From the Guidelines
To treat dyshidrotic eczema, start with gentle skin care and topical corticosteroids, using the least potent preparation required to keep the eczema under control, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. The mainstay of treatment for dyshidrotic eczema involves the use of topical corticosteroids, which can be used safely if certain precautions are taken, such as explaining the benefits and risks to patients and using the least potent preparation required to keep the eczema under control 1. When prescribing topical corticosteroids, considerations should be made for the age of the patient, the site to be treated, and the extent of the disease, as outlined in the management of atopic eczema guidelines 1. Some key points to consider in the management of dyshidrotic eczema include:
- Time for explanation and education is essential, to ensure patients understand the treatment and potential risks 1
- Adequate amounts of emollients should be prescribed, and these should be used liberally, to help manage symptoms and prevent flare-ups
- Deterioration in previously stable eczema may be due to secondary bacterial infection or to development of a contact dermatitis, and should be investigated and treated accordingly
- Attempts to eradicate the house dust mite are not currently recommended, and dietary restriction is of little or no benefit in adults, and should only be considered in selected infants under professional supervision 1.
From the Research
Treatment Options for Dishydrotic Eczema
- Topical anti-inflammatory treatments are used to control eczema symptoms, including dishydrotic eczema 2, 3
- Potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% are ranked among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 2, 3
- Janus kinase inhibitors, such as ruxolitinib 1.5% and delgocitinib 0.5%, are also effective in treating eczema 2, 3
- Topical calcineurin inhibitors, such as tacrolimus 0.1%, can be used as an alternative to topical steroids 2, 3
- Crisaborole 2% is a topical phosphodiesterase-4 inhibitor that can be used to treat mild to moderate eczema 2, 3
Systemic Treatments for Eczema
- Systemic immunosuppressive treatments, such as dupilumab, can be used to treat moderate to severe eczema 4
- Dupilumab is a biological treatment that has been shown to be effective in reducing eczema signs and symptoms in the short term 4
- Other systemic treatments, such as ciclosporin, can also be used to treat eczema, but the evidence for their efficacy is of low or very low certainty 4
Diagnosis and Management of Eczema
- Diagnosis of eczema is based on clinical history, physical examination, and patch testing 5
- Treatment of eczema includes moisturizers, topical corticosteroids, topical calcineurin inhibitors, crisaborole, phototherapy, and systemic medications, including biologics 5
- Management of eczema involves a comprehensive approach, including avoidance of triggers, use of moisturizers, and treatment of flare-ups 5