Less frequent washing and application of a thick emollient such as petrolatum are the treatments of choice for this patient. Irritant hand dermatitis often occurs through friction, removal of the protective skin barrier, and irritation from the surfactant properties of the soap in persons who overwash their hands. Overwashing is common in patients with obsessive-compulsive disorder. Irritant dermatitis will be especially marked on the dorsal hands where the stratum corneum is thinner than that of the palms. Topical petrolatum moisturizer is an inexpensive and effective way of repairing the damaged skin barrier by softening the stratum corneum, reducing skin water loss, and helping maintain a barrier to decrease further irritation. The petrolatum moisturizer should be applied several times daily, particularly after hand washing when it is most necessary.
Topical diphenhydramine is an antihistamine but irritant dermatitis is not driven by histamine. Therefore, an antihistamine will not be effective.
Although topical lidocaine may relieve the pain, it will not heal the skin barrier and it should not be applied repeatedly to fissured skin because of possible absorption.
Neomycin is not indicated since this patient does not have an infection. There is no purulence or crusting, and there are no pustules or erosions to indicate bacterial infection.