From the Guidelines
Dyshidrotic eczema is typically treated with topical corticosteroids, but for severe cases, oral psoralen-ultraviolet A (PUVA) therapy has shown significant improvement or clearance in 81-86% of patients.
Treatment Options
- Topical corticosteroids are usually the first line of treatment for dyshidrotic eczema, but the provided evidence does not discuss this in detail.
- Oral PUVA therapy has been shown to be effective in treating hand and foot eczema, with significant improvement or clearance in 81-86% of patients 1.
- Topical PUVA has shown mixed results, with some uncontrolled studies suggesting it to be an effective treatment, with clearance or considerable improvement reported in 58-81% of dyshidrotic eczema patients 1.
Important Considerations
- The evidence from comparative studies for topical PUVA was less convincing, with some studies showing no difference between topical PUVA and placebo or other treatments 1.
- The lack of efficacy of topical PUVA was supported by a small controlled study with 20% 8-MOP gel, in which no patient achieved clearance 1.
- A randomized study comparing 8-MOP PUVA paint and NB-UVB in dyshidrotic eczema showed a reduction in mean severity scores of 75% and clearance rates of 8% and 17%, respectively 1.
From the Research
Treatment Options for Dyshidrotic Eczema
The treatment for dyshidrotic eczema can vary depending on the severity and individual response to therapy. Some of the treatment options include:
- Local narrowband UVB phototherapy, which has been shown to be as effective as paint-PUVA therapy in patients with chronic hand eczema of dry and dyshidrotic types 2
- Adjuvant botulinum toxin A, which has been found to be superior to standard therapy with topical corticosteroids in reducing symptoms and preventing relapses 3
- Radiation therapy, which has been used to achieve complete remission of refractory dyshidrotic eczema in some cases 4
- Treatment of coexisting hyperhidrosis with oxybutynin, which has been shown to improve symptoms of dyshidrotic eczema in some patients 5
Assessment and Evaluation
The severity of dyshidrotic eczema can be assessed using the Dyshidrotic Eczema Area and Severity Index (DASI), which takes into account the number of vesicles, erythema, desquamation, and itch, as well as the extension of the affected area 6
Key Findings
- Local narrowband UVB phototherapy and paint-PUVA therapy have been found to be equally effective in treating chronic hand eczema of dry and dyshidrotic types 2
- Adjuvant botulinum toxin A has been found to be superior to standard therapy with topical corticosteroids in reducing symptoms and preventing relapses 3
- Radiation therapy can be used to achieve complete remission of refractory dyshidrotic eczema in some cases 4
- Treatment of coexisting hyperhidrosis with oxybutynin can improve symptoms of dyshidrotic eczema in some patients 5