From the Guidelines
Mometasone furoate is the recommended corticosteroid for hand eczema due to its demonstrated long-term efficacy in chronic cases. According to the guidelines for the management of contact dermatitis, an open prospective randomized trial has shown the effectiveness of mometasone furoate in chronic hand eczema 1. This study provides high-quality evidence (Quality of evidence I) and a moderate strength of recommendation (Strength of recommendation B).
When using mometasone furoate for hand eczema, it is essential to follow a treatment regimen that includes applying a thin layer to affected areas twice daily for 2-4 weeks, then tapering to once daily or less frequently as symptoms improve. For maintenance, consider weekend-only therapy or switching to less potent steroids like hydrocortisone 1% for long-term management.
Key considerations for treatment include:
- Using ointment formulations for dry eczema and creams for weeping lesions
- Applying the medication after bathing when the skin is slightly damp
- Following with a moisturizer to minimize side effects like skin thinning
- Considering occlusion therapy or discussing systemic options with a healthcare provider for hands that don't respond to topicals.
The use of mometasone furoate has been shown to be effective in managing chronic hand eczema, and its long-term intermittent use can help reduce symptoms and improve quality of life 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Clobetasol propionate gel, cream and ointment are super-high potency corticosteroid formulations indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid responsive dermatoses. The recommended corticosteroid for hand eczema is clobetasol propionate 2.
- Key points:
- It is a super-high potency corticosteroid formulation.
- Treatment should be limited to 2 consecutive weeks.
- The total dosage should not exceed 50 g per week.
From the Research
Recommended Corticosteroid for Hand Eczema
- The study 3 found that clobetasol propionate 0.05% foam probably improves participant-rated control of symptoms compared to vehicle, with a risk ratio (RR) of 2.32 and a number needed to treat for an additional beneficial outcome (NNTB) of 3.
- Mometasone furoate cream used thrice weekly may slightly improve investigator-rated symptom control compared to twice weekly, with a RR of 1.23 3.
- Another study 4 found that a combination treatment with fluticasone propionate 0.05% cream and clobetasole ointment 0.05% was effective in patients with chronic hand eczema.
- Triamcinolone 0.1% cream was compared to fumaric acid 5% cream in the treatment of hand eczema, and the results showed that triamcinolone was more effective in decreasing excoriation, population, lichenification, EASI score, and itching 5.
- A more recent study 6 compared the efficacy of petrolatum and panthenol ointment vs. 0.1% triamcinolone acetonide in 10% urea cream for the treatment of mild-to-moderate chronic hand eczema, and found that the healing ointment was alternatively efficacious for treatment of CHE.
Key Findings
- Topical corticosteroids, such as clobetasol propionate and mometasone furoate, are effective in improving symptom control in patients with hand eczema 3.
- Combination treatments, such as fluticasone propionate and clobetasole ointment, may also be effective 4.
- Triamcinolone 0.1% cream was found to be more effective than fumaric acid 5% cream in decreasing symptoms of hand eczema 5.
- Newer treatments, such as petrolatum and panthenol ointment, may be alternatively efficacious for treatment of CHE 6.
- The treatment of chronic hand eczema remains a challenge, and new topical and systemic therapeutics are being investigated 7.