What is the treatment for hand eczema?

From the Guidelines

The treatment for hand eczema should prioritize a combination of moisturizing, topical medications, and trigger avoidance, with the most recent and highest quality evidence supporting the use of topical corticosteroids and non-steroidal alternatives like tacrolimus or pimecrolimus ointment 1. When managing hand eczema, it's essential to start with frequent application of fragrance-free moisturizers throughout the day, especially after washing hands.

• For mild cases, over-the-counter 1% hydrocortisone cream applied twice daily for up to two weeks can reduce inflammation.
• More severe cases may require prescription-strength topical corticosteroids like triamcinolone 0.1% or fluocinonide 0.05% applied twice daily for 1-2 weeks.
• Non-steroidal alternatives include tacrolimus 0.1% or pimecrolimus 1% ointment, particularly useful for long-term management as they don't cause skin thinning. Some key considerations in the treatment of hand eczema include:
• Identifying and avoiding triggers such as irritating soaps, frequent hand washing, and allergens is crucial for preventing flares.
• Wearing cotton gloves at night over moisturizer can enhance absorption.
• For severe, persistent cases, oral antihistamines like cetirizine 10mg daily may help with itching, while short courses of oral steroids or other immunosuppressants might be prescribed by a dermatologist 1. It's also important to note that hand eczema responds best to consistent treatment, as the thick skin on palms requires persistent care to penetrate effectively and heal the damaged skin barrier 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). The treatment for hand eczema is not explicitly mentioned in the provided drug label for pimecrolimus (TOP) cream 1%. However, it does mention that ELIDEL Cream is used to treat eczema (atopic dermatitis), but it does not specify hand eczema.

• The label states that ELIDEL Cream is for use after other prescription medicines have not worked for the patient or if the doctor recommends that other prescription medicines should not be used.
• It is essential to follow the doctor's advice and instructions when using ELIDEL Cream. 2

From the Research

Treatment Options for Hand Eczema

• Topical corticosteroids are a common treatment for hand eczema, with studies showing their effectiveness in reducing symptoms 3, 4, 5
• Calcineurin inhibitors, such as tacrolimus, may also be effective in treating hand eczema, although more research is needed to confirm their efficacy 3, 6
• Phototherapy, including ultraviolet (UV) light therapy, can be an effective treatment for hand eczema, particularly for severe cases 3, 6
• Systemic treatments, such as oral retinoids and immunosuppressants, may be necessary for severe or chronic hand eczema, but can have significant side effects 3, 6, 7
• Emerging therapies, including targeted biologics and small molecule inhibitors, are being investigated for the treatment of hand eczema, but more research is needed to determine their efficacy and safety 7

Specific Treatments

• Clobetasol propionate 0.05% foam has been shown to improve participant-rated control of symptoms compared to vehicle 3
• Mometasone furoate cream may improve investigator-rated symptom control when used thrice weekly compared to twice weekly 3
• Alitretinoin 10 mg and 30 mg have been shown to improve investigator-rated and participant-rated symptom control compared to placebo 3
• Tacrolimus 0.1% has been shown to improve investigator-rated symptom control compared to vehicle, although more research is needed to confirm its efficacy 3, 6

Considerations

• Treatment of hand eczema should be individualized based on the severity and subtype of the condition, as well as the patient's medical history and preferences 4, 7
• A combination of topical and systemic treatments may be necessary to achieve optimal results 6, 7
• Further research is needed to determine the long-term efficacy and safety of various treatments for hand eczema, as well as to develop more targeted and effective therapies 3, 7