Dry, Itchy, Cracked Hands: Differential Diagnosis and Management

Clinical Approach

Absence of scabies in household makes scabies unlikely but not impossible (asymptomatic carriers exist). Consider:

Differential Diagnosis

Condition	Key Features	Triggers
Irritant contact dermatitis	Dry, fissured, burning; dorsal hands, web spaces	Frequent washing, solvents, gloves, cold weather
Allergic contact dermatitis	Vesicular, pruritic; may spread beyond contact site	Nickel, fragrances, preservatives, rubber accelerators
Atopic dermatitis (eczema)	Chronic, flexural; personal/family atopy history	Stress, climate, irritants
Psoriasis (palmoplantar)	Well-demarcated plaques, silvery scale, nail pitting	Koebner, stress, strep
Dyshidrotic eczema (pompholyx)	Deep-seated vesicles on palms/lateral fingers; intense itch	Heat, sweat, stress, metals
Tinea manuum	Unilateral, scaly, active border; often with tinea pedis	Dermatophyte infection
Nutritional deficiency	Zinc, essential fatty acids, B vitamins, vitamin A	Malabsorption, restrictive diet

Diagnostic Steps

1. History: occupation, hobbies, products, atopy, medications.
2. Exam: distribution, morphology, nails, feet.
3. Patch testing (allergic contact).
4. KOH prep / fungal culture (tinea).
5. Biopsy if uncertain.

General Skin Barrier Repair

• Gentle cleanser (syndet), lukewarm water.
• Frequent thick emollients (ceramides, petrolatum, urea 5–10%).
• Cotton gloves under vinyl for wet work.
• Topical corticosteroids (mild-mid potency) for inflammation; calcineurin inhibitors for chronic use.

When to See a Dermatologist

Persistent >2 weeks, worsening, painful fissures, signs of infection, suspected contact allergy.