From the Research
For lichenified eczema on the dorsal hands in pediatric patients, a potent topical corticosteroid such as mometasone 0.1% ointment is generally recommended, as it has been shown to be effective in treating atopic dermatitis with a low risk of adverse effects 1.
Key Considerations
- Apply a thin layer to affected areas once daily for 7-10 days, then reduce to intermittent use (2-3 times weekly) as the condition improves.
- Ointment formulations are preferred over creams for lichenified skin as they provide better penetration and moisturization.
- For children, it's essential to limit treatment duration to minimize potential side effects such as skin thinning.
- Always apply the medication after bathing when skin is slightly damp, and follow with a thick moisturizer like petroleum jelly or ceramide-containing creams.
- Occlusion (covering with cotton gloves overnight) may enhance effectiveness for stubborn lichenified areas but should be used cautiously and intermittently.
Treatment Approach
- Topical therapy is the first-line treatment for pediatric atopic dermatitis, and providers should work closely with patients and caregivers to promote the success of topical treatments 2.
- If no improvement occurs within 2 weeks, reassessment by a healthcare provider is recommended as stronger steroids may occasionally be needed for short periods under medical supervision.
Important Notes
- The most recent and highest quality study 3 compared alitretinoin and phototherapy as first-line treatments for severe chronic hand eczema, but its findings may not be directly applicable to pediatric patients with lichenified eczema on the dorsal hands.
- However, the study highlights the importance of considering treatment compliance and long-term effects when selecting a therapy for chronic hand eczema.
- In the context of pediatric patients, mometasone 0.1% ointment remains a suitable option due to its efficacy and safety profile, as supported by the study from 1998 1.