What is the best treatment for grey eczema?

Best Treatment for Grey Eczema

High-potency topical corticosteroids are the most effective first-line treatment for grey eczema (dyshidrotic eczema), with 94.1% good or excellent clinical response in acute phases. 1

First-Line Treatment Options

Topical Corticosteroids

• For acute phase (2-4 weeks):

  • High-potency topical corticosteroids (e.g., betamethasone dipropionate) 1
  • Apply once daily (effectiveness is similar between once daily and twice daily application) 2
  • Potent topical corticosteroids are significantly more effective than mild corticosteroids (70% vs 39% treatment success) 2

• For longer treatment periods:

  • Medium-potency corticosteroids to minimize side effects 1
  • Low-potency corticosteroids for mild cases 1

Important Considerations

• Limit high-potency corticosteroids to short periods (2-4 weeks) to avoid side effects such as skin atrophy, telangiectasias, and striae 1
• Risk of skin thinning is low with short-term use (1% across studies) but increases with higher-potency steroids and longer use 2

Second-Line Treatment Options

Topical Calcineurin Inhibitors

• Tacrolimus 0.1% is among the most effective topical treatments, comparable to potent corticosteroids 3, 4
• Consider for sensitive areas or when concerned about corticosteroid side effects
• Note: May cause more application site reactions than corticosteroids 3

Phototherapy

• PUVA (Psoralen plus UVA) therapy is highly effective for dyshidrotic eczema
• Results in significant improvement or clearance in 81-86% of patients 1
• Oral PUVA is superior to UVB for hand eczema 1

Third-Line Treatment Options (For Severe/Refractory Cases)

JAK Inhibitors

• Ruxolitinib 1.5% and delgocitinib 0.5% are highly effective topical options 3, 4
• Ranked among the most effective treatments in recent studies 4

Systemic Therapies

For severe, widespread, or refractory cases:

• Biologics (e.g., dupilumab)
• Oral JAK inhibitors (e.g., abrocitinib, baricitinib, upadacitinib)
• Traditional immunomodulators (e.g., cyclosporine, methotrexate) 1

Adjunctive Measures

Skin Care and Prevention

• Apply fragrance-free emollients 3-8 times daily, especially after bathing 1
• Identify and eliminate triggering substances 1
• Consider air purifiers to reduce PM 2.5 exposure 1

Infection Prevention

• For erosive lesions: Antiseptic washes with aqueous chlorhexidine 0.05% 1
• Bleach baths with 0.005% sodium hypochlorite twice weekly can help prevent infections 1
• Treat clinically evident infections with appropriate antibiotics 1

When to Consider Referral

• Diagnostic uncertainty
• Failure to respond to appropriate topical steroids
• Need for second-line or systemic treatments 1

Common Pitfalls to Avoid

• Using mild-potency steroids for moderate-to-severe cases (significantly less effective) 3, 2
• Applying potent steroids more than once daily (no added benefit) 2
• Using potent steroids continuously for more than 4 weeks (increases risk of side effects) 1
• Neglecting moisturization (crucial even when skin appears normal) 1
• Failing to address potential triggers and infection 1