In the near future, hand eczema patients may benefit from new therapeutic principles such as biologics for the treatment of atopic eczema and topical Janus Kinase inhibitors. Most patients with hand eczema can be managed with a combination of skin protective measures and topical treatments. Outpatient and inpatient measures]. 2010 Aug 31;10:8. doi: 10.1186/1471-5945-10-8. Considering that the hands are human ‘tools’ in many professions, behavioural aspects have to be considered in the management of the disease more than it may be the case with other skin diseases. Soak your hands in lukewarm water for 5-10 minutes and then pat them dry. New therapeutic principles such as biologics and topical Janus Kinase inhibitors may be available for the management of hand eczema patients in the near future. Atopic dermatitis and psoriasis: two different immune diseases or one spectrum? This review discusses the spectrum of therapeutic options for hand eczema, the evidence for their efficacy and safety, and proposes a stepwise approach of intensity of treatment depending on disease severity and chronicity. As for cyclosporine, an increased risk for skin cancer under long‐term use and UV protection should be considered. In contrast to alitretinoin, acitretin is not approved for the treatment of hand eczema, but efficacy in the management of patients with hyperkeratotic hand eczema has been reported. Treatment is focused on protecting your hands from further damage and from an infection. Hand dermatitis is also called hand eczema. Topical therapies should consider the appropriate choice of vehicles, suitable pharmaceutical vehicle depending on the condition of the skin and the acuteness of the eczema.20 Generally, the principles ‘moist on moist’ and ‘greasy on dry’ propose to use hydrating vehicles on acute lesions of hand eczema and lipid‐rich vehicles on chronic ones. [Ultraviolet therapy in patients with chronic hand eczema]. However, sulfonated shale oil preparations seem to have a better safety profile45 and have been proven to be efficacious in mild‐to‐moderate atopic eczema in children46; thus, they might be tried for topical therapy of hand dermatitis, although no studies on their efficacy and safety in hand dermatitis are available. L23. Once you know what’s causing the hand eczema, treatment can bring relief. Seven patients showed a satisfactory response at the 3‐month assessment, but 17 of 30 patients discontinued treatment, 15 of those because of adverse effects. Overall tolerability was good. Hand dermatitis often has unique causes, commonly job-related and can require specific testing and treatments. was study investigator and/or consultant for Leo, Novartis, Pfizer and Perre Fabre and received speaker's honoraria from Galderma, Leo, Novartis, Pierre Fabre and Sanofi. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Although topical corticosteroids are the mainstay of treatment, few studies of their rational use, efficacy and side-effects have been conducted. As stated in the ESCD guidelines,6 the diagnosis of hand dermatitis requires a thorough workup including a detailed patient history, signs and symptoms, evaluation of atopy, e.g. Especially in irritant hand eczema, application of topical glucocorticosteroids has been subject to debate, with some authors reporting no benefit29, 30 denied by others.31 Since no specific therapies exist to enhance epidermal barrier recovery, especially the ultrapotent topical corticosteroids inhibiting epidermal lipid synthesis32 should be avoided in irritant dermatitis. A study of inter‐ and intraobserver reliability, Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis, The Quality of Life in Hand Eczema Questionnaire (QOLHEQ): validation of the German version of a new disease‐specific measure of quality of life for patients with hand eczema, S2k guidelines for the use of topical preparations on the skin, Positionspapier: diagnostik und therapie der xerosis cutis, Preventive and therapeutic effects of a moisturizer. Secondary bacterial infection may require an oral antibiotic, usually flucloxacillin. They should be … A dermatologist may recommend 1 of the following treatments: phototherapy – controlled exposure to ultraviolet (UV) light steroid tablets or very strong steroid cream immunosuppressant creams or ointments, such as pimecrolimus or tacrolimus A single‐blind placebo‐controlled study, Open‐label exploratory study of acitretin for the treatment of severe chronic hand dermatitis, Cyclosporin in the treatment of patients with atopic eczema – a systematic review and meta‐analysis, Comparison of cyclosporine and topical betamethasone‐17,21‐dipropionate in the treatment of severe chronic hand eczema, Off‐label use of azathioprine in dermatology: a systematic review, Azathioprine and allopurinol: a two‐edged interaction, Outcome of treatment with azathioprine in severe atopic dermatitis: a 5‐year retrospective study of adult outpatients, Azathioprine treatment and drug survival in patients with chronic hand eczema – results from daily practice, Safety and efficacy of methotrexate in psoriasis: a meta‐analysis of published trials, Methotrexate versus acitretin in the treatment of chronic hand dermatitis, Experience with low‐dose methotrexate for the treatment of eczema in the elderly, Drug survival of methotrexate treatment in hand eczema patients: results from a retrospective daily practice study, Understanding the immune landscape in atopic dermatitis: the era of biologics and emerging therapeutic approaches, Dupilumab treatment of very severe refractory atopic hand eczema, A retrospective review of dupilumab for hand dermatitis, Effect of dupilumab on hand eczema in patients with atopic dermatitis: an observational study, JAK inhibitors for atopic dermatitis: an update, Janus kinase inhibitors: a review of their emerging applications in dermatology, Pharmacological properties of JTE‐052: a novel potent JAK inhibitor that suppresses various inflammatory responses in vitro and in vivo, Efficacy and safety of topical delgocitinib in patients with chronic hand eczema: data from a randomised, double‐blind, vehicle‐controlled Phase 2a study, CARPE: a registry project of the German Dermatological Society (DDG) for the characterization and care of chronic hand eczema, Chronic hand eczema: a prospective analysis of the Swiss CARPE registry focusing on factors associated with clinical and quality of life improvement, Characteristics and provision of care in patients with chronic hand eczema: updated data from the CARPE registry, Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project, The effectiveness of integrated care for patients with hand eczema: results of a randomized, controlled trial, Canadian hand dermatitis management guidelines, Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema. USA.gov. But finding the cause is essential to get relief. Lavender essential oil is an eczema treatment proven to help reduce these common symptoms that can help heal dry skin. Over-the-counter (OTC) hydrocortisone cream can temporarily relieve redness and itching. Finally, in chronic hyperkeratotic hand eczema, keratolytic, anti‐proliferative and moisturizing effects are needed with keratolytic ointments (containing salicylic acid up to 20% if necessary, urea 10–20%) and lipid‐rich ointments, including water‐in‐oil and oil‐in‐water emulsions, to be used.24 The efficacy and safety of topical base preparations in the management of hand eczema should be studied using the same stringent criteria as for specific pharmacological therapies; unfortunately, only few preparations are evaluated in studies and registered as medical devices.25 Basic topical therapy may be underestimated by patients and physicians as ‘bland’ and without active ingredients.1 The result of such an attitude may be a reduced adherence, application that is inadequate or in insufficient quantity, ultimately compromising treatment.26 This underscores the need of patient education interventions in the management of hand eczema.27 Base therapy should be continued even after the visible signs of hand eczema have subsided, because the epidermal barrier damage will take longer to be restored. contact to allergens or irritants, these have to be avoided first which may require preventive measures or absence from work. Consistently with the marketing approval, the ESCD guidelines recommend the use of alitretinoin for treating severe, chronic hand eczema that does not respond, or responds inadequately, to topical corticosteroids.6 As all retinoids, however, alitretinoin is teratogenic which limits its use in women of child‐bearing age. The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Alitretinoin is more effective than placebo in controlling symptoms, but advantages over other treatments need evaluating. Bath-PUVA treatment, UVB and Grenz rays can also suppress hand eczema. Thus, dupilumab seems to have a potential to control hand eczema in a significant proportion of patients with concomitant atopic dermatitis, but further studies are needed to assess its use in patients with other aetiologies of hand eczema. If you know the cause of your eczema, it is important that you avoid exposure as soon as possible. Methotrexate has been widely used in dermatology for the treatment of psoriasis and psoriasis arthritis where its efficacy is well established.67 The evidence for its use in hand eczema is limited. In subacute hand eczema, basic topical therapy should have anti‐inflammatory, antipruritic and moisturizing effects; this may be achieved by moisturizing water‐in‐oil and oil‐in‐water emulsions. Take a comfortably warm bath. You need to shut down the underlying inflammation by applying high potency steroids along with thick moisturizers (ie., ointment or balm). If you suspect that you have some form of eczema, see a doctor to get your condition diagnosed and treated. . These self-care habits can help you manage dermatitis and feel better: 1. Treatments for severe hand eczema that has not responded effectively to emollients and potent topical steroids include phototherapy and the drug treatment alitretinoin (Toctino). Botulinum toxin has been used with success in the treatment of dyshidrotic hand eczema. As you can see from Mark’s story, finding the cause often takes time, detective work, and expertise. Similar efficacy was reported in a later study (HANDEL) from the United States.54 Data from real‐world clinical use are consistent with those from clinical trials.55-57 According to the Cochrane review,4 alitretinoin 30 mg achieved investigator‐rated control in 432 compared with 157 participants per 1000 with placebo. Learn about our remote access options, Department of Dermatology, University Hospital Jena, Jena, Germany, Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. To help your hands heal, your dermatologist may also include a moisturizer, barrier repair cream, or cortisone cream in your treatment plan. The aroma can help facilitate sleep, when itching is often at its worst. Moisturizers usually contain more water than oil, and when the water evaporates it can dry out the skin. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. It is common and can affect about one in every 20 people. Comparison of oral psoralen-UV-A with a portable tanning unit at home vs hospital-administered bath psoralen-UV-A in patients with chronic hand eczema: an open-label randomized controlled trial of efficacy. Hand eczema is a socially significant disease because of its high prevalence, morbidity and the associated lost working time due to sick leave.1 Clinically, it is a heterogenous condition under the aspects of aetiology, clinical manifestations and acuteness. In some cases, a diluted bleach bath may help your hand eczema calm down by decreasing eczema-exacerbating bacteria on your skin, according to the Mayo Clinic. The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema. The primary efficacy parameter was physician global assessment of overall CHE severity, with response defined as clear or almost clear hands. 2019 Apr 26;4(4):CD004055. This site needs JavaScript to work properly. 1. A period of four to six weeks should involve 3–4 radiation sessions. For over 50 years, topical corticosteroids have been the mainstay of the topical treatment of hand eczema. Protection of the hands is very important for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Treatment of hyperkeratotic dermatitis of the palms (eczema keratoticum) with oral acitretin. Irrespective of the cause, continued contact with irritant substances will make any hand or foot eczema worse. A double‐blind RCT, The US FDA ‘black box’ warning for topical calcineurin inhibitors: an ongoing controversy, Topical vitamin D3 derivatives in treating hyperkeratotic palmoplantar eczema: a report of five patients, Successful treatment of refractory chronic hand eczema with calcipotriol/betamethasone ointment: a report of three cases, Calcipotriol ointment shows comparable efficacy to topical steroids in chronic hand eczema, Highly increased urinary 1‐hydroxypyrene excretion rate in patients with atopic dermatitis treated with topical coal tar, Coal tar, pine tar and sulfonated shale oil preparations: comparative activity, efficacy and safety, Efficacy and tolerability of pale sulfonated shale oil cream 4% in the treatment of mild to moderate atopic eczema in children: a multicentre, randomized vehicle‐controlled trial, Treatment of severe recalcitrant dermatoses of the palms and soles with PUVA‐bath versus PUVA‐cream therapy, Narrowband UVB and cream psoralen‐UVA combination therapy for plaque‐type psoriasis, Comparison of oral psoralen‐UV‐A with a portable tanning unit at home vs hospital‐administered bath psoralen‐UV‐A in patients with chronic hand eczema: an open‐label randomized controlled trial of efficacy, Chronic hand eczema in Germany: 5‐year follow‐up data from the CARPE registry, Efficacy and safety of oral alitretinoin (9‐cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double‐blind, placebo‐controlled, multicentre trial, A phase 3, randomized, double‐blind, placebo‐controlled study evaluating the efficacy and safety of alitretinoin (BAL4079) in the treatment of severe chronic hand eczema refractory to potent topical corticosteroid therapy, Efficacy and tolerability of alitretinoin for chronic hand eczema under daily practice conditions: results of the TOCCATA open study comprising 680 patients, Impact on quality of life of alitretinoin in severe chronic hand eczema: FUGETTA real‐world study, Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real‐world observational study, Ultraviolet therapy in patients with chronic hand eczema, Veien NK. Results: Eighty-one patients with hand eczema were included in the study. 12. Endogenous cofactors such as hyperhidrosis need to be considered in the treatment planning.13 If exogenous factors are present, e.g. Hand eczema is a common skin disease that tends to become chronic and may interfere with many types of work. 3. According to the Cochrane review, local combination ultraviolet light therapy (PUVA) may lead to improvement in investigator‐rated symptom control when compared to local narrow‐band UVB after 12 weeks of treatment.4 Due to the side effects of systemic psoralen application, especially nausea and the need for full body UV protection and specific sunglasses, some clinics have abandoned systemic PUVA and use bath or cream PUVA treatment in hand eczema instead. Management of chronic hand and foot eczema. You should also consider consulting with a dermatologist to make sure you’re using the most appropriate treatment methods. orcid.org/https://orcid.org/0000-0001-7696-3274, orcid.org/https://orcid.org/0000-0002-7543-8299, I have read and accept the Wiley Online Library Terms and Conditions of Use, Hand dermatitis: a review of clinical features, prevention and treatment, Hand eczema classification: a cross‐sectional, multicentre study of the aetiology and morphology of hand eczema, Hand eczema: epidemiology, prognosis and prevention, Guidelines for diagnosis, prevention and treatment of hand eczema, Guidelines for diagnosis, prevention and treatment of hand eczema–short version, Recent epidemiological and genetic studies in atopic dermatitis, Acrokeratosis paraneoplastica (Bazex syndrome) – a systematic review on risk factors, diagnosis, prognosis and management, Immune response patterns in non‐communicable inflammatory skin diseases, Atopic dermatitis endotypes and implications for targeted therapeutics. Significantly more patients receiving delgocitinib (45.7%) compared with vehicle (14.9%) {odds ratio 4.89 [95% confidence interval (CI) 1.49–16.09]; P = 0.009} achieved treatment success (PGA 0–1).79 The mean HECSI score at Week 8 was significantly lower with delgocitinib (13.0) compared with vehicle (25.8) [adjusted mean difference −12.88 (95% CI −21.47 to −4.30); P = 0.003].79 The incidence of adverse events was similar with delgocitinib and vehicle; none led to discontinuation of delgocitinib.79 A phase 3 study with the compound may be expected. You may have eczema if you notice any of the following symptoms on your hands or fingers: Redness Itching Pain Extreme dryness Cracks Blisters Treatment options for hand eczema depending on disease severity and chronicity (based on probable efficacy, not strength of evidence). The efficacy of topical timolol for the treatment of recalcitrant fissures and erosions in patients with chronic hand eczema was supported in a short communication published in the Journal of the American Academy of Dermatology.. A dermatologist at a skin clinic in Nashik, India, Manoj Pawar, MD, described the use of topical timolol in a 45-year-old man with chronic persistent hand eczema. The treatment of xerosis cutis is a mainstay in the early forms of atopic and irritant hand dermatitis.21 Basic topical therapy helps to reduce inflammation and itching, has corticosteroid‐sparing effects and promotes epidermal barrier recovery. Moisturize your skin. Number of times cited according to CrossRef: Therapy of Allergic and Irritant Contact Dermatitis. 2012 Nov 8;367(19):1829-37. doi: 10.1056/NEJMcp1104084. Ultraviolet light is sometimes used to treat extreme eczema. 2009 May 7;151(19):35-7. Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. It is helpful to see your doctor, who may refer you to a dermatologist. Patients are prospectively assessed by dermatological examination and patient questionnaire, and socio‐economic data and data on diagnostics, skin status, severity and treatment of chronic hand eczema and atopy criteria are repeatedly evaluated. Moisturisers (emollients)are an essential part of treating hand dermatitis. Treatment includes avoid what’s causing the hand eczema. 2. Please enable it to take advantage of the complete set of features! Clearly, further studies are necessary including more patients and differentiating better between hand eczema and psoriasis. However, not all dermatologists or dermatology clinics offer this form of therapy, and it involves extended periods of treatment for the patient. The more water there is in a lotion or moisturizer, the more likely it is to worsen your hand eczema. Worsening of the dermatitis occurred in two patients (7%). Schempp CM, Müller H, Czech W, Schöpf E, Simon JC. While topical tar preparations have been used widely in the treatment of recalcitrant hand dermatitis in the past, no clinical studies exist proving their efficacy and safety in this condition according to modern evidence‐based criteria.  |  While you are being treated for your hand eczema, protecting your hands will make the treatment more effective. Wet dressings are an effective method to treat severe eczema and often reduce symptoms in several hours to days. ‐19 pandemic Responses, defined as clear or almost clear, were achieved in up to 48% of patients treated with alitretinoin, compared with 17% for placebo (P < 0.001), with up to 75% median reduction in disease signs and symptoms. TA was study investigator and/or consultant for Leo Pharma, Sanofi, Pfizer and Lilly and received speaker's honoraria from Sanofi. Treatment of chronic palmoplantar eczema with local bath-PUVA therapy. emollients or moisturizers, is a key component in the treatment of any kinds of eczema. Be sure to read the label to determine which moisturizer has the least amount of water. A psoralen is given before the ultraviolet light. Similar results were shown for participant‐rated control (high‐certainty evidence). Photodermatol Photoimmunol Photomed. Emollients have been shown to be useful in reducing eczema activity and in the primary prevention of hand eczema. This can occur acutely but may also be a condition referred to as chronic hand eczema (CHE) or chronic hand dermatitis (CHD). Do topical corticosteroids modulate skin irritation in human beings? Over 12 weeks, her hand eczema improved from ‘very severe’ and a hand eczema severity index (HECSI) score of 244 (of 360) to ‘almost clear’ with a HECSI score of 11.73, In a retrospective chart review, the outcome of 38 dupilumab‐treated patients with hand dermatitis was evaluated.74 From the publication, it is unclear if these were only patients with atopic dermatitis, or if also other aetiologies were included. The general safety precautions with methotrexate therapy should be observed, such as monitoring the serum liver enzymes and complete blood count, as well as the cumulative dosage; a weekly dose of 30 mg should not be exceeded.1 The ESCD guidelines mention the lack of evidence for the efficacy of methotrexate for the treatment of hand eczema, but since this treatment has been used over the years, it may be considered if first‐ and second‐line therapy has been insufficient or contraindicated.6, Atopic dermatitis is an inflammatory, pruritic, chronic or chronically relapsing skin disease characterized by persistent itch, erythema and lichenification. COVID-19 is an emerging, rapidly evolving situation. This may mean taking time off work for engineers, cooks, hairdressers and others. Currently, data on only one register on patients with chronic hand eczema are available (CARPE80 and a Swiss “sister‐registry”81). Arch Dermatol. Add 10 drops to 1 tablespoon of coconut oil or almond oil, and gently rub into the skin. Unterlassene Notfallbehandlung eines akuten allergischen Kontaktekzems. In older patients, the important differential diagnosis of acrokeratosis paraneoplastica (Bazex syndrome) should not be overlooked.8 Specific treatment should only be started if a consolidated diagnosis has been reached. Eczema on the hands and fingers is a common condition. Their long‐term or frequent use is not indicated in hand eczema due to their well‐known side effects such as osteoporosis, osteonecrosis, glaucoma, cataracts, hypothalamic‐pituitary‐adrenal axis suppression, hyperglycaemia, hypertension and immunosuppression.50 Nevertheless, according to German registry data, a significant percentage of patients with chronic hand eczema seem to be treated with systemic corticosteroids in contrast to current guidelines.51, Alitretinoin is an endogenous vitamin A derivative which binds with high affinity in a saturable manner to all 6 known retinoid receptors (RAR‐α, RAR‐β, RAR‐γ, RXR‐α, RXR‐β and RXR‐γ).52 It is the only approved systemic treatment licensed specifically for hand eczema. Severity of hand eczema, compliance to treatment, patients' information level, adherence to preventive behaviours, and the protective behaviour score were evaluated at baseline, and at the 4th and 8th week. 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