From the Guidelines
For hand eczema maintenance, I recommend hydrocortisone valerate 0.2% ointment applied thinly to affected areas twice daily for 1-2 weeks during flares, then reducing to once daily for another week before transitioning to intermittent use (2-3 times weekly) for maintenance, as this approach balances the need to control symptoms with the risk of side effects like skin thinning 1.
Key Considerations
- Limit continuous use to 2-4 weeks to prevent side effects.
- Apply the ointment after washing hands and follow with a fragrance-free moisturizer 30 minutes later to lock in hydration.
- For maintenance therapy between flares, use the ointment proactively at the first sign of itching or redness, applying it 1-2 times weekly to previously affected areas.
Rationale
This regimen is supported by the understanding that hydrocortisone valerate is a medium-potency corticosteroid effective in reducing inflammation by inhibiting inflammatory mediators and vasoconstriction 1. The ointment formulation provides better occlusion and penetration than creams, making it particularly effective for the thicker skin on hands. It's also important to note that topical corticosteroids, like hydrocortisone valerate, are the mainstay of treatment for atopic eczema and can be used safely if certain precautions are taken, including explaining the benefits and risks to patients and using the least potent preparation required to keep the eczema under control 1.
Important Precautions
- Avoid using this medication on broken or infected skin.
- Consider using cotton gloves at night after application to enhance absorption. Given the more recent and higher quality evidence from 1, which demonstrates the effectiveness of long-term intermittent use of topical corticosteroids in chronic hand eczema, this approach is preferred over continuous use to minimize side effects while maintaining control over symptoms.
From the FDA Drug Label
Hydrocortisone Valerate Cream USP, 0.2% should be applied to the affected area as a thin film two or three times daily depending on the severity of the condition. The recommended treatment for hand eczema maintenance with hydrocortisone valerate ointment is to apply a thin film two or three times daily.
- Key points:
- Apply as a thin film
- Two or three times daily
- Depending on the severity of the condition 2
From the Research
Treatment Options for Hand Eczema
- Topical corticosteroids, such as hydrocortisone valerate ointment, are commonly used to treat hand eczema 3
- The efficacy of topical corticosteroids in maintaining control of hand eczema symptoms is supported by studies, with clobetasol propionate 0.05% foam showing improvement in participant-rated control of symptoms compared to vehicle 3
- However, the optimal frequency of application is unclear, with one study suggesting that once daily application of a strong corticosteroid cream may be superior to twice daily application in diminishing eczema 4
Maintenance Therapy
- Maintenance therapy with a moisturizer, such as a urea-containing moisturizer, may be beneficial in addition to topical corticosteroid treatment 4
- The use of topical calcineurin inhibitors, such as tacrolimus 0.1%, may also be effective in improving investigator-rated symptom control, but the evidence is rated as moderate certainty 3
Comparison of Treatments
- A head-to-head trial comparing topical delgocitinib cream with oral alitretinoin capsules found that delgocitinib cream showed superior efficacy and a more favorable safety profile over 24 weeks 5
- Another study found that alitretinoin 10 mg and 30 mg improved investigator-rated symptom control compared with placebo, but the risk of adverse events, such as headache, increased with alitretinoin 30 mg 3
Future Directions
- New therapeutic principles, such as biologics and topical Janus Kinase inhibitors, may offer benefits for hand eczema patients in the future 6
- Further research is needed to establish the optimal treatment approach for hand eczema, including the use of hydrocortisone valerate ointment for maintenance therapy 7