Treatment of Dyshidrotic Eczema

First-Line Treatment

The British Medical Journal recommends applying topical corticosteroids to affected areas twice daily for acute flares, using the least potent preparation required to control symptoms 1, 2
The British Medical Journal suggests using moisturizers (emollients) at least once daily to the whole body, preferably oil-in-water creams or ointments rather than alcohol-containing lotions, to help manage dry skin 3
Keeping nails short is recommended to prevent secondary infection from scratching, as advised by the British Medical Journal 2
The British Medical Journal advises using dispersible cream as a soap substitute for cleansing to prevent further drying of the skin 2
Avoiding irritant clothing such as wool and wearing cotton clothing instead is recommended by the British Medical Journal 2

For severe itching, the British Medical Journal considers oral antihistamines with sedative properties (such as diphenhydramine or clemastine) as short-term adjuvant therapy, particularly for sleep disturbance 1, 2
The British Medical Journal states that non-sedating antihistamines have little value in controlling pruritus associated with dyshidrotic eczema 2
Applying emollients after bathing is recommended by the British Medical Journal for maximum effectiveness in managing dry skin 2
Topical polidocanol cream can help relieve itching, as suggested by the Annals of Oncology 3

For secondary bacterial infection, the British Medical Journal recommends using appropriate antibiotics such as flucloxacillin for Staphylococcus aureus, which is the most common pathogen 1, 2
For herpes simplex infection (eczema herpeticum), the British Medical Journal advises administering oral acyclovir early in the course of disease; use intravenous acyclovir for ill, febrile patients 1, 2

The British Medical Journal suggests considering ichthammol (1% in zinc ointment) or coal tar preparations for recalcitrant cases, which can be particularly useful for lichenified eczema 2

For severe, refractory cases, the British Journal of Dermatology recommends considering oral PUVA therapy, which has shown significant improvement or clearance in 81-86% of patients with hand and foot eczema 5, 6
The British Journal of Dermatology states that topical PUVA has shown mixed results, with some uncontrolled studies reporting improvement but comparative studies showing less convincing efficacy 5, 6
Systemic corticosteroids have a limited but definite role for severe cases, but should not be used for maintenance treatment, as advised by the British Medical Journal 1

Most patients will respond well to first-line management and do not require referral to a specialist, according to the British Medical Journal 1
The British Medical Journal recommends considering referral to a dermatologist if there is failure to respond to treatment, development of contact dermatitis, or need for second-line therapies 1