What is the first line of treatment for winter hand dermatitis?

First-Line Treatment for Winter Hand Dermatitis

The first-line treatment for winter hand dermatitis consists of immediate and frequent moisturizer application combined with gentle hand hygiene practices using lukewarm water and mild soaps, followed by topical corticosteroids for active inflammation. 1, 2

Immediate Moisturization Strategy

Apply moisturizer immediately after every hand washing using two fingertip units to adequately cover both hands. 1, 2

• Use moisturizers packaged in tubes rather than jars to prevent contamination 1, 2
• Keep pocket-sized moisturizers available for frequent reapplication throughout the day 1, 2
• At night, apply moisturizer followed by cotton or loose plastic gloves to create an occlusive barrier that enhances penetration 1, 2
• For severe dryness, use the "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks 1, 2

Proper Hand Hygiene Practices

Wash hands with lukewarm or cool water (never hot water) and soap for at least 20 seconds, as hot water damages the skin barrier through lipid fluidization. 1, 2

• Select soaps or synthetic detergents without allergenic surfactants, preservatives, fragrances, or dyes 1, 2
• Choose products with added moisturizers to minimize irritation 1, 2
• Pat dry hands gently rather than rubbing to avoid friction damage 1, 2
• Avoid washing hands with dish detergent or other harsh irritants 1, 2

Topical Anti-Inflammatory Treatment

Apply topical corticosteroids to treat active inflammation when conservative measures with moisturizers alone are insufficient. 1, 2, 3

• Clobetasol propionate 0.05% foam probably improves symptom control compared to vehicle when assessed after 15 days of treatment (RR 2.32,95% CI 1.38 to 3.91; NNTB 3) 4
• For maintenance after achieving remission, mometasone furoate cream used thrice weekly may provide better control than twice weekly application 4
• Be cautious of potential steroid-induced skin barrier damage with prolonged use 1, 2
• Topical calcineurin inhibitors (tacrolimus 0.1%) are an alternative that probably improves investigator-rated symptom control compared to vehicle 4

Identify and Avoid Triggers

Identify and eliminate irritants that are particularly problematic in winter, including excessive hand washing, hot water exposure, and harsh detergents. 1, 2

• Avoid very hot or very cold water during hand washing 1, 2
• Do not use disinfectant wipes to clean hands 1, 2
• Avoid applying gloves when hands are still wet from washing or sanitizer, as this traps irritants 1, 2
• For alcohol-based hand sanitizers, use products with at least 60% alcohol and added moisturizers, but do not wash hands with soap immediately before or after using them 1, 2

Common Pitfalls to Avoid

Several practices worsen winter hand dermatitis and must be avoided:

• Using very hot water for hand washing, which increases skin permeability through lipid disruption 1, 2
• Rubbing hands dry instead of patting 1, 2
• Increased duration of glove occlusion without underlying moisturizer application 1, 2
• Washing hands with soap immediately before or after using alcohol-based sanitizer, which is unnecessary and increases dermatitis risk 1, 2

When to Escalate Treatment

Consider dermatology referral and advanced therapies if hand dermatitis does not improve after 6 weeks of first-line treatment. 2

• Second-line options include phototherapy (PUVA or narrow-band UVB), stronger topical steroids, or systemic therapies 2, 4, 3
• For recalcitrant cases, systemic options include oral cyclosporin (3 mg/kg/d), which probably improves symptom control compared to topical betamethasone 4
• Alitretinoin (10-30 mg) improves both investigator-rated and participant-rated symptom control compared to placebo (high-certainty evidence), though headache risk increases with the 30 mg dose 4
• Consider patch testing if allergic contact dermatitis is suspected, particularly if there is a change in baseline dermatitis or recalcitrant disease 1, 2