What is the best cortisone (corticosteroid) cream for treating hand eczema (atopic dermatitis)?

Best Cortisone Cream for Hand Eczema

For hand eczema treatment, a medium-potency topical corticosteroid such as 0.1% triamcinolone acetonide is recommended as the first-line treatment option due to its superior efficacy compared to other agents. 1, 2

Treatment Algorithm

First-Line Treatment:

• Apply a medium-potency topical corticosteroid (0.1% triamcinolone acetonide) twice daily for up to 4 weeks 1
• Use the least potent corticosteroid preparation required to keep dermatitis under control 3
• Apply a thin layer of the corticosteroid to affected areas and rub in gently 4
• Allow the corticosteroid to absorb for a few minutes before applying moisturizer 3

Proper Application Technique:

• Clean and gently dry the affected area before applying any treatments 3
• Apply topical corticosteroid before barrier creams/moisturizers for optimal effectiveness 3
• Follow with moisturizer application to help restore skin barrier function 5, 4
• Consider the "soak and smear" technique: soak hands in plain water for 20 minutes and immediately apply moisturizer to damp skin nightly for up to 2 weeks 5, 4

Adjunctive Measures:

• Use soap substitutes instead of regular soaps 4
• Apply moisturizer after washing hands and before wearing gloves 5, 4
• For nighttime treatment, apply moisturizer followed by cotton or loose plastic gloves to create an occlusive barrier 5, 3
• Avoid moisturizers in jars to prevent contamination; use tube-packaged products instead 5

Evidence Comparison

Topical Corticosteroid Efficacy:

• 0.1% triamcinolone acetonide has demonstrated superior efficacy compared to alternative treatments like fumaric acid 5% cream in reducing excoriation, population, lichenification, and pruritus in hand eczema 2
• Triamcinolone 0.1% cream was shown to significantly reduce Hand Eczema Severity Index (HECSI) scores, itching, dryness, burning sensation, and erythema in a recent 2024 study 1
• Betamethasone valerate 0.1% may be more effective than pimecrolimus for participants' global assessment, but has greater potential for side effects with long-term use 6

Alternative Options:

• Pimecrolimus is less effective than moderate and potent corticosteroids for treating eczema 6
• Healing ointment with anti-inflammatory ingredients could be an alternative for mild-to-moderate chronic hand eczema to prevent complications from long-term steroid application 7
• Topical tacrolimus may be considered where topical steroids are unsuitable or ineffective 5

Special Considerations and Pitfalls

Cautions with Topical Corticosteroids:

• Do not apply topical steroids more than twice daily, as more frequent application does not improve efficacy but increases risk of side effects 5, 3
• Avoid using topical steroids under occlusion without underlying moisturizer application 3
• For recalcitrant cases, consider patch testing to identify possible allergic triggers 4
• Potent and very potent corticosteroids should be used with caution for limited periods only 5

For Persistent Hand Eczema:

• Consider referral for patch testing if hand eczema is persistent or not responding to first-line treatment 5, 4
• For severe chronic hand eczema that doesn't respond to topical treatments, consider alitretinoin 5
• PUVA therapy may be considered for treating chronic hand eczema 5
• Evaluate for secondary bacterial infection and treat if present (typically with flucloxacillin for S. aureus) 5