What is the recommended treatment for dyshidrosis eczema using steroid cream?

Treatment of Dyshidrosis Eczema with Topical Corticosteroids

Topical corticosteroids are the mainstay of treatment for dyshidrotic eczema and should be used at the lowest effective potency to control symptoms, with moderate-potency preparations like triamcinolone acetonide being appropriate for most cases of dyshidrosis. 1, 2

Selection of Topical Corticosteroid Potency

• For mild dyshidrotic eczema, use mild-potency topical corticosteroids first 1
• For moderate dyshidrotic eczema, moderate-potency topical corticosteroids (such as triamcinolone acetonide) are recommended as they provide significantly better treatment success compared to mild preparations 3
• For severe or recalcitrant dyshidrotic eczema, potent topical corticosteroids may be necessary but should be used for limited periods only 1
• Very potent topical corticosteroids should be reserved for severe cases that don't respond to potent preparations, with caution due to increased risk of side effects 3

Application Method

• Apply topical corticosteroids as a thin film to affected areas 2
• Once-daily application of potent topical corticosteroids is as effective as twice-daily application for treating flares 3
• For moderate-potency preparations like triamcinolone, application 2-3 times daily is standard depending on severity 2
• Do not apply more frequently than recommended as this doesn't improve efficacy but increases risk of side effects 1

Duration of Treatment

• Use topical corticosteroids for short courses to control flares 1
• Very potent and potent categories should be used with caution for limited periods only 1
• For chronic dyshidrotic eczema, consider weekend therapy (proactive approach) with topical corticosteroids to prevent relapses after initial control is achieved 3

Monitoring and Side Effects

• The main risk of topical corticosteroids is skin thinning, which occurs more frequently with higher potency preparations 3
• Risk of pituitary-adrenal axis suppression exists with extensive use, particularly in children 1
• Monitor for signs of skin atrophy, telangiectasia, or striae 1
• If infection develops, discontinue occlusive dressings if used and institute appropriate antimicrobial therapy 2

Adjunctive Therapies

• Emollients should be used regularly as they provide a surface lipid film which retards evaporative water loss 1, 4
• For severe pruritus, sedating antihistamines may be useful as a short-term adjuvant during relapses 1
• Non-sedating antihistamines have little to no value in treating dyshidrotic eczema 1
• For cases with secondary bacterial infection, flucloxacillin is usually the most appropriate antibiotic 1

Treatment-Resistant Cases

• For recalcitrant dyshidrotic eczema, consider:
  • Topical calcineurin inhibitors (tacrolimus) as rotational therapy with corticosteroids 5
  • Tar preparations, though compliance may be limited 4
  • Referral to a dermatologist if not responding to first-line management 1
• PUVA (psoralen plus ultraviolet A) therapy may be considered for severe, treatment-resistant cases, though evidence from randomized controlled trials has not consistently demonstrated efficacy 1

Special Considerations

• Avoid soap and detergents as they remove natural lipids from the skin surface 1
• Use dispersible cream as a soap substitute to cleanse the skin 1
• Keep nails short to minimize damage from scratching 1
• For hand eczema, occupational factors should be considered and appropriate protective measures implemented 6