Pękanie skóry dłoni powoduje duży dyskomfort oraz zwiększa ryzyko ran i uszkodzeń. W wielu przypadkach dolegliwość ta jest spowodowana przesuszeniem naskórka pod wpływem zimna lub środków dezynfekujących. Może być też objawem m.in. atopowego zapalenia skóry czy cukrzycy.
Przesuszenie skóry dłoni jest następstwem naruszenia warstwy rogowej naskórka. Znajdująca się w niej bariera hydrolipidowa odpowiada za utrzymanie właściwego nawilżenia skóry. Naruszenie tej naturalnej bariery ochronnej skutkuje zwiększoną wrażliwością na urazy mechaniczne.
Nadmiernie sucha skóra staje się zaczerwieniona i szorstka. Jest narażona na pękanie, zwłaszcza na zgięciach palców. W miejscu pęknięć często tworzą się krwawiące rany, które są podatne na zakażenia. Na suchej skórze mogą pojawiać się także wypryski, wykwity i wypełnione płynem surowiczym pęcherzyki. Pękanie skóry dłoni może mieć wiele przyczyn.
- Warunki atmosferyczne
Skóra dłoni jest szczególnie narażona na pękanie zimą i jesienią, kiedy panują niskie temperatury i trwa sezon grzewczy. Ogrzewanie pomieszczeń skutkuje zmniejszeniem wilgotności powietrza, co sprzyja utracie wody przez naskórek. Z kolei zimne powietrze i mórz dodatkowo podrażniają wysuszoną skórę dłoni.
- Środki chemiczne
Pękanie skóry dłoni może być objawem zapalenia skóry rąk. Jest to powszechne schorzenie wśród osób, które w pracy często myją dłonie i używają środków chemicznych czy dezynfekujących. Środki drażniące ścierają, podrażniają i niszczą warstwę rogową skóry. Na długotrwałą i powtarzającą się ekspozycję na substancje chemiczne narażone są szczególnie niektóre grupy zawodowe, m.in. pracownicy ochrony zdrowia, kosmetyczki, mechanicy i sprzątacze.
- Alergie
Pękanie skóry dłoni może być oznaką alergicznego kontaktowego zapalenia. Substancjami uczulającymi są często m.in. nikiel, z którego wytwarza się sztućce, dwuchromian potasu występujący w barwnikach, kleju i farbach oraz lateks i mieszaniny gumy używane do produkcji rękawiczek. Zmiany skórne mogą wystąpić na opuszkach palców, wale paznokciowym oraz grzbietowej powierzchni ręki.
- Atopowe zapalenie skóry
Nadmierne przesuszenie i pękanie skóry dłoni jest charakterystycznym objawem atopowego zapalenia skóry. W przebiegu tego schorzenia występuje niedobór głównych lipidów warstwy barierowej skóry. Prowadzi to do nadmiernej utraty wody i osłabienia naskórka. Skóra staje się wówczas szczególnie wrażliwa na działanie m.in. środków chemicznych czy alergenów. Zmiany skórne w przebiegu AZS obejmują zwykle dłoniową powierzchnię rąk i palców, a niekiedy także nadgarstki. Charakterystyczny dla tego schorzenia jest uporczywy świąd w obrębie zmienionych chorobowo miejsc.
- Cukrzyca
Przesuszanie naskórka prowadzące do pękania skóry na palcach to objaw często towarzyszący cukrzycy. Podwyższony poziom cukru u diabetyków powoduje zmiany zwyrodnieniowe w tętniczkach i włośniczkach oraz żyłach. Skutkuje to niedożywieniem skóry, która staje się sucha i ma tendencję do łuszczenia się.
- Niedoczynność tarczycy
W przebiegu niedoczynności tarczycy wskutek niedoborów hormonalnych dochodzi do spowolnienia metabolizmu i procesu keratynizacji, co przekłada się na zmniejszoną produkcję lipidów. Skutkuje to brakiem właściwego nawilżenia skóry i nadmiernym odparowywaniem wody z naskórka.
- Niewłaściwa dieta
Inną przyczyną pękania skóry na dłoniach może być też brak zbilansowanej diety i związane z tym niedobory witaminowe. Witamina A odpowiada m.in. za wzmocnienie funkcji ochronnych naskórka, a witamina C zapewnia skórze elastyczność. Niedobór tych składników odżywczych negatywnie wpływa na kondycję skóry.
Przesuszenie skóry dłoni może być również spowodowane niedostatecznym nawodnieniem organizmu. Skutkuje to niewystarczającym nawilżeniem skóry i utratą przez nią elastyczności oraz zdolności do regeneracji.
Problemy skórne mogą wynikać także z nadużywania alkoholu. Zawarty w alkoholu etanol niszczy keratynocyty, czyli komórki odpowiadające za produkcję keratyny, z której zbudowany jest naskórek. Zbyt częste spożywanie alkoholu skutkuje utratą elastyczności skóry.
Na stan skóry ma również wpływ palenie papierosów. Obecna w ich składzie nikotyna zwęża naczynia krwionośne w zewnętrznych warstwach skóry. Powoduje to ograniczenie przepływu krwi do skóry – następstwem jest niedostarczanie skórze odpowiedniej ilości tlenu i składników odżywczych.
- Nieodpowiednia higiena
Przesuszanie naskórka może być następstwem niewłaściwej higieny. Mycie dłoni w zbyt ciepłej lub zimnej wodzie podrażnia skórę. Zbyt mocne wycieranie rąk również przyczynia się do uszkodzeń naskórka. Kontakt z wodą narusza naturalną barierę ochronną naskórka, jednak zazwyczaj jest ona w stanie szybko się zregenerować. Jeżeli jednak naskórek jest już podrażniony przez inne czynniki, np. niską temperaturę czy środki chemiczne, regeneruje się wolniej. Z tego powodu niedokładne wycieranie dłoni może spowodować dodatkowe uszkodzenia.
Leczenie przesuszenia i pękania skóry dłoni
W leczeniu kluczowe jest regularne nawilżanie i natłuszczanie skóry. Można użyć maści i kremów z aloesem, mocznikiem, witaminą A czy naturalnymi olejami roślinnymi, np. z migdałów. Do mycia rąk nie powinno się używać bardzo zimnej lub bardzo ciepłej wody. Po myciu rąk trzeba je dokładnie wycierać – niewskazane jest jednak silne pocieranie ręcznikiem o dłonie, ponieważ może to dodatkowo podrażnić skórę. Dłonie należy delikatnie osuszać – warto używać jednorazowych ręczników papierowych.
Należy także chronić skórę przed wpływem niskich lub zbyt wysokich temperatur, m.in. podczas mrozów warto zakładać rękawiczki. Powinno się też zrezygnować z korzystania z sauny. Oprócz tego należy unikać kontaktu z czynnikami drażniącymi, m.in. środkami chemicznymi.
Jeżeli zmiany skórne się utrzymują, w celu ustalenia przyczyny dolegliwości należy skonsultować się z lekarzem rodzinnym i dermatologiem. W przypadku stwierdzonych niedoborów składników odżywczych niezbędne jest urozmaicenie diety. Jeżeli przyczyną przesuszenia skóry dłoni jest uczulenie, oprócz unikania alergenu konieczne może okazać się przyjmowanie doustnych leków przeciwhistaminowych. W przypadku kontaktowego zapalenia skóry lekarz może przepisać miejscowe kortykosteroidy.
Jeżeli wskutek pękania skóry w rany wdało się zakażenie, lekarz może zdecydować o zastosowaniu miejscowych lub doustnych środków przeciwgrzybiczych lub przeciwbakteryjnych.
Źródło: „Zapalenie skóry rąk: etiologia, rozpoznanie i leczenie”, w: „Dermatologia po dyplomie”, t. 1, nr 2, 2010, s. 9-17.
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