Guidelines for diagnosis, prevention and treatment of hand eczema – short version

Abstract

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest.

Hand eczema: treatment

“…Considering their long history of use, it seems odd that the recent Cochrane review identified only nine studies that evaluated topical corticosteroids as the main intervention. 6 For long-term use, topical glucocorticosteroids with an improved therapeutic index (TIX, ratio between desired effects and especially atrophogenic side effects) should be considered. 4 The present ESCD guidelines recommend topical corticosteroids as first-line treatment in the management of hand eczema, but they point to the fact that as they may be very effective in the short term, they may inhibit epidermal barrier repair and cause skin atrophy, thus interfering with recovery in the long term.…”

“…37 Also in a sequential maintenance therapy study of atopic hand eczema, pimecrolimus 1% cream twice daily was not superior to vehicle. 6 The most valuable advantage of the compounds is their safety over longterm usage, without the induction of atrophy or interference with barrier repair. 6 The most valuable advantage of the compounds is their safety over longterm usage, without the induction of atrophy or interference with barrier repair.…”

Benefit-risk tradeoff preferences for chronic hand eczema treatments

“…Symptoms of hand eczema (HE)/dermatitis include erythema, dryness, fissures, itching, vesicles, papules and hyperkeratosis; the most frequently affected areas are the backs of the hands and fingers (2)(3)(4)(5). Chronic HE (CHE) is defined as eczema that persists for >3 months or recurs !2 times within 12 months, despite sufficient therapy and appropriate patient adherence (3). Epidemiologic data on CHE in the United States are sparse; one survey of self-reported CHE in a managed care organization estimated the prevalence to be 16% (6).…”

“…Management of sCHE is difficult, with few available treatments for patients who become refractory to potent topical corticosteroids (2,3,5,13,18,19). In the United States, there are no agents specifically indicated for treatment of sCHE refractory to potent topical corticosteroids.…”

Prävention der BK 5101

“…Am Anfang und im Vordergrund stehen stets die ambulante dermatologische Diagnostik und Therapie, für deren Qualitätssicherung im Patientenmanagement mittlerweile eine S3-Leitlinie existiert [7]. Ambulante Leistungen umfassen das Angebot von Hautschutzschulungsmaßnahmen, zumeist in Form eines sog.…”