Why is the skin on my finger tips peeling?

Why is the skin on my fingers peeling?

• The skin on my finger tips on both hands are peeling. Its just on my finger tips though. This happens every year at around the same time. I have had eczema since birth. Are they related? What does this mean? Thanks :)

• Answer:

  It's eczema. Everyone here doesn't understand because they don't have hand eczema. I've had the condition now for 5 years and I have the most stubborn form of eczema but, it is somewhat under control now. Here is what I did: 1) 80% of cases are caused because of an allergic reaction (contact dermatitis). Go to your doctor and get blood tests done to determine if you are allergic to anything. Next, you need to do patch testing to see if it is anything you're coming into contact with. 2) If the patch testing is negative, I'm all but certain you're like me and you're eczema is caused by mechanical trauma. Now, you might say, "I'm not in a profession where I use my hands a lot." Well, neither am I. I'm in financial services and the only thing I use my hands for is shaking hands and typing. Nonetheless, I am certain my skin overreacts to trivial trauma incurred. In any event, there is little you can do to avoid this. 3) Remedies: the first line of defense is topical steroids. Go straight for the strongest stuff, Clobetasol, and make sure you put it on your hands in the morning and wrap your hands with clobetasol (occlusion) at night. If clobetasol doesn't work, the next line of defense is immunosuppresents: tacrilomus (Protopic). Apply protopic in the morning and at night, under occlusion (i.e. put on groves). If after a while, you notice the protopic doesn't work, the next line of defense is to expose your hands to a narrow band of UV light. There are two types of UV light therapy 1) PUVA and 2) narrowband uvb. PUVA requires that you apply an emollient to your hand which makes your hands sensitive to light, then you expose your hand to a small band of UV-A light, which your doctor administers. Narrowband uv-b therapy uses the 310-312 bands of light to treat eczema. I personally used narrowband uvb because it had a greater safety profile and i didn't need to use an emollient prior to therapy. I found that the narrowband uv-b improved my condition but it hasn't gotten better. The next line of defense that I have yet to try is alitretinoin which is an antineoplastic agent and a derivative of vitamin A. This retinoid was originally developed as a topical ointment used to treat kaposi's sarcoma. In 2009, pharmaceutical company Basilea developed an oral form of the drug to treat hand eczema. It is marketed as Toctino and it is a first of it's kind--the only systemic treatment that is for hand eczema. It is available in every single developed country except the united states. Currently basilea is concluding stage 3 clinical trials. Once it becomes available in the united states, I'll be the first in line to take it. So far, thousands of people in europe, canada, and oceania have had great success with toctino. There are people who have been suffering for 30 years with this condition and toctino has cured them. If you live in the US like me, and can't wait, you can purchase toctino through a canadian pharmacy but, be prepared to dish out a pretty penny. A 90 supply (the minimum dosing cycle) costs upwards of $2000. I would rather wait for it to come to the US so my insurance can cover it. Some other treatments that you should NOT consider include oral immunosuppresants and steroid injections. 4) Safety profiles a. Clobetasol - has been shown to cause atrophy of the skin but, i wouldn't worry about it. The skin on your hands is very thick. I've been using it for two years with no problems. b. Tacrilomus (protopic) - it has been shown that pro topic causes lymphoma in rats. However, i think this is overblown. The rats were given an oral form of the drug and we're talking about a less potent (topical) form of the drug which is localized only to the hands. c. PUVA and narrowband uvb- I think both are relatively safe but, if you're skin tone is darker, it's slightly safer. In other words, if you have fair skin, red hair, and freckles, I may think twice about choosing narrowband uvb or puva as a therapy but, then again, I think the chances of skin cancer are slim. You aren't exposed to the whole spectrum of ultraviolet light, you're only exposed to a very small band of light--usually the 311 band. I think uvb has a better safety profile altogether d. Alitretinoin (Toctino) aka: 9-cis-retinoic acid-- this drug has a relatively good safety profile. The only thing I would worry about it hairloss. However, people have mentioned that hair does grow back after the drug is no longer present in the liver.