What is the treatment for dyshidrotic dermatitis?

Treatment of Dyshidrotic Dermatitis

Topical corticosteroids are the first-line treatment for dyshidrotic dermatitis, with potency selection based on severity and location. 1, 2

First-Line Treatment Options

Topical Corticosteroids

• Use medium to high potency topical corticosteroids for acute flares of dyshidrotic dermatitis 1
• Apply twice daily until symptoms improve, then taper to maintenance therapy 1
• For maintenance, consider intermittent use (twice weekly) to prevent relapses 1
• Choose the least potent preparation that effectively controls symptoms 2
• For severe flares, high potency steroids like betamethasone dipropionate or clobetasol propionate can be effective 1

Emollients and Skin Care

• Apply emollients after bathing to provide a surface lipid film that reduces water loss 2
• Use dispersible creams as soap substitutes, avoiding regular soaps and detergents 2
• Keep nails short to minimize trauma and secondary infection risk 2

Management of Acute Vesicular Phase

For Weeping Lesions

• Potassium permanganate soaks at 1:10,000 concentration for weeping vesicular lesions 3
• Apply particularly for cases with fissures to accelerate wound closure 3
• Use as antiseptic baths or compresses to treat vesicular lesions 3

Second-Line and Refractory Disease Treatment

Topical Calcineurin Inhibitors

• Tacrolimus 0.1% ointment applied once daily to affected areas 1
• Particularly useful for areas where prolonged steroid use is concerning 1

Phototherapy Options

• Oral PUVA therapy has shown significant improvement in 81-86% of patients with hand and foot eczema 2
• Narrowband UVB may be considered, showing a 75% reduction in mean severity scores in some studies 2
• Oral PUVA has been shown to be superior to UVB in prospective controlled studies 2

For Secondary Infection

• For bacterial superinfection, flucloxacillin is usually the most appropriate antibiotic 2
• Use erythromycin when there is resistance to flucloxacillin or in patients with penicillin allergy 2
• For herpes simplex virus infection, administer acyclovir early in the course of disease 2

Management of Triggers and Exacerbating Factors

Avoidance Strategies

• Identify and avoid contact irritants and allergens 2, 4
• Consider patch testing in cases unresponsive to standard treatment 1, 4
• Avoid extremes of temperature and irritant clothing 2

Dietary Considerations

• Consider low-cobalt and/or low-nickel diet in patients with metal hypersensitivity 5
• Dietary restrictions may help reduce flares in selected patients 5

Treatment Algorithm Based on Severity

Mild Cases

• Moisturizers and low to medium potency topical steroids 3, 2
• Avoid triggers and irritants 2

Moderate Cases

• Medium to high potency topical steroids 1
• Add potassium permanganate soaks for weeping vesicles 3
• Consider tacrolimus ointment for steroid-sparing effect 1

Severe or Refractory Cases

• High potency topical steroids for short periods 1, 2
• Consider oral PUVA therapy 2
• For severe pruritus, short-term sedating antihistamines may be useful as adjuvant therapy 2

Important Caveats

• Potent and very high potency topical corticosteroids should be used with caution and for limited periods due to risk of side effects 1, 2
• Combination therapy with antibiotics and steroids has not shown additional benefit compared to steroids alone 1
• Bacteriological swabs are not routinely indicated but may be necessary if patients do not respond to treatment 2