Hand Eczema: Treatment Options

Abstract

Hand eczema is a common disease, it affects young people, is often work-related, and the burden of the disease is significant for the individual as well as for society. Factors to be considered when choosing a treatment strategy are, among others, whether the eczema is acute or chronic, the severity of the disease, and the specific sub-diagnosis of hand eczema, which relates to the etiology as well as the morphology of the disease. Optimal treatment is still a challenge. This review seeks to provide an overview of the most updated treatment of hand eczema. Treatment options comprise patient education with information on hand eczema prevention and basic treatment and for patients with allergic contact dermatitis also with information about allergen avoidance. Topical treatment is primarily topical topical corticosteroids, which is—and has been for many years—first-line treatment for hand eczema, to be used for a limited period of time. Topical calcineurin inhibitors are widely used as off-label treatment for hand eczema; however, evidence for efficacy is sparse. Physical treatment with UVB and PUVA is effective, although time-consuming and sometimes too troublesome for the patients. With respect to systemic therapy, this is reserved for a patient with severe and long-lasting hand eczema. Alitretinoin is the only systemic therapy, which is licensed for severe chronic hand eczema, while other systemic therapies are also effective, but off-label use. Systemic treatment will in most cases be prescribed from 4 months and up to several years, and should always be accompanied by regular blood sample check. topical corticosteroids are the mainstay primary choice of medical treatment, but should not be continued on a daily basis for more than 8 weeks. Second-line treatment comprises topical calcineurin inhibitors, phototherapy, and systemic treatment.