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Dermatology/Skin Itches behind nails hand finger

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Question
Respected Sir,
.My daughter in law 31 years old is having some problem of developing skin itches by the side and back side of finger nails in hand.He has been seen by a Dermatologist at Hyderabad who gave her two creams.As she is engaged with household work involving water handling and which cannot be avoided the condition is not improving
Medicines prescribed 1)Salicylic Acid 12% cream and 2)combined cream containing Mometasone Fuorate and Fusidic Acid
but the condition is not improving
         What I understand that as the swelling .itches are developing only at the back side of the nail this is probably not a problem of Cuticle Infection/Paronychia.As the nails itself  are not showing any problem (no fungus at nail)this is probably not a problem of Onychomycosis.
There is another problem called Chilblains/Erythema Perino
         I would like to know whether this problem,if any can be cured with proper medicines/Steroid with Antibiotic Creams.
         With thanks

Answer
Your daughter has what is called hand eczema from all the moisture. Dec. 20, 2004 -- Seeking relief from the red, dry, cracked, and inflamed skin of hand eczema? Two new studies spotlight treatments that could help even the roughest cases.

Both studies were conducted in Europe on people with moderate to severe hand eczema, also called hand dermatitis. The results appear in the December issue of the Archives of Dermatology.

The first study tested an oral medicine called alitretinoin. It is similar to a medicine used to treat acne.

More than 300 people in 10 European countries enrolled. Their symptoms had lasted at least three months and hadn't responded well to standard therapy such as steroid creams.

Participants took a placebo pill or 10, 20, or 40 mg of alitretinoin once daily for 12 weeks. Alitretinoin outperformed the placebo across the board. The best results occurred at the highest dose.

At the end of 12 weeks, eczema symptoms completely disappeared or nearly vanished in slightly more than half of the group taking 40 mg of alitretinoin. The 20 mg dose was second best, followed by the 10 mg dose.

Alitretinoin was generally well tolerated at all levels. The most common side effects were headache, dry lip, flushing, and dry mouth.

The researchers included Thomas Ruzicka, MD, of Germany's Heinrich-Heine University Hospital. The journal notes that several scientists involved in the project had received grants, consultancy fees, or were employees of Basilea Pharmaceutica, the study's sponsor and alitretinoin's maker.

The second study took a different approach. It focused on home- vs. hospital-based treatment of a psoralen medication combined with use of a tanning unit.

Ultraviolet light is sometimes used to treat extreme eczema. A psoralen is given before the ultraviolet light. The treatment, called PUVA, is traditionally administered at a hospital.

Participants were more than 150 Dutch patients who had suffered moderate to severe hand eczema for at least a year. They were divided into two groups. One group was treated at a hospital; the other patients used a commercial, portable tanning device at home.

After 10 weeks, both groups showed similar and substantial decreases in eczema. The improvements were maintained for eight weeks.

The home-based group had two advantages. They missed less work for treatments and their travel costs were lower. That was expected, say the researchers, who included Dutch dermatologist A. Marco van Coevorden, MD, of University Hospital Groningen.

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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