From the Guidelines
Dishidrotic eczema treatment should prioritize a combination of topical corticosteroids, moisturizers, and trigger avoidance, with consideration of phototherapy and systemic therapies for severe cases, as recommended by the most recent guidelines 1. When managing dishidrotic eczema, it's essential to consider the following key points:
- Topical corticosteroids are a mainstay of treatment, but their use should be guided by the principle of using the least potent preparation required to keep the eczema under control 1.
- Moisturizers play a crucial role in restoring the skin barrier function, and fragrance-free options like CeraVe or Vanicream should be applied frequently, especially after handwashing.
- Trigger avoidance is vital, and patients should be advised to avoid irritating soaps, frequent water exposure, stress, and nickel-containing items.
- For severe or persistent cases, high-potency steroids like clobetasol 0.05% ointment or oral antihistamines like cetirizine 10mg daily may be necessary, and wet wraps can provide relief by applying moisturizer and covering with damp cotton gloves.
- In cases where infection develops, medical attention is necessary, and antibiotics may be prescribed.
- For severe cases unresponsive to these treatments, a dermatologist might consider oral steroids, phototherapy, or immunosuppressants like tacrolimus ointment, as outlined in the most recent guidelines 1. It's also important to note that the management of atopic eczema, which includes dishidrotic eczema, involves a comprehensive approach that includes explanation, education, and the use of emollients, as emphasized in earlier guidelines 1. However, the most recent guidelines 1 provide the most up-to-date recommendations for the management of atopic dermatitis, including the use of phototherapy and systemic therapies.
From the Research
Treatment Options for Dyshidrotic Eczema
- Topical corticosteroids are a common treatment for dyshidrotic eczema, with high-potency corticosteroids such as clobetasol propionate being effective for limited-course treatment of inflammatory and pruritic manifestations of moderate-to-severe corticosteroid-responsive dermatoses 2, 3
- Clobetasol propionate exerts anti-inflammatory, immunosuppressive, and antimitotic effects, influencing the growth, differentiation, and function of various cells and inhibiting cytokine production 2
- An emollient added to a steroid can help restore the normal moisturizing process of the skin, which may be particularly important in soothing the discomfort of dry skin conditions often encountered in moderate-to-severe dermatoses 3
- Dyshidrotic eczema is often difficult to manage, and current treatment options are being reviewed to provide extra attention to therapeutic considerations 4
- Topical corticosteroids can work safely and effectively in patients with dyshidrotic eczema, and correct patient application is critical to successful use 5
Application and Usage
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 5
- Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 5
- Patients may be taught application using the fingertip unit method, where one fingertip unit is the amount of medication dispensed from the tip of the index finger to the crease of the distal interphalangeal joint and covers approximately 2% body surface area on an adult 5