What is the treatment for hand dermatitis?

From the Guidelines

Treatment for hand dermatitis involves a multi-faceted approach, prioritizing the identification and avoidance of triggers, and the use of gentle, fragrance-free soaps and frequent moisturizer application, as recommended by the American Contact Dermatitis Society 1.

Key Considerations

• Identify and avoid irritants and allergens that may be causing or worsening the condition
• Use gentle, fragrance-free soaps and apply moisturizers frequently, especially after washing hands
• For mild cases, consider over-the-counter 1% hydrocortisone cream applied twice daily for up to two weeks to reduce inflammation
• More severe cases may require prescription-strength topical corticosteroids, such as triamcinolone 0.1% or fluocinonide 0.05%, applied twice daily for 1-2 weeks
• For chronic or resistant cases, consider topical calcineurin inhibitors, such as tacrolimus 0.1% or pimecrolimus 1%, used twice daily as steroid-sparing agents

Additional Recommendations

• Protect hands with cotton gloves when doing wet work, and wear vinyl gloves over cotton ones when using potential irritants
• Nighttime treatment with thick emollients under cotton gloves can be particularly effective for healing
• If infection is present, appropriate antibiotics may be necessary
• Persistent cases should be evaluated for patch testing to identify specific allergens, as recommended by the American Contact Dermatitis Society 1

Advanced Therapies

• For severe or widespread hand dermatitis, consider phototherapy or systemic therapies, such as oral medications or injectable biologics, as recommended by the Journal of the American Academy of Dermatology 1
• The decision to initiate these advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of the condition, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions.

From the Research

Treatment Options for Hand Dermatitis

• Topical corticosteroids, such as clobetasol propionate 0.05% foam, may improve participant-rated control of symptoms compared to vehicle 2
• Topical calcineurin inhibitors, such as tacrolimus 0.1%, may improve investigator-rated symptom control compared to vehicle 3, 2
• Phototherapy, including ultraviolet (UV) light, may lead to improvement in investigator-rated symptom control 2
• Oral interventions, such as alitretinoin 10 mg and 30 mg, may improve investigator-rated and participant-rated symptom control compared to placebo 2
• Medium-potency topical corticosteroid products, such as hydrocortisone butyrate 0.1% cream, may be effective in treating chronic hand dermatitis 4

Efficacy and Safety of Treatments

• Topical tacrolimus 0.1% may improve induration and scaling, and prolong the time to recurrence of hand dermatitis symptoms 3
• Pimecrolimus cream 1% may be effective in treating mild-to-moderate chronic hand dermatitis, with significant pruritus relief compared to vehicle 5, 6
• Alitretinoin 10 mg and 30 mg may have a higher risk of adverse events, such as headache, compared to placebo 2

Comparison of Treatments

• There is limited evidence to support one specific treatment over another for hand dermatitis 2
• Topical corticosteroids and UV phototherapy are two of the major standard treatments, but more research is needed to determine their effectiveness compared to other treatments 2
• Well-designed and well-reported, long-term studies comparing different treatments are needed to establish a standard severity scale and define hand eczema and its subtypes 2