From the Guidelines
Dyshidrotic eczema can be effectively treated with a combination of topical medications and lifestyle modifications, prioritizing the use of high-potency topical corticosteroids and moisturizers to reduce inflammation and support the skin barrier. For mild cases, start with high-potency topical corticosteroids like clobetasol 0.05% or fluocinonide 0.05% cream applied twice daily to affected areas for 1-2 weeks, then taper to medium-potency options like triamcinolone 0.1% for maintenance 1. Calcineurin inhibitors such as tacrolimus 0.1% ointment or pimecrolimus 1% cream are good steroid-sparing alternatives, especially for sensitive areas or long-term use.
Key Treatment Considerations
- For severe or resistant cases, oral antihistamines like cetirizine 10mg daily can help with itching, while short courses of oral prednisone (starting at 40mg daily with a 2-week taper) may be needed for acute flares.
- Keeping the skin moisturized with fragrance-free emollients like petroleum jelly or ceramide-containing creams is essential, applied multiple times daily.
- Avoid known triggers including frequent hand washing, irritating soaps, and contact with allergens.
- Wearing cotton gloves at night after applying medications can improve penetration and prevent scratching.
Specialist Referral and Advanced Therapies
For chronic cases, phototherapy or systemic immunosuppressants like methotrexate or cyclosporine may be necessary under specialist supervision, as outlined in recent guidelines for the management of atopic dermatitis 1. These treatments work by reducing inflammation and supporting the skin barrier, which is compromised in dyshidrotic eczema due to immune dysregulation and barrier dysfunction.
From the Research
Dyshidrotic Eczema Treatment
- Dyshidrotic eczema, also known as dyshidrosis, is a common chronic dermatitis of the hands and feet that may cause significant physical discomfort, psychological distress, and occupational impairment 2.
- Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis, and can be used to treat dyshidrotic eczema 3, 4.
- The use of topical corticosteroids has significantly enhanced the treatment of patients with dermatoses such as psoriasis and eczema, including dyshidrotic eczema 4.
- Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 5.
- Effectiveness is similar between once daily and twice daily (or more) frequent use of potent topical corticosteroids to treat eczema flare-ups 5.
- Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 5.
- Topical 0.05% clobetasol cream is widely used for the treatment of chronic hand eczema, including dyshidrotic eczema, for its efficacy, tolerability, and safety 6.
Treatment Options
- Topical corticosteroids, such as clobetasol propionate, can be used to treat dyshidrotic eczema 3, 4, 5, 6.
- Emollients, such as moisturizers, can help restore the normal moisturizing process of the skin and improve the penetration of steroids into the skin 4.
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 3.
Application and Dosage
- Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 3.
- The fingertip unit method can be used to teach patients how to apply topical corticosteroids correctly 3.
- One fingertip unit is the amount of medication dispensed from the tip of the index finger to the crease of the distal interphalangeal joint and covers approximately 2% body surface area on an adult 3.