The goal of treatments for hand eczema is to reduce the inflammation and symptoms such as swelling, skin flaking, redness and itching. Treatment of hand eczema proceeds in a step-wise fashion: avoidance of irritants, use of topical corticosteroids and lubrication, and use of cyclosporine in severe cases. The method used to treat eczema on your hands will depend on the severity of the episode and your responsiveness to previous treatments.
Identification and Avoidance
It is necessary to identify the irritants that can cause hand eczema. Exposure to water and allergens are associated with eczema of the hands. Chemicals such as soap and detergents and industrial/environmental substances may cause eczema of the hands. Be sure to tell your doctor which chemicals and irritants you expose your hands to at work and at home. If your doctor suspects allergy to chemical irritants, which causes eczema with hand swelling and blister-like lesions, she should evaluate you for occupational and environmental allergens by patch testing.
Then take steps to avoid the irritants that can cause hand eczema. Avoid contact with water by reducing the frequency of exposure to water through hand washing and reducing exposure to soaps and detergents and other irritants. If exposure to chemicals and water is unavoidable, use vinyl gloves to protect the hands. Use cotton-lined gloves or "beauty gloves" for the most protection.
Topical Corticosteroids and Moisturizers
In hand eczema, topical corticosteroids are a main treatment. Your doctor may prescribe medium to high-potency topical corticosteroids twice daily. For more severe eczema, your doctor may use wet dressings soaked in Burrow's solution followed by super potent corticosteroids. Burrow's solution is mixture of aluminum acetate in water. At night, use the steroid cream with cotton-lined gloves.
Moisturizers are recommended as part of hand eczema treatment. Avoid traditional cream moisturizers, however, and opt for a greasy moisturizer such as petroleum jelly. Wrapping the hands in plastic and loosely securing the plastic with tape will help to increase the absorption of the topical corticosteroid into the skin. This is called occlusion.
Your doctor may prescribe topical tar hand soaks with Balnetar oil twice a day, followed by topical corticosteroid.
If you need immediate control of a severe episode of eczema, your doctor may consider systemic corticosteroids.
Topical Psoralen and Ultraviolent A
If your eczema is a chronic case and is unresponsive to other treatments, you should be referred to a dermatologist. At the dermatologist's office, you may receive topical psoralen and ultraviolet A treatment and/or Grenz ray therapy. Once you receive treatment either orally or topically with psoralen, you will then be exposed to ultraviolet A light. UV A light increases the skin's sensitivity to psoralen, which in turn reduces the abnormal growth of skin. This procedure is done two to three times per week for a variable length of time. Grenz rays are similar to ultraviolet light in that they have a low penetration. Treatments are administered once a week or once every 2 weeks for three or four sessions.
Oral Immunosuppressants
If your eczema remains unresponsive and disabling, your doctor may consider using low doses of oral immunosuppressants such as methotrexate or cyclosporine. These types of drugs are the last line of treatment and are used long-term for severe hand eczema. Side effects of methotrexate include gastrointestinal symptoms such as nausea, vomiting and diarrhea. Cyclosporine can cause other cancers, renal failure and increased chance of infection. These drugs must be used under the supervision of a physician.
References
- Skin Disease: Diagnosis and Treatment, Thomas P. Habif, M. D. 2005
- National Eczema Association: Hand Eczema
