From the Research
For dyshidrotic eczema unresponsive to betamethasone 0.05% ointment, consider stepping up to a more potent topical corticosteroid like clobetasol propionate 0.05% applied twice daily for 2 weeks, as potent TCS were ranked amongst the most effective treatments in a network meta-analysis of 291 studies involving 45,846 participants 1. Alternatively, tacrolimus 0.1% ointment or pimecrolimus 1% cream can be effective steroid-free options, especially for sensitive areas like the hands. Some key points to consider when treating dyshidrotic eczema include:
- The use of topical anti-inflammatory treatments, such as potent TCS, tacrolimus 0.1%, and ruxolitinib 1.5%, which were ranked as the most effective in reducing patient-reported symptoms and clinician-reported signs in a network meta-analysis 1.
- The potential for local adverse effects, such as application-site reactions, which were more likely to occur with tacrolimus 0.1% and crisaborole 2% compared to TCS 1.
- The importance of supportive measures, such as avoiding irritants, using cotton gloves at night, and maintaining skin hydration with fragrance-free moisturizers.
- The consideration of systemic immunosuppressants, such as methotrexate or dupilumab, for chronic, recalcitrant cases.
- The potential benefit of treating coexisting hyperhidrosis with oxybutynin, as seen in two case reports of patients with relapsing dyshidrotic eczema 2. It is also important to note that the evidence for the treatment of dyshidrotic eczema is largely based on studies of atopic dermatitis, and more research is needed to determine the most effective treatments for this specific condition.