Treatment of Dyshidrosis Eczema with Topical Corticosteroids
Selection of Topical Corticosteroid Potency
- For mild dyshidrotic eczema, use mild-potency topical corticosteroids first 1
- For severe or recalcitrant dyshidrotic eczema, potent topical corticosteroids may be necessary but should be used for limited periods only 2, 1
Application Method
- Do not apply more frequently than recommended as this doesn't improve efficacy but increases risk of side effects 1
Duration of Treatment
- Use topical corticosteroids for short courses to control flares 2
- Very potent and potent categories should be used with caution for limited periods only 2
Monitoring and Side Effects
- Risk of pituitary-adrenal axis suppression exists with extensive use, particularly in children 1
- Monitor for signs of skin atrophy, telangiectasia, or striae 1
Adjunctive Therapies
- Emollients should be used regularly as they provide a surface lipid film which retards evaporative water loss 1
- For severe pruritus, sedating antihistamines may be useful as a short-term adjuvant during relapses 3
- Non-sedating antihistamines have little to no value in treating dyshidrotic eczema 3
- For cases with secondary bacterial infection, flucloxacillin is usually the most appropriate antibiotic 2
Treatment-Resistant Cases
- Referral to a dermatologist if not responding to first-line management 1
- PUVA (psoralen plus ultraviolet A) therapy may be considered for severe, treatment-resistant cases, though evidence from randomized controlled trials has not consistently demonstrated efficacy 4