Treatment of Hand and Foot Eczema with Topical Corticosteroids and Emollients

First-Line Topical Corticosteroid Strategy

The American Academy of Dermatology recommends applying potent topical corticosteroids, such as clobetasol propionate 0.05% or mometasone furoate, twice daily to hands and feet, as these areas have thicker skin that tolerates higher potency steroids better than facial or flexural areas 1
After achieving clearance, consider proactive maintenance therapy with topical corticosteroids applied twice weekly to previously affected sites to prevent relapse 2

Apply emollients liberally and frequently throughout the day, immediately after hand washing and bathing, to provide a surface lipid film that retards water loss 1, 2
Continue aggressive emollient use even when eczema appears controlled, as this is the cornerstone of maintenance therapy 1, 2
Use soap-free cleansers exclusively and avoid hot water, as these remove natural skin lipids and aggravate hand eczema 2

Sedating antihistamines, such as diphenhydramine, can be prescribed exclusively at nighttime to help patients sleep through severe itching episodes, as their benefit comes from sedation, not direct anti-pruritic effects 1, 2
Non-sedating antihistamines have no value in eczema and should not be used 1

Watch for increased crusting, weeping, or pustules, which indicate secondary bacterial infection with Staphylococcus aureus 1, 2
Add oral flucloxacillin as first-line antibiotic while continuing topical corticosteroids, and do not delay or withhold corticosteroids when infection is present 1, 2

For hand and foot eczema failing topical therapy, oral PUVA (psoralen plus UVA) is superior to UVB phototherapy, with 81-86% of patients achieving significant improvement or clearance 3
Local PUVA may be more effective than narrow-band UVB for hand eczema, though adverse events (mainly erythema) occur more frequently with UVB 3

The hands and feet tolerate higher potency steroids better than thin-skinned areas due to thicker stratum corneum 1
Systemic corticosteroids should only be used for acute severe flares requiring rapid control after exhausting all other options, never for maintenance treatment 1

Failure to respond to potent topical corticosteroids after 4 weeks warrants referral for consideration of systemic therapy 1, 2
Need for phototherapy or systemic immunosuppressive therapy requires specialist management 1