From the Guidelines
Oral corticosteroids for severe dishidrotic eczema should be used at a dose of 0.5-1 mg/kg/day (usually 20-60 mg daily) for a short period, typically 1-2 weeks, followed by a gradual taper over another 1-2 weeks to prevent rebound flares, as evidenced by the general principles of corticosteroid use in dermatology 1. The treatment should be short-term due to potential side effects like weight gain, mood changes, increased blood sugar, and bone density loss. Key considerations for oral steroid use in dishidrotic eczema include:
- Starting with a dose of 0.5-1 mg/kg/day, which is a common range for various dermatological conditions, including pemphigus vulgaris, as suggested by the British Association of Dermatologists' guidelines 1
- Limiting the duration of treatment to minimize side effects, with the goal of tapering off the steroids once the condition is under control
- Monitoring patients for side effects, especially those on longer courses or with comorbidities like diabetes or hypertension
- Continuing topical treatments like potent corticosteroid creams and moisturizers while on oral steroids to support skin health and reduce the need for systemic therapy
- Focusing on trigger avoidance and maintenance therapy with topical treatments after completing the steroid course to prevent recurrence. While the provided evidence does not directly address dishidrotic eczema, the principles of corticosteroid use outlined in the guidelines for pemphigus vulgaris 1 can be applied to inform treatment decisions for severe dishidrotic eczema, prioritizing the minimization of morbidity, mortality, and improvement of quality of life.
From the Research
Dyshidrotic Eczema Treatment
- Dyshidrotic eczema is a common cause of palmar dermatitis in adults, characterized by a recurrent vesicular eruption affecting the soles, palms, or both 2.
- The treatment of dyshidrotic eczema may involve the use of topical corticosteroids, which are effective in reducing inflammation and relieving symptoms.
Oral Steroid Dosage
- There is limited evidence on the use of oral steroids for dyshidrotic eczema, but guidelines suggest that systemic corticosteroids should generally be avoided for atopic dermatitis (AD) due to the potential for side effects and the availability of other treatment options 3.
- However, oral steroids may be considered for severe cases of AD or as a bridge to other systemic therapies, under certain circumstances, and for a limited time 3.
- The use of oral steroids for dyshidrotic eczema is not well established, and more research is needed to determine the optimal dosage and treatment duration.
Topical Corticosteroid Treatment
- Topical corticosteroids are a common treatment for eczema, and their effectiveness depends on the potency and frequency of application 4.
- Moderate-potency topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, while potent topical corticosteroids may be more effective than moderate-potency topical corticosteroids 4.
- Applying potent topical corticosteroids once daily is probably as effective as twice daily application in treating eczema flare-ups 4.
Treatment Recommendations
- The management of eczema should involve a stepped approach, with topical therapies used as first-line treatment, and systemic therapies reserved for severe disease 5.
- Topical corticosteroids should be used once daily, and topical calcineurin inhibitors may be useful for sensitive sites 5.
- Oral antihistamines, oral or topical antistaphylococcal treatments, and probiotics are not recommended for treating eczema due to limited evidence of their effectiveness 5.