From the FDA Drug Label
Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails.
- Urea (TOP) can be used for the treatment of eczema, which includes dyshidrotic eczema.
- The treatment is useful for hyperkeratotic conditions, which may be associated with dyshidrotic eczema.
- Key benefits of using urea (TOP) for dyshidrotic eczema treatment include promotion of normal healing and debridement of hyperkeratotic surface lesions 1.
From the Research
The treatment for dyshidrotic eczema should prioritize reducing inflammation and managing symptoms, with first-line treatments including potent topical corticosteroids such as clobetasol propionate 0.05% applied twice daily for 2-4 weeks to affected areas, as supported by 2.
Key Considerations
- For hand involvement, using these medications under occlusion (with cotton gloves worn overnight) can improve effectiveness.
- Moisturizers should be applied frequently throughout the day, particularly after handwashing, using fragrance-free products like petroleum jelly or ceramide-containing creams.
- Avoiding triggers is essential - identify and eliminate contact with irritants such as soaps, detergents, and metals like nickel.
Additional Treatment Options
- For severe or resistant cases, additional treatments include topical calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus 1% ointment), phototherapy (UVA or narrow-band UVB), as shown to be effective in 3 and 4.
- Oral antihistamines like hydroxyzine 25mg at bedtime for itch relief may also be considered.
- In particularly severe cases, short courses of oral corticosteroids (prednisone 20-40mg daily with taper over 2-3 weeks), or immunosuppressants like methotrexate or cyclosporine may be necessary, as discussed in 5.
Treatment Rationale
These treatments work by reducing the inflammatory response in the skin that causes the characteristic small, intensely itchy blisters on hands and feet that define this condition.
Important Considerations
- The risk of developing corticosteroids' side-effects depends on the potency of the product, extended period of use, and the volume of product applied, as noted in 2.
- Clobetasol propionate is a group I- highly potent corticosteroid, which should be used for a maximum period of 2 weeks.
- The use of emollients, such as those found in clobetasol propionate emollient cream, can help restore the normal moisturizing process of the skin, as discussed in 6.