From the Research
Treatment for dyshidrotic eczema should prioritize topical corticosteroids, with potent or moderate potency being more effective than mild, as evidenced by a recent Cochrane review 1.
Key Considerations
- The goal of treatment is to reduce inflammation, control the immune response, and restore the skin barrier.
- Topical corticosteroids are the first-line treatment, with potent or moderate potency being more effective for moderate or severe eczema.
- Applying topical corticosteroids once daily does not decrease treatment success compared to twice daily application, as shown in a pooled analysis of 15 trials 1.
- Proactive therapy with twice weekly application of topical corticosteroids can prevent eczema relapse, reducing the likelihood of flare-ups from 58% to 25% 1.
Treatment Options
- For mild cases, over-the-counter 1% hydrocortisone cream can be applied twice daily for up to two weeks.
- For moderate to severe cases, prescription-strength topical corticosteroids like betamethasone or clobetasol may be needed, typically applied twice daily for 1-2 weeks.
- Calcineurin inhibitors such as tacrolimus 0.1% ointment or pimecrolimus 1% cream are steroid-free alternatives, particularly useful for sensitive areas or long-term management.
- Severe flares might require oral corticosteroids like prednisone, while chronic cases may benefit from phototherapy or immunosuppressants like methotrexate or cyclosporine.
- Antihistamines such as diphenhydramine or cetirizine can help manage itching.
- Cold compresses provide temporary relief, and wearing cotton gloves at night after applying moisturizers enhances treatment effectiveness.
Emerging Therapies
- Dupilumab, a biologic medication, has shown promise in treating recalcitrant dyshidrotic eczema, as reported in two case studies 2.
- Further studies are needed to establish the efficacy of dupilumab in treating dyshidrotic eczema.