Hand eczema – why do your hands crack, and what can you do?
Dry hands that crack. Small fissures on the fingertips. Redness, itching, and skin that stings every time you wash your hands. You may have tried numerous hand creams, but the skin keeps cracking.
It could be hand eczema.
Hand eczema is an inflammatory skin condition that can occur when the skin's protective barrier is repeatedly stressed. Frequent hand washing, water, cleaning agents, gloves, cold, and contact allergies are among the most important factors.
The most important thing is not just to add more moisture to the hands. It is to find out why the skin keeps getting damaged – and at the same time, protect it so that it has the opportunity to recover.
In this article, I go through both the science behind hand eczema and my experiences from more than 20 years of working with problem skin. I also show how you can put together a simple skincare routine that fits into a daily life where your hands need to be used.
In this article, you will get answers to
- What hand eczema is and what it looks like.
- Why hands and fingertips crack.
- What water, soap, hand sanitizer, cold, and gloves mean.
- How to distinguish between irritation, allergies, and other skin diseases.
- How to care for very dry and cracked hands.
- My Raz Signature Treatment with Ai, Repair Barrier Cream, and Repair Perfume Free.
- When hand eczema requires medical treatment.
- How to prevent new outbreaks.
What is hand eczema?
Hand eczema is a collective term for inflammatory skin changes on the hands.
It is, therefore, not one specific disease with one specific cause.
Hand eczema can occur due to repeated irritation, contact allergy, or an atopic disposition. In many people, several factors are involved at the same time.
Typical symptoms are:
- Dry, rough, and scaly skin.
- Redness or other color changes.
- Itching, stinging, and a burning sensation.
- Small blisters or oozing areas.
- Thickened, hard skin.
- Painful fissures in fingers, fingertips, and palms.
On darker skin, the inflammation may appear brownish, grayish, or violet instead of clearly red.
Some experience eczema especially on the back of the hands. Others get it between the fingers, around the nails, or on the fingertips.
And then there are those whose skin becomes so dry and thickened that it cracks every time the fingers are bent.
This can make everyday tasks like buttoning a shirt, peeling potatoes, or opening a bottle painful.
What are fissures?
The small cracks that occur in very dry skin are called fissures.
A fissure is a crack in the skin, which can be superficial or go deeper into the skin layers.
When the skin has become hard, dry, and less elastic, it can no longer follow the movements of the fingers without being strained.
Therefore, cracks often occur around fingertips, knuckles, and joints.
If the crack reaches down to living skin tissue, it can sting, bleed, and be very painful.
But remember: Cracks in the hands are a symptom – not a diagnosis.
You can have cracks without actual eczema. And you can have hand eczema without cracks.
Why do people get hand eczema?
The hands are among the most exposed areas of the body.
We use them all day long. We wash them, sanitize them, work with them, expose them to cold, and come into contact with a wide range of chemical and mechanical influences.
Therefore, hand eczema is particularly common among people who work with water, cleaning, food, patients, hair products, or other substances that stress the skin.
1. Water and soap – why do hands get dry?
It may seem strange that water can help make the skin dry.
But it is actually one of the most important explanations for hand eczema.
The skin's outermost layer is called stratum corneum. It consists of skin cells surrounded by an organized mixture of fats.
Among the most important fats are ceramides, cholesterol, and free fatty acids.
Together, they help the skin retain water and limit the penetration of irritating substances.
With repeated contact with water, the outermost skin layer swells. When the skin subsequently dries, it changes volume again.
If the process is repeated many times, it can contribute to disturbing the skin barrier.
Detergents and soap can simultaneously remove the skin's surface lipids and affect the proteins in the outermost skin layer.
The result can be increased water loss, dryness, and irritation.
It is therefore not because water molecules simply pull the skin's fats with them when they evaporate. The mechanism is more complex and relates especially to repeated wetting, drying, and influence from washing-active substances.
The more often the skin barrier is stressed, the harder it becomes for it to recover between exposures.
2. Wet work – one of the biggest risk factors
In dermatology, we use the term wet work.
This covers, among other things, work with frequent hand washing, prolonged contact with water, or repeated use of liquid-tight gloves.
Hairdressers, nurses, cleaning staff, kitchen employees, and others with very wet work have an increased risk of hand eczema.
A systematic review of research into hand hygiene found a clear correlation between frequent hand washing and the risk of hand eczema.
This does not mean that you should stop washing your hands.
It means that you should avoid unnecessary washing and protect the skin as best as possible.
3. Cold and dry air
Many people find that their hands get worse in the winter.
This is no coincidence.
Cold outside air and dry indoor air can increase the stress on an already vulnerable skin barrier.
At the same time, temperature changes, wind, and friction from clothing and gloves can worsen the discomfort.
If your hands always start to crack when autumn arrives, I would start protective skincare before the cracks appear.
It is far easier to maintain a reasonably functioning skin barrier than to have to rebuild comfort in skin that has already cracked.
4. Contact allergy
Sometimes hand eczema is not only due to irritation.
It can also be caused by allergic contact eczema.
Here, the immune system has developed a specific hypersensitivity to a substance.
This could be, for example, certain preservatives, fragrances, rubber chemicals, or metals.
In the case of allergic contact eczema, very small amounts of the relevant allergen can trigger an outbreak.
And an important detail: You can develop a contact allergy to a substance you have used for years without previous problems.
If your hand eczema keeps returning, even if you take good care of the skin, it may therefore be relevant to be examined for contact allergy.
Read more in our article about contact eczema – the difference between irritation and allergy.
5. Atopic disposition
If you have had childhood eczema or atopic dermatitis, your skin may be more predisposed to developing hand eczema.
This is partly because the skin barrier in people with atopic dermatitis is often more vulnerable.
This does not mean that everyone with atopic eczema gets hand eczema.
But it does mean that the same influences can be more difficult to tolerate.
I go through this connection in more detail in the article about atopic eczema.
What happens in the skin when hands crack?
This is where it gets interesting.
When the skin barrier is intact, it limits water loss and protects against the surroundings.
When the barrier is damaged, the so-called transepidermal water loss, TEWL, often increases.
This means that more water evaporates through the skin.
At the same time, irritating substances can more easily affect the living skin layers.
The skin's cells react by releasing inflammatory signaling molecules, and the immune system becomes activated.
This can cause redness, swelling, itching, and stinging.
With long-term inflammation and repeated mechanical stress, the skin can become thickened.
This is called lichenification or hyperkeratosis, depending on the nature of the change.
The thickened skin can feel hard and less supple.
And when you bend your fingers, it can crack.
This also explains why a hand cream alone is not always enough.
If the skin continues to be exposed to the same stresses, and there is simultaneously active inflammation, you are constantly working against the skin's opportunity to recover.
You must both protect the barrier and manage the inflammation that may be present.
What can hand eczema be confused with?
Not all dry, itchy, or scaly hands are caused by hand eczema.
Fungal infection on the hands
Fungal infection on the hand, tinea manuum, can cause scaly, dry skin.
It is often most pronounced on one hand and can occur together with athlete's foot.
Fungal infection requires different treatment than eczema. If the diagnosis is uncertain, the doctor can examine the skin and possibly take a fungal sample.
Psoriasis
Psoriasis can cause well-defined, thickened, and scaly areas on the palms.
It can be difficult to distinguish from chronic hand eczema based solely on appearance.
Dyshidrotic eczema
Dyshidrotic eczema, also called pompholyx, typically produces small, deep-seated, and often very itchy blisters on the sides of the fingers or in the palms.
It is considered a clinical pattern of hand eczema and can have several different triggering factors.
Infection
If the skin becomes increasingly warm, swollen, painful, or develops pus, an infection may have occurred.
This must be evaluated by a doctor.
What can you do yourself about dry, cracked hands?
If your hands are cracking, I would start with three things.
First: Reduce the influences that damage the skin.
Next: Use moisture and barrier care regularly.
And finally: Get any active eczema treated correctly.
It sounds simple, but this is often where the biggest difference lies.
Wash your hands gently
Use lukewarm rather than very hot water.
Choose a mild, fragrance-free cleansing product when washing is necessary.
Avoid scrubbing your hands with brushes, coarse sponges, or peeling products.
Pat your hands dry, including between the fingers.
And use hand cream afterward.
Is hand sanitizer better than soap for hand eczema?
It depends on the situation.
Alcohol-based hand sanitizer can, in many contexts, be less stressful for the skin than repeated washing with water and soap, especially when the hands are not visibly dirty.
However, hand sanitizer can sting on cracked skin, and it does not replace hand washing in situations where soap and water are necessary for hygienic reasons.
Therefore, always follow relevant hygiene recommendations at your workplace.
Use gloves correctly
Protective gloves can be a great help when cleaning, washing dishes, and doing other wet work.
But gloves can also cause problems.
When the skin is enclosed in a liquid-tight glove, the humidity and temperature rise. The skin can become softened, and friction and sweat can worsen irritation.
Therefore, protective gloves should only be used when necessary and no longer than the task requires.
For longer use, a clean, dry cotton glove under the protective glove can be useful.
Also remember that gloves must be suitable for the chemicals you are working with.
A regular glove does not necessarily protect against all cleaning agents, solvents, or other substances.
What do you do about deep cracks in the fingertips?
In the case of deep fissures, it is important to protect the area from further mechanical stress.
A suitable plaster or wound dressing can in some cases protect the crack while the skin gets rest.
Avoid picking off hard skin edges or trying to sand the skin away.
If the crack is deep, very painful, bleeds repeatedly, or does not heal, it should be evaluated by the doctor.
I do not recommend peeling or scrubbing on active hand eczema with cracks. This will often be yet another unnecessary stress on the skin barrier.
Raz Signature Treatment against hand eczema
When I work with very dry and cracked hands, I think of two different needs.
During the day, the skin must be able to function.
You must be able to work, use your phone, put on clothes, and wash your hands without feeling that everything around you gets greasy.
At night, you can allow yourself a richer and more protective care.
This is the background for my division between Repair Barrier Cream during the day and Repair Perfume Free in the evening.
I would also like to tell you about my experience with Ai as a supplementary product.
But let me first explain what the individual products contribute.
Hand Cream – the daily moisturizing care
Hand Cream 1723 is the hand cream I would have lying by the sink, on the desk, or in the bag.
The formulation is interesting because it combines several different types of moisturizing and barrier-caring ingredients.
Glycerin and Sodium PCA are moisture-binders, also called humectants.
They help keep water in the skin's outermost layer.
Caprylic/Capric Triglycerides and other softening fats contribute to making the skin more supple and comfortable.
Panthenol is an ingredient that is used in many products for dry and sensitive skin, partly because of its moisture-binding and skin-caring properties.
Ectoin is a so-called compatible solute that is interesting in cosmetic formulations because of its water-binding and cell-protective properties.
It is the combination that I find relevant.
A good hand cream should not just feel pleasant while you are applying it. It should be so easy to use that you actually get it used several times a day.
INTERNAL NOTE – to be deleted before publication: The current fragrance-free formulation must appear in the final product declaration. On the website, there is still an older ingredient list with fragrances, which should be updated.
Repair Barrier Cream – protection during the day
Repair Barrier Cream has a different function in the routine.
Whereas the regular Hand Cream is primarily the light daily moisturizing care, the idea with Repair Barrier Cream is to give the skin a more lasting protective care.
This is particularly relevant when the hands are repeatedly exposed to cold, friction, and washing.
A barrier cream can help limit drying out and make the skin more comfortable.
But it cannot make the hands immune to water, soap, or chemicals.
And it cannot replace protective gloves when the work requires them.
I would therefore use Repair Barrier Cream as part of the daily skincare – not as an invisible safety glove.
INTERNAL NOTE – to be deleted before publication: Note: The precise ingredient explanation for Repair Barrier Cream must be completed based on the product's approved, current INCI list. I will not attribute ceramides, ectoin, or other specific active ingredients to it without having verified the formulation.
Repair Perfume Free – the rich care at night
In the evening, I would choose a richer ointment.
Repair Perfume Free is a water-free, lipid-rich formulation that can be used to soften and protect very dry skin.
A rich ointment can form a protective layer on the skin surface and limit the evaporation of water.
This is particularly relevant when the hands are rough, tight, and less supple.
At night, you also have the practical advantage that you can apply a larger amount without having to use your hands in the same way as during the day.
If you find that the ointment leaves grease on the bedding, you can use clean, loose-fitting cotton gloves.
They can, among other things, be bought at the pharmacy.
The gloves make it possible to have an appropriate amount of ointment on the hands without it transferring to everything around you.
It is a practical advantage – not documentation that the ointment treats eczema better under gloves.
Ai Anti-Irritation – my experience with supplementary care
Ai Anti-Irritation is a product we at Raz Skincare have many years of practical experience with for skin that feels irritated or scaly.
The formulation contains mineral-rich seawater extract, glycerin, purple willow extract, and lactic acid.
Glycerin is a well-documented moisture-binding ingredient.
The other ingredients are interesting in a cosmetic context, but their presence does not document that Ai as a finished product treats the inflammation that lies behind hand eczema.
Ai can also sting on cracked or very inflamed skin.
This is not a sign that the product is working better.
I would therefore not recommend that you grit your teeth and continue if the skin reacts strongly.
My special method with Ai and cotton gloves
A method I have used in my practical consulting is to moisten cotton gloves with Ai and let them sit on the hands for approximately 15 minutes.
Then the gloves are removed, the skin is allowed to dry, and subsequent care is applied.
I would like to explain the method, because it is part of our experience with the products.
However, it is important to distinguish between experience and documentation.
There is no clinical evidence that specifically using Ai under damp gloves for 15 minutes improves hand eczema, and the method is not an established dermatological treatment.
At the same time, damp gloves can soften the skin, and Ai can cause stinging on cracks and open areas.
Therefore, it is not a routine I would generally recommend for active, weeping, or severe hand eczema.
If you wish to use the method on intact, dry skin that you already know tolerates Ai, it should be brief and discontinued if discomfort occurs. For actual hand eczema, it should be included as a possible supplement to – not a replacement for – a professionally assessed treatment plan.
My recommended morning and evening routine
You do not need to use all the products to get started.
The most important thing is that the routine is simple, that the skin tolerates the products, and that you simultaneously reduce the stressors that worsen your hands.
Morning – protection throughout the day
1. Gentle hand washing
Wash your hands when necessary with lukewarm water and a mild, fragrance-free cleanser.
Powder to Mousse can be an option if the current fragrance-free version is documented and your skin tolerates the product.
Avoid cleansing unnecessarily often.
2. Ai – only as an individual supplement
If you use Ai and tolerate it, it comes before the rich creams.
My specific method with Ai-dampened cotton gloves for approximately 15 minutes is described above, but it is not a documented treatment for hand eczema.
It should be avoided on open, weeping, or very irritated areas.
3. Repair Barrier Cream
When the skin is dry, apply Repair Barrier Cream as the day's protective skincare.
4. Hand Cream as needed
Use Hand Cream after washing your hands and during the day when the hands feel dry.
For very dry skin, more frequent application may be necessary.
Evening – rich and protective care
1. Wash hands only if necessary
Use lukewarm water and avoid harsh scrubbing.
2. Possible Ai care
If you use Ai and tolerate it, apply it before the ointment. The method with damp gloves is optional and not a substitute for medical treatment.
3. Repair Perfume Free
Apply an appropriate amount to the dry areas, especially fingertips, knuckles, and other places where the skin is rough.
4. Clean cotton gloves
If you wish to protect the bedding and keep the ointment on your hands, you can use loose-fitting cotton gloves.
They must be clean and dry, and you should take them off if your skin becomes too warm, damp, or irritated.
If your doctor has prescribed eczema medication, follow the specific plan for application and sequence.
When is skincare not enough?
It is important to understand that hand eczema is an inflammatory skin disease.
A moisturizer can help protect the skin barrier, but it does not necessarily treat active inflammation.
For actual hand eczema, the doctor will often use a topical corticosteroid cream of an appropriate strength and for a specific duration.
For recurring or chronic hand eczema, further treatment or a referral to a dermatologist may be needed.
Options may include light therapy and specific prescription medications, depending on the type and severity of the disease.
When should you be tested for contact allergy?
If hand eczema keeps coming back, one should consider whether there is a contact allergy or a persistent exposure at work or at home.
The dermatologist can test for contact allergy with a patch test.
Here, selected allergens are placed on the skin under controlled conditions, and reactions are read according to a specific schedule.
A patch test is different from a regular prick test.
It specifically examines delayed contact allergic reactions.
Can hand eczema be an occupational injury?
Yes, hand eczema can be work-related.
If your symptoms began or worsened in connection with your work, it is important to talk to your doctor about the connection.
This applies, among other things, if you work with frequent hand washing, cleaning agents, food, hairdressing chemicals, or prolonged use of gloves.
Work-related hand eczema can, in relevant cases, be reported as an occupational disease.
And here it is important not just to try to moisturize the problem away while the same exposures continue.
When can you expect improvement?
It depends on what is wrong with the hands.
If the skin is merely dry and rough, regular moisturizing can make it more comfortable relatively quickly.
If you have active hand eczema, deep fissures, or are continuously exposed to irritants, the process can be significantly longer.
I will therefore not promise that your hands will be normal after two or three days.
That would be unprofessional.
Improving skin comfort is also not the same as the disease's inflammation being gone.
The goal is for the skin to gradually become more supple, for dryness to be reduced, for new cracks to be prevented, and for any eczema to come under control.
When your hands finally get better, you do not necessarily have to stop the skincare.
If your everyday life continues to stress your hands, they still need protection.
Consistency beats intensity.
Frequently asked questions about hand eczema
Why do my fingertips crack?
Fingertips can crack when the skin becomes very dry, thickened, and less elastic. Repeated hand washing, cold, friction, and hand eczema can contribute. Deep or persistent cracks should be assessed by a doctor.
Is dry skin the same as hand eczema?
No. Dry hands can occur without inflammation. Hand eczema involves inflammatory skin changes, such as redness, itching, blisters, stinging, or cracks.
Is hand eczema contagious?
No. Hand eczema is not contagious. However, certain infections can resemble eczema and require different treatment.
What is best for hand eczema – hand cream or rich ointment?
Both can have a role. A light hand cream is practical during the day, while a rich ointment can be suitable for very dry skin in the evening. Active eczema may require medical treatment.
Why do my hands get worse in the winter?
Cold, wind, and dry indoor air can worsen dehydration and make the skin barrier more vulnerable. Please start with protective skincare before cracks appear.
Can I use hand sanitizer when I have hand eczema?
Yes, when relevant for hand hygiene. Alcohol-based hand sanitizer can in some situations be less harsh on the skin than repeated washing with soap and water, but it can sting on cracked skin.
Are cotton gloves good for dry hands?
They can be practical at night over a rich ointment because they reduce smearing on the bedding. They must be clean and dry. The gloves themselves are not a medical treatment for hand eczema.
Can I use Ai under wet gloves?
It is a method we have experience with at Raz Skincare, but it is not clinically documented as a treatment for hand eczema. Moisture and Ai can irritate damaged skin. Do not use the method on open or severely inflamed areas.
Should I use both Hand Cream and Repair Barrier Cream?
Not necessarily. Hand Cream can be the light, daily moisturizer, while Repair Barrier Cream can be included when you want a more protective cream. The most important thing is regular use of a product your skin tolerates.
Why does my hand eczema keep coming back?
Often because the hands are continuously exposed to the same stressors. There may also be an atopic predisposition, contact allergy, or insufficiently treated inflammation. Recurring hand eczema should be investigated.
REMEMBER
You can always book a skin analysis with me, and I will be happy to help. You can read much more about my skin analysis and service at this link.
If your hands are very inflamed, have deep cracks, weep, hurt, or keep having eczema, I would recommend that you contact your doctor or a dermatologist.
And remember that it does not help to find the world's best hand cream if you simultaneously expose your hands to the same harmful influences day after day.
Take good care of them. You have to use them for the rest of your life.
Hugs, Raz
Knowledge hungry?
If you want to read more or see where I get my knowledge from, here are some articles that I believe are good.
1. Guidelines for diagnosis, prevention, and treatment of hand eczema
A central European guideline from 2022 that reviews causes, diagnostics, prevention, and treatment of hand eczema. It is particularly relevant for the relationship between irritants, contact allergy, protective gloves, and medical treatment.
2. S2k guideline diagnosis, prevention, and therapy of hand eczema
A detailed German dermatological guideline from 2023 with practical recommendations on wet work, hand washing, gloves, skincare, and treatment.
3. Hand hygiene and hand eczema: A systematic review and meta-analysis
A systematic review of 45 studies on the relationship between hand hygiene and hand eczema. Particularly interesting because it examines hand washing, wet work, and alcohol-based hand disinfection.
A review from 2024 that examines the prevalence of hand eczema among healthcare workers. It shows why prevention is so important in professions with frequent hand hygiene.
5. Incidence Rate of Hand Eczema in Different Occupations: A Systematic Review and Meta-analysis
A meta-analysis comparing the risk of hand eczema in different occupations. Hairdressers, nurses, and metalworkers are among the professional groups studied.
6. Hand eczema and wet work: dose-response relationship and effect of leaving the profession
A Danish study of work-related hand eczema that examines the relationship between the scope of wet work and the skin's ability to recover.
A systematic review of work-related and personal risk factors for contact dermatitis. It sheds light on, among other things, the importance of wet work and atopic dermatitis.
8. The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis
A review that examines why people with atopic dermatitis have an increased risk of hand eczema. It is an important source for understanding genetic and skin barrier-related predisposition.
A systematic review of preventive measures such as moisturizers, barrier creams, gloves, and education in skin protection. Relevant for everyone who works with their hands in stressful environments.
10. Chronic Hand Eczema Guidelines From an Expert Panel of the International Eczema Council
An international expert consensus on the assessment and diagnosis of chronic hand eczema. It emphasizes that hand eczema can have multiple simultaneous causes and that correct assessment is crucial.