What are alternative treatments for dyshidrotic eczema unresponsive to betamethasone (betamethasone) 0.05% ointment, and is a cream or ointment formulation more effective?

From the Guidelines

For dyshidrotic eczema unresponsive to betamethasone 0.05% ointment, consider alternative treatments such as a combination of calcipotriene 0.005% and betamethasone 0.064% ointment, as it has shown favorable results in achieving absent to mild disease in patients with psoriasis 1. When considering alternative treatments, it's essential to note that ointments are generally more effective than creams for dyshidrotic eczema due to their better occlusion and penetration properties, especially for thick skin on palms and soles.

• Key points to consider:
  • Combination therapy with calcipotriene and betamethasone may be beneficial for patients with dyshidrotic eczema, as seen in psoriasis treatment 1.
  • Ointments are preferred over creams for their enhanced occlusion and penetration properties.
  • Non-steroid alternatives like tacrolimus 0.1% or pimecrolimus 1% ointment may be considered for sensitive areas or when concerned about steroid side effects.
  • Identifying and avoiding triggers, using gentle fragrance-free soaps, applying moisturizers frequently, and considering cotton gloves at night can enhance treatment outcomes. In the context of real-life clinical medicine, a combination of calcipotriene 0.005% and betamethasone 0.064% ointment may be a viable alternative for patients with dyshidrotic eczema unresponsive to betamethasone 0.05% ointment, as it has shown promising results in a similar skin condition, psoriasis 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. ELIDEL Cream is used on the skin for short periods, and if needed, treatment may be repeated with breaks in between. ELIDEL Cream is for use after other prescription medicines have not worked for you or if your doctor recommends that other prescription medicines should not be used

For dyshidrotic eczema unresponsive to betamethasone 0.05% ointment, alternative treatments may include:

• Topical calcineurin inhibitors like pimecrolimus (ELIDEL Cream 1%) The choice between a cream or ointment formulation depends on the individual patient's needs and the severity of their eczema. According to the label, ELIDEL Cream is used for short periods, and if needed, treatment may be repeated with breaks in between 2.

From the Research

Alternative Treatments for Dyshidrotic Eczema

• For dyshidrotic eczema unresponsive to betamethasone 0.05% ointment, alternative treatments include:
  • PUVA therapy, which has been shown to be effective in treating chronic palmoplantar eczema, including dyshidrotic eczema 3
  • Narrowband UVB phototherapy, which has been found to be as effective as PUVA therapy in treating chronic hand eczema of dry and dyshidrotic types 4
  • Topical anti-inflammatory treatments, such as tacrolimus 0.1%, potent topical corticosteroids, and ruxolitinib 1.5%, which have been ranked as amongst the most effective treatments for eczema 5

Cream or Ointment Formulation

• The effectiveness of a cream or ointment formulation for dyshidrotic eczema is not directly compared in the provided studies
• However, the study on topical anti-inflammatory treatments for eczema found that the formulation of the treatment (e.g. cream or ointment) was not a significant factor in determining its effectiveness 5
• The choice of formulation may depend on individual patient preferences and needs, such as the severity of the eczema and the presence of any allergies or sensitivities

Efficacy of Treatments

• The study on PUVA therapy found that dyshidrotic eczema responded better to both oral and bath PUVA treatments, and remained longer in remission than hyperkeratotic eczema 3
• The study on narrowband UVB phototherapy found that it was as effective as PUVA therapy in treating chronic hand eczema of dry and dyshidrotic types 4
• The study on topical anti-inflammatory treatments found that potent topical corticosteroids, tacrolimus 0.1%, and ruxolitinib 1.5% were amongst the most effective treatments for eczema, while mild topical corticosteroids and PDE-4 inhibitors were amongst the least effective 5