Treatment of Dyshidrotic Eczema on Hands During Second Trimester of Pregnancy

First-Line Approach: Skin Barrier Protection and Topical Therapy

Avoid all irritants, including harsh soaps, detergents, frequent hand washing with hot water, and disinfectant wipes, to prevent skin barrier damage in pregnant women with dyshidrotic eczema 1
Use lukewarm or cool water for hand washing rather than hot water to prevent further skin barrier damage in pregnant women with dyshidrotic eczema 1
Pat hands dry gently rather than rubbing to minimize trauma to vesicular lesions in pregnant women with dyshidrotic eczema 1
Choose fragrance-free, dye-free cleansers without allergenic surfactants or preservatives for pregnant women with dyshidrotic eczema 1
Apply moisturizer immediately after every hand washing using two fingertip units for adequate coverage in pregnant women with dyshidrotic eczema 1
Use fragrance-free moisturizers containing petrolatum or mineral oil, which are most effective and least allergenic for pregnant women with dyshidrotic eczema 1
Implement the "soak and smear" technique nightly: soak hands in plain water for 20 minutes, then immediately apply thick moisturizer to damp skin for up to 2 weeks in pregnant women with dyshidrotic eczema 1
Reapply moisturizer frequently throughout the day using pocket-sized tubes to prevent contamination in pregnant women with dyshidrotic eczema 1
Limit prolonged use of topical corticosteroids to avoid steroid-induced skin barrier damage, but do not hesitate to use them for active flares in pregnant women with dyshidrotic eczema 1

Prednisolone is 90% inactivated by the placenta, making topical and systemic corticosteroids relatively safe during the second trimester of pregnancy for women with dyshidrotic eczema 2

Use cotton glove liners under protective gloves if occupational exposure is unavoidable for pregnant women with dyshidrotic eczema 1
Choose accelerator-free gloves (neoprene or nitrile) if glove-related allergic contact dermatitis is suspected in pregnant women with dyshidrotic eczema 1
Apply water-based moisturizers under gloves (oil-based products can break down latex and rubber) for pregnant women with dyshidrotic eczema 1
Never apply gloves when hands are still wet from washing or sanitizer for pregnant women with dyshidrotic eczema 1

Do not use superglue to seal fissures or vesicles in pregnant women with dyshidrotic eczema 1
Avoid washing hands with dish detergent or other known irritants for pregnant women with dyshidrotic eczema 1
Do not increase glove occlusion duration without underlying moisturizer application for pregnant women with dyshidrotic eczema 1
Avoid betamethasone and dexamethasone systemically if corticosteroids are needed, as these are far less inactivated by the placenta compared to prednisolone for pregnant women with dyshidrotic eczema 2

Refer immediately if no improvement after 6 weeks of conservative treatment for pregnant women with dyshidrotic eczema 1
Refer for patch testing if allergic contact dermatitis is suspected in pregnant women with dyshidrotic eczema 1
Refer for consideration of phototherapy or systemic therapy in recalcitrant cases of dyshidrotic eczema in pregnant women 1
Refer if there is any change in the baseline pattern of the dermatitis in pregnant women with dyshidrotic eczema 1

Azathioprine may be considered if already being used prior to pregnancy, though risks of teratogenicity exist (albeit low) for pregnant women with dyshidrotic eczema 2
Systemic corticosteroids (prednisolone) can be used if needed, as there is no significant increased risk of stillbirth, preterm delivery, or congenital malformations, though intrauterine growth retardation has been linked to their use for pregnant women with dyshidrotic eczema 2
Avoid methotrexate, mycophenolate mofetil, cyclophosphamide, and JAK inhibitors due to known fetal risks for pregnant women with dyshidrotic eczema 2