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What kind of a skin problem is this?

Q: For the last about three years, I have developed a skin problem which is confined to my hands only. The skin on my fingers (first finger of right hand is worst affected) has developed dryness to the extent that it converts into cuts in the finger and blood comes out of it and gives pain. This has developed in other fingers also. The treatment I took first was of homeopathy but it did not help. Thereafter I went to a Skin Institute and they prescribed one tablet over a day and two creams to be applied at the infected portion. It did not work initially. Thereafter they peeled off my infected skin. I continued to apply the same creams and tablet, then it worked and all my dry skin started becoming normal, but it was just for a while. Accidentally I could not continue the treatment and there was a break of about 15 days. During this period the problem has again developed. Kindly advise me, should I continue with the treatment from Skin Institute as it worked as long as you are getting the treatment, the moment I stop it the problem would again emerge. Or I should again revert back to homeopathy? Is there any other treatment you would like to advise me?

A:You could either be suffering from hand dermatitis or psoriasis (though we would need to see personally to confirm that). Hand dermatitis (also known as hand eczema) often results from a combination of causes, including genetic makeup (constitutional factors), injury (contact with irritants) and allergy. It is frequently caused or aggravated by work, when it is known as occupational dermatitis. Hand dermatitis is particularly common in industries involving cleaning, catering, metalwork, hairdressing, healthcare and mechanical work. Hand dermatitis varies in severity. It may affect the backs of the hands, the palms or both sites. Often it starts as a mild intermittent complaint, but it can become increasingly severe and persistent. The affected skin initially becomes red and dry, then progresses to itchy papules (bumps) and fluid-filled blisters (vesicles), scaling, cracking (fissures), weeping (exudation) and swelling (oedema). Bacterial infection can result in pustules, crusting and pain. Longstanding dermatitis at the ends of the fingers may result in deformed nails. Hand dermatitis can spread to affect other sites, particularly the forearms and feet. Aggravating factors: family history of atopic dermatitis, asthma or hay fever. Contact with irritants (frequent immersion of the hands in water,when skin is exposed to detergents,solvents), Allergy (nickel, fragrances, rubber products (in gloves) and p-phenylenediamine (in hair-dyes). Investigations mainly include Patch tests (a batch of materials including the suspected allergen are applied to the upper back in a concentration that would produce no reaction if the patient were not sensitised. The patch tests are removed 48 hours later and a final reading is made at 96 hours.) This will tell you what allergens are causing your problems. Where possible, avoid wet-work and contact with irritants. Protect your hands using vinyl gloves, which are less likely than rubber to cause allergic reactions. Don't wear these for long periods, as sweating will also aggravate dermatitis. Always make sure the gloves are scrupulously clean inside. Use emollients frequently. A thin smear of a thick barrier cream should be applied to all affected areas before work, and reapplied after washing and whenever the skin dries out. Topical steroids to reduce inflammation. These come in various strengths and should only be applied to areas of active dermatitis once or twice daily. Generally a potent topical steroid is used for several weeks. Oral or topical antibiotics may be required - if cracked lesions have got infected. Oral corticosteroids or PUVA therapy in severe cases. No, I don't think homeopathy will work for you. Put Psoriasis is another diagnosis which you can discuss with your dermatologist the next time you visit him/her.

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