Systemic Treatment of Hand Eczema
Antihistamines can be used to help itch. Common antihistamines include:
- Sometimes needed if infection develops
- Most infections are caused by staph and so Keflex (Cephalexin) 500mg QID x 7 days is commonly prescribed
Oral corticosteroids (Prednisone)
- May be effective in a short course for recurrent pomphylx and dyshidrotic hand dermatitis.
- Treatment does of 0.5-1mg/kg or 20-40mg prednisone tapered over several weeks can be effective.
- Warning about side effects of prednisone mst always be given.
Cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil are occasionally used for treatment-resistant chronic hand dermatitis. None of these medicines have received regulatory approval to treat hand dermatitis and more research is necessary in order to confirm their safety and effectiveness in treating this condition. Because these agents have the potential to cause significant side-effects, their use must be strictly monitored by a physician and regular laboratory tests are necessary while undergoing therapy.
- Cyclosporine has been reported to be effective in atopic dermatitis, pompholyx, and psoriasis. Its effectiveness has been demonstrated in two small studies in hand dermatitis with a dosage of 3 mg/kg. The use of cyclosporine requires careful monitoring. Serious side-effects include kidney dysfunction, increased blood pressure, and increased risk of infections and various cancers.
- Methotrexate has been reported to improve hand dermatitis in several case reports. Side-effects include nausea, vomiting, and diarrhea. Long-term use can lead to liver cirrhosis, pulmonary fibrosis (lung scarring), and pancytopenia (lowering of all blood cell counts).
- Azathioprine has been reported to improve atopic dermatitis and pompholyx, but there is very limited research studying its benefits for hand dermatitis. Use of this drug requires careful monitoring as it can cause a serious lowering of the white blood cell count.
- Mycophenolate mofetil (MMF) may be considered for use in chronic hand dermatitis when patients do not respond to other therapies. There is concern over MMF's teratogenic potential and long-term use may increase cancer risk.
- 9-cis retinoic acid (alitretinoin) (Toctino®) is a new oral retinoid that is currently approved for use in Europe. Research has demonstrated significant clinical improvement in patients with chronic hand eczema, especially for the variant known as hyperkeratotic dermatitis.
- Side-effects include headache, flushing.
- Strict pregnancy prevention is required 1 month before, during, and for 1 month after treatment with alitretinoin for women of child bearing potential due to the teratogenicity of the product.