What are the treatment options for hand dermatitis (eczema)?

From the Guidelines

Treatment for hand dermatitis should prioritize avoiding triggers, moisturizing regularly, and using medications when necessary, with the goal of reducing inflammation, repairing the skin barrier, and preventing further damage to the skin, as recommended by the American Contact Dermatitis Society in 2020 1. To manage hand dermatitis, it is essential to identify and eliminate potential irritants such as harsh soaps, frequent hand washing, or allergens. Using mild, fragrance-free cleansers and applying a thick moisturizer (like petroleum jelly, Cetaphil, CeraVe, or Eucerin) immediately after washing hands and several times throughout the day can help to repair the skin barrier. For mild cases, over-the-counter 1% hydrocortisone cream can be applied twice daily for up to two weeks, as suggested by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. More severe cases may require prescription-strength topical corticosteroids like triamcinolone 0.1% or fluocinonide 0.05% applied twice daily for 1-2 weeks. For chronic or resistant cases, a dermatologist may prescribe calcineurin inhibitors (tacrolimus or pimecrolimus) or PDE4 inhibitors (crisaborole), and severe flares may require oral corticosteroids like prednisone (typically 20-40mg daily for 5-7 days) or other immunosuppressants, as recommended by the American Contact Dermatitis Society in 2020 1. Some key points to consider in the treatment of hand dermatitis include:

• Identifying and avoiding allergens and irritants
• Using mild, fragrance-free cleansers and moisturizers
• Applying topical corticosteroids or other medications as prescribed by a dermatologist
• Wearing cotton-lined gloves during wet work and cotton gloves at night after applying moisturizer to enhance treatment effectiveness
• Considering patch testing for individuals with suspected allergic contact dermatitis, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Hand Dermatitis Treatment Options

• Initial treatment should be aimed at controlling inflammation and restoring the skin's natural barrier 2
• Common management recommendations include the avoidance of irritants and potential allergens along with the use of emollients and topical corticosteroids to decrease inflammation 2
• Simple petroleum-based emollients are very effective at restoring hydration and repairing the stratum corneum 2

Emollient Therapy

• Topically applied lipids may interfere with skin barrier function, and emollients containing skin-related lipids have been suggested to facilitate repair of the skin barrier 3
• The frequent use of emollients may be useful in the therapy of hand dermatitis, but the superiority of emollients containing skin-related lipids over traditional emollients is still lacking 3
• A study comparing an emollient containing skin-related lipids with a petrolatum-based emollient found no significant differences in the improvement of clinical signs, itching, and patients' assessment of efficacy 3

Stepwise Approach to Therapy

• A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others 4
• First-line therapy for atopic hand dermatitis should be a combination of emollients and topical corticosteroids; possible alternatives include topical calcineurin inhibitors or coal tar 5

Alternative Therapies

• The use of a healing ointment with anti-inflammatory ingredients could be alternatively efficacious for treatment of chronic hand eczema to prevent complications from the long-term application of steroids 6
• A study found that a petrolatum and panthenol ointment was effective in improving clinical signs and reducing transepidermal water loss in patients with mild-to-moderate chronic hand eczema 6