Hand Eczema Treatment Guidelines

Initial Treatment and Maintenance

The British Journal of Dermatology recommends applying a thin layer of topical corticosteroid to affected areas and rubbing in gently, with adjunctive measures such as using soap substitutes and emollients regularly 1, 2
The Journal of the American Academy of Dermatology suggests applying moisturizer after washing hands and before wearing gloves, and considering the "soak and smear" technique: soaking hands in plain water for 20 minutes and immediately applying moisturizer to damp skin nightly for up to 2 weeks 3, 4

The British Journal of Dermatology recommends considering patch testing to identify possible allergic triggers, and evaluating for secondary bacterial infection and treating if present, with referral for second-line treatments such as phototherapy, azathioprine, or cyclosporin for steroid-resistant cases 1, 2

The Journal of the American Academy of Dermatology suggests that not considering potential allergic contact dermatitis as a cause of persistent hand eczema can lead to inadequate treatment, and that using barrier creams alone has questionable value in protecting against irritants 3, 4

The British Medical Journal recommends applying most preparations twice daily 5
For inadequate response to first-line treatment, the American Academy of Dermatology suggests considering stepping up to a potent topical steroid and evaluating for possible allergic contact dermatitis 6
The American Academy of Dermatology recommends a short course (up to 2 weeks) of very potent topical steroid like clobetasol propionate for severe or recalcitrant cases, with consideration of referral for phototherapy or systemic therapy if no improvement 7
The American Academy of Dermatology advises against using occlusive dressings with high-potency steroids and being alert for signs of topical steroid allergy (worsening dermatitis despite treatment) 7

The American Academy of Dermatology recommends applying moisturizer after washing hands and before wearing gloves, and using water-based moisturizers under gloves (oil-based moisturizers can break down latex and rubber) 6
The American Academy of Dermatology suggests considering cotton glove liners or loose plastic gloves for occlusive therapy at night 8