What are the topical treatments for hand dermatitis (eczema)?

From the Guidelines

Topical treatments for hand dermatitis include the application of a topical steroid, such as hydrocortisone 1%, as a first-line therapy, with the consideration of potential topical steroid-induced damage to the skin barrier 1. When managing hand dermatitis, it is essential to identify and avoid irritants, and the use of barrier creams or regular moisturizers may be helpful in preventing further irritation.

• Key considerations in the treatment of hand dermatitis include:
  • Avoiding irritants and switching to less-irritating products
  • Using barrier creams or regular moisturizers to prevent further irritation
  • Applying topical steroids, such as hydrocortisone 1%, as a first-line therapy
  • Considering potential topical steroid-induced damage to the skin barrier
  • Seeking a dermatology consultation for recalcitrant cases, where phototherapy, systemic therapy, or occupational modification may be necessary 1. The most recent and highest quality study, published in 2020, emphasizes the importance of awareness of the irritating nature of wet work and exposure to surfactants and detergents in the management of hand dermatitis 1.
• Additional treatment options may include:
  • Topical antibiotics, such as mupirocin 2%, for infected eczema
  • Coal tar preparations to reduce inflammation in chronic cases
  • Wet wrap therapy using moisturizer under cotton gloves overnight for severe cases However, these options are not explicitly mentioned in the most recent study, and therefore, the primary recommendation is to follow the guidelines outlined in the 2020 study 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 in a class of medicines called topical calcineurin inhibitors Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between.

Topical treatment for hand dermatitis (eczema) is pimecrolimus cream 1% (ELIDEL Cream), a topical calcineurin inhibitor, used for short periods with breaks in between as needed 2.

From the Research

Topical Treatments for Hand Dermatitis (Eczema)

• Topical corticosteroids, such as clobetasol propionate and flupredniden acetate, are commonly used to treat hand eczema 3, 4
• Emollients have been shown to be useful in reducing eczema activity and in the primary prevention of hand eczema 5
• A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects 5
• Petrolatum and panthenol ointment has been shown to be effective in treating mild-to-moderate chronic hand eczema, with fewer side effects compared to traditional topical corticosteroids 6
• Other topical agents, such as delgocitinib, retapamulin, halometasone/triclosan, calcipotriol/betamethasone, tacrolimus, and pimecrolimus, have demonstrated varying degrees of clinical efficacy in treating hand eczema 7

Specific Topical Treatments

• Clobetasol propionate: a strong potency topical corticosteroid that has been shown to be effective in treating hand eczema, with a mean time to healing of 11 days 4
• Flupredniden acetate: a medium potency topical corticosteroid that has been shown to be effective in treating hand eczema, although less so than clobetasol propionate 4
• 0.1% triamcinolone acetonide in 10% urea cream: a topical corticosteroid that has been shown to be effective in treating mild-to-moderate chronic hand eczema, although with more side effects compared to petrolatum and panthenol ointment 6