From the Guidelines
Dyshidrotic eczema can be effectively treated with topical corticosteroids, moisturizers, and trigger avoidance, rather than relying on PUVA therapy due to its limited efficacy shown in studies 1. When considering treatment options, it's essential to prioritize approaches that have demonstrated significant benefits in reducing morbidity, mortality, and improving quality of life. For dyshidrotic eczema, the evidence suggests that topical corticosteroids and moisturizers are effective first-line treatments.
Key Treatment Components
- Topical corticosteroids: Medium to high potency, such as triamcinolone 0.1% cream or clobetasol 0.05% ointment, applied to affected areas for limited durations.
- Moisturizers: Frequent application of fragrance-free moisturizers like CeraVe or Vanicream, especially after handwashing.
- Trigger avoidance: Avoiding known triggers including nickel, cobalt, fragranced products, and excessive hand washing.
Additional Considerations
- Soaking hands in cool water with colloidal oatmeal can provide relief, followed immediately by moisturizer application.
- For persistent cases, consider tacrolimus 0.1% ointment as a steroid-sparing agent.
- Oral antihistamines like cetirizine 10mg daily can help manage itching.
- Monitoring for signs of infection, such as increased pain, warmth, or yellow discharge, is crucial, as antibiotics may be needed in such cases. The approach to treating dyshidrotic eczema should focus on reducing inflammation, restoring the skin barrier, and managing symptoms, rather than solely relying on PUVA therapy, which has shown mixed results in terms of efficacy 1.
From the Research
Treatment Options for Dyshidrotic Eczema
- Localized narrowband UVB phototherapy and paint-PUVA are effective treatments for chronic hand eczema of dry and dyshidrotic types, with no significant difference in clinical response between the two treatment modalities 2
- Localized high-dose UVA1 irradiation is an effective and safe treatment for vesicular dyshidrotic eczema, with similar efficacy to cream PUVA 3
- Topical corticosteroids, such as clobetasol propionate, can be effective in treating dyshidrotic eczema, but their use should be limited to a maximum of 2 weeks due to the risk of side effects 4, 5
- Oral interventions, such as alitretinoin, can also be effective in controlling symptoms of dyshidrotic eczema, but their use should be evaluated carefully due to potential side effects 5
Comparison of Treatment Options
- A comparison of localized narrowband UVB phototherapy and paint-PUVA found no significant difference in clinical response between the two treatment modalities 2
- A comparison of localized high-dose UVA1 irradiation and cream PUVA found similar efficacy between the two treatments 3
- A review of interventions for hand eczema found that topical corticosteroids and UV phototherapy were two of the major standard treatments, but evidence is insufficient to support one specific treatment over another 5
Considerations for Treatment
- The risk of developing corticosteroids' side-effects depends on the potency of the product, extended period of use, and the volume of product applied 4
- The use of topical corticosteroids should be limited to a maximum of 2 weeks due to the risk of side effects 4, 5
- Oral interventions, such as alitretinoin, can have potential side effects, such as headache, and their use should be evaluated carefully 5