Consensus statement on the management of chronic hand eczema

Abstract

The management of chronic hand eczema is often inadequate. There are currently no evidence-based guidelines specifically for the management of chronic hand eczema, and evidence for established treatments for hand eczema is not of sufficient quality to guide clinical practice. This consensus statement, based on a review of published data and clinical practice in both primary and secondary care, is intended to guide the management of chronic hand eczema. It describes the epidemiology and pathogenesis of hand eczema, its diagnosis and its effect on patients' quality of life. Management strategies include a skin education programme, lifestyle changes, and the use of emollients, barriers and soap substitutes. Topical drug therapy includes topical steroids and calcineurin inhibitors. Treatment with psoralen ultraviolet A and systemic therapies may then be appropriate, although there is no strong evidence of efficacy. Alitretinoin has been shown to be effective in a randomized controlled trial, and is currently the only treatment specifically licensed for the treatment of hand eczema. Recommendations for management are summarized in a treatment algorithm.

Successful treatment of refractory chronic hand eczema with calcipotriol/betamethasone ointment: A report of three cases

“…CHE is a common dermatological condition with frequent relapses, occurs possibly as a result of long-term exposure to various irritants and allergens (2,3). Up to 70% of cases of CHE are severe (4), and its treatment has proven to be a considerably difficult task for dermatologists.…”

“…Although its efficacy is limited, it is considered to be relatively safe (3,7). Systemic treatments are indicated for refractory CHE, the majority of which have not been investigated in randomized clinical trials and are therefore prescribed off-label (2,3,8). At present, the only treatments approved are alitretinoin, which may be considered a second-line option as it has shown good response rates in clinical trials and observational studies (9)(10)(11)(12).…”

“…Psoralen plus ultraviolet therapy may be considered as a second-line option when topical corticosteroids are ineffective. Although its efficacy is limited, it is considered to be relatively safe (3,7). Systemic treatments are indicated for refractory CHE, the majority of which have not been investigated in randomized clinical trials and are therefore prescribed off-label (2,3,8).…”

Alitretinoin in treatment of chronic hand eczema – mechanism of action

“…wSKAzAniA terApeutyczne, interAKcje i objAwy niepożądAne Kwas 9-cis-retinowy jest zarejestrowany do doustnego leczenia przewlekłego wyprysku rąk opornego na terapię miejscową [6]. W formie żelu stosuje się go do leczenia miejscowego mięsaka Kaposiego u pacjentów chorych na AIDS (0,1% alitretynoina, nazwa handlowa Panretin ® ) [32].…”

“…Podstawą postępowania jest próba eliminacji przypuszczalnego czynnika wywołującego oraz ochrona skóry przez noszenie odpowiednich rękawic ochronnych. W działaniach profilaktycznych podkreśla się również rolę emolientów i środków barierowych [6,7], natomiast lekami pierwszego rzutu w terapii są niezmiennie zewnętrzne glikokortykosteroidy, najczęściej II i III grupy. Dzięki nim uzyskuje się szybką poprawę stanu skóry i zmniejszenie subiektywnych dolegliwości, jednak ze względu na działania niepożądane, np.…”