title: Repeated mechanical trauma to the hands: the use of anti-impaction gloves for treatment and return to work.
abstract: BACKGROUND
  Repeated mechanical trauma to the hands can result in frictional hand dermatitis (FHD) and (in some cases) hyperkeratotic hand dermatitis (HHD), forms of irritant contact dermatitis. These conditions can be chronic and debilitating and are often refractory to many therapies. Most case reports of FHD describe avoidance of frictional trauma as a management solution. This is the first study to examine anti-impaction gloves as a treatment for FHD.
  
  
  OBJECTIVE
  To determine whether anti-impaction gloves are effective in helping patients with FHD and HHD return to work.
  
  
  METHODS
  We describe a small case series of a subset of patients who presented to our occupational contact dermatitis clinic between January 2004 and June 2008 with either HHD or FHD. Of the 11 patients evaluated, 9 had a diagnosis of FHD and 2 were diagnosed with HHD. They were all treated with anti-impaction gloves, tazarotene cream (Allergan, Inc., Irvine, CA), and clobetasol propionate ointment (Taro Pharmaceuticals Inc., Brampton, Ontario, Canada) and were followed over the long term to determine the impact of treatment on their ability to maintain their jobs. All but one began use of anti-impaction gloves in the workplace.
  
  
  RESULTS
  All patients with FHD were able to return to work with the use of anti-impaction gloves, topical treatments, and (in some cases) modified work duties. Neither of the two cases of HHD resolved with treatment or with discontinuation of work.
  
  
  CONCLUSIONS
  Anti-impaction gloves are shown to aid in the return-to-work process for those with FHD but not for those with HHD.
authors.affiliation: James R. Nethercott Occupational Health Clinic, Occupational Disease Specialty Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Kwok
authors.forename: Victoria
authors.initials: V
authors.lastname: Arrandale
authors.forename: Sandy
authors.initials: S
authors.lastname: Skotnicki-Grant
mesh_terms: D000328:Adult; D017453:Dermatitis, Irritant / Q000209:etiology / Q000628:therapy*; D009783:Dermatitis, Occupational / Q000209:etiology / Q000628:therapy*; D005260:Female; D017575:Gloves, Protective; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014937:Work