively dry and rough skin, it usually occurs in the skin folds and is known to be extremely itching. Read more on. Ringworm (Fungal Infections) are usually caused by dermatophytes. It presents with a round ring-like rash which is why it is referred to as ringworm.
Most of these skin infections are itchy. There are many different species of dermatophytes that may be responsible. Is one type of fungal skin infection that causes a dark brown to black patch on the palms but usually does not itch. Scabies is a skin infestation caused by a tiny mite, Sarcoptes scabiei hominis.
Although scabies spreads quickly among people in close contact, it is easily treated and prevented. Itching is a common symptom that occurs when the mites burrow into the skin and lay eggs with the tracks that triggers an allergic reaction. Itching of the palms due to scabies is a symptom more commonly seen in children with scabies. Psoriasis is a skin condition marked by dry thickened patches of skin that are extremely itching. It is believed to be an autoimmune condition where there is a problem with the normal rate of shedding of skin cells. It can occur anywhere on the body, sometimes covering large portions of the skin throughout the body.
When there is pain and stiffness of the small joints (like the fingers) then it may be psoriatic arthritis. Other Conditions There are many non-dermatological conditions that can lead to itchy skin.
It may not always affect only the palms. Among these conditions is diabetes mellitus, a common chronic endocrine disease. Eruptive xanthomatosis is a skin condition that may occur with diabetes and it can sometimes even be the first sign of diabetes.
Words their way 3rd edition. Itching of the palm is a common symptom. Itching of the skin may also occur with liver, gallbladder and kidney diseases.
Psoriasis, a hereditary skin condition, causes the skin to turn red in one or more places. Pus-filled bumps or silver scales may also appear on the skin, states WebMD.
Patients with psoriasis also experience swollen or stiff joints and pain in the affected areas. Similar to psoriasis, eczema causes scales to appear on the skin. Patients with eczema also develop clear blisters and red patches on the skin. In addition to skin conditions, patients with diabetes sometimes experience an itchy rash on the hands and the feet. This rash, characterized by small yellow or red bumps, may also appear on the arms and the legs, claims WebMD.
With proper diabetes management, this rash should disappear on its own and should not return. Patients with scabies, also known as the human itch mite, develop a small, blistery rash and sores on various parts of the body. Itchy hands and feet are more common on infants and children with scabies than adults, reports WebMD.
Who gets hand dermatitis? Hand dermatitis is common (especially in young adult females) and accounts for 20–35% of all dermatitis. It may occur at any age, including during childhood.
It is particularly prevalent in people with a history of. Hand dermatitis is particularly common in industries involving cleaning, catering, metalwork, painting and. This is mainly due to the, but specific can contribute. What causes hand dermatitis?
Hand dermatitis often results from a combination of causes, including:. Genetic and unknown factors (constitutional hand dermatitis).
Injury. Immune reactions. Hand dermatitis is frequently caused or aggravated by work, when it is known as. Irritants include water, detergents, solvents, acids, alkalis, cold, heat and friction. These damage the outer stratum corneum, removing lipids and disturbing the skin’s barrier function. Water loss and inflammation lead to further impairment of barrier function.
Is a delayed hypersensitivity reaction with elicitation and memory phases involving T lymphocytes and release of cytokines. What are the clinical features of hand dermatitis? Hand dermatitis may affect the backs of the hands, the palms or both. It can be very itchy, often burns, and is sometimes painful. It has acute, relapsing and chronic phases. Acute hand dermatitis presents with:. Red macules, papules and plaques.
Swelling. Blistering and weeping.
Fissuring. Features of chronic hand dermatitis include:. Dryness and scale. Lichenification. There are various causes and clinical presentations of hand dermatitis.
Atopic hand dermatitis hand dermatitis depends on constitutional weakness of the skin barrier function and is triggered by contact with irritants. It may affect one or both dorsal hands and palms. It may manifest as a discoid pattern of eczema. Patients may also have eczema in other sites including feet, hands, flexures.
Nummular dermatitis Nummular dermatitis or tends to affect the dorsal surfaces of the hands and fingers as circumscribed plaques. Other sites of the body may or may not be affected. Vesicular hand dermatitis Vesicular hand dermatitis is also known as, cheiropompholyx and dyshidrotic eczema. Intensely itchy crops of skin-coloured blisters arise on the palms and the sides of the hands and fingers.
Similar symptoms often affect the feet. It is likely this form of dermatitis is triggered by via sweating. Chronic relapsing vesiculosquamous dermatitis Chronic relapsing vesiculosquamous dermatitis is a common pattern of palmar and finger dermatitis, in which episodes of acute vesicular dermatitis are followed by chronic scaling and fissuring. Hyperkeratotic hand dermatitis Hyperkeratotic hand dermatitis is a chronic, dry, non- inflammatory palmar dermatitis. It can appear similar to, but is less red and less well circumscribed. Fingertip dermatitis Fingertip dermatitis can be isolated to one or several fingers.
Irritant contact dermatitis The hands are the most common site for, and is often due to wet work and repeated exposure to low-grade irritants. The finger-webs are the first place to be affected, but inflammation can extend to fingers, the backs of the hands and the wrists.
Irritant contact dermatitis often spares the palms. Acute irritant dermatitis is due to injury by potent irritants such as acids and alkalis, often in an occupational setting. Repeated exposure to low-grade irritants such as water, soaps, and detergents leads to chronic cumulative irritant dermatitis. Allergic contact dermatitis may be difficult to distinguish from constitutional forms of hand dermatitis and irritant contact dermatitis. There are about 30 common and innumerable uncommon or rare ones. Common allergens include, (in gloves) and (permanent hair-dye). Clues to contact allergy depend on the allergen, but may include:.
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Periodic flare-ups associated with certain tasks or places hours to days earlier. Irregular, asymmetrical distribution of rash. Sharp border to the rash (eg, at wrist corresponding with cuff of rubber glove). Hand dermatitis. Complications of hand dermatitis. Bacterial infection ( and/or ) can result in pustules, crusting and pain.
Dermatitis at the ends of the fingers may result in deformed nails. Dermatitis can spread to affect other sites, particularly the forearms and feet. How is hand dermatitis diagnosed? Hand dermatitis is usually straightforward to diagnose and classify by history and examination, considering:. Acute, relapsing or chronic course. Past history of skin disease.
Dermatitis on other sites. Differential diagnosis includes:. Contact urticaria — for example, to (immediate redness, itching and swelling that resolves within an hour). Protein contact dermatitis, most often affecting (combination of urticaria and dermatitis induced by reactions to meat).
( symmetrical, well circumscribed, red, scaly plaques). (unlilateral or asymmetrical, peripheral scale). Patients with chronic hand dermatitis may have to detect contact allergens. Patch tests in patients with hand dermatitis. What is the treatment for hand dermatitis?
Patients with all forms of hand dermatitis should be most particular to:. Minimise contact with irritants — even water. Use non-soap when washing hands, rinse carefully, and ensure hands are completely dry afterwards. Completely avoid touching that have been identified by patch testing. Wear task-appropriate. Apply thick before work/school and reapply after washing or when the skin dries out (this may be 10–20 times in a day).
Vinyl gloves are less likely than rubber gloves to cause allergic reactions. They must be scrupulously clean and should have no holes. They should not be worn for long periods. Sweating under the gloves aggravates dermatitis. Lined gloves or inner cotton gloves improve comfort.
Reduce inflammation. Use a potent topical steroid on dermatitis on the backs of the hands and an ultrapotent topical steroid on palms. Cream formulation is usually best for vesicular hand dermatitis, and ointment for chronic dermatitis. They should be applied to areas of active dermatitis once or twice daily for several weeks, then discontinued or frequency/potency reduced. Short-term occlusion increases potency and is warranted if standard applications have not been effective. Secondary infection may require oral antibiotic, usually.
Severe acute flares of hand dermatitis are treated with prednisone for 2–4 weeks. Chronic intractable hand dermatitis may be treated with secondline agents such as,. Remove worm blaster vista.
How can hand dermatitis be prevented? Hand dermatitis can be prevented by careful protective measures and active treatment. It is very important that people with ( eczema) are made aware of the risk of hand dermatitis, particularly when considering occupation.
What is the outlook for hand dermatitis? With careful management, hand dermatitis usually recovers completely. A few days off work may be helpful. When occupational dermatitis is severe, it may not be possible to work for weeks or months. Occasionally a change of occupation is necessary.