Efficacy

No systematic reviews were found.

Oral therapy with a nickel-chelating compound

In a multicentre, randomised, double-blind, crossover study, oral treatment with triethylenetetramine, 300 mg daily for a 6-week period, or a lactose-containing placebo was given to 23 nickel-positive patients with chronic hand eczema after a 4-week rest period before crossover.36 No significant improvement occurred in hand eczema on the basis of either the patients' or the doctor's evaluation. In a double-blind, placebo-controlled RCT, disulfiram with a gradually increased dose was given for at least 6 weeks after having reached the full dosage of 200 mg.37 Hand eczema was graded according to a semi-quantitative scoring system. During the treatment period, the hand eczema healed in five out of the 11 disulfiram-treated patients, compared with two out of 13 in the placebo group (not significant). Using the semiquantitative scoring system, results in favour of disulfiram were statistically significant for scaling and frequency of flares but not for the sum of parameters. Two open trials without controls found insufficient evidence on the effect of the nickel-chelating compound disulfiram.38,39 In one uncontrolled study, two out of 11 patients with nickel allergy and hand eczema healed and eight improved considerably under the treatment with disulfiram, 200 mg daily for 8 weeks.38 Mild relapses were observed in all patients within 2-16 weeks after discontinuation of treatment. In the other open study, out of 11 nickel-positive patients with chronic dyshidrotic hand eczema aggrevated by oral challenge with nickel, seven patients cleared, improvement was seen in two patients, and in two the dermatitis remained unchanged during the treatment with disulfiram, 200-400 mg daily for 4-10 weeks.39

Low-nickel diet

In a non-randomised trial of 24 patients with dyshidrotic hand eczema caused by nickel, the effects of a low-nickel diet for 3 months (eight patients) were compared with oral disodium cromoglycate for 3 months (nine patients) and with seven patients who did not give consent to the study and who did not receive any treatment.40 All 24 patients were evaluated blind for itching and number of vesicles. The low-nickel diet did not improve these patients, but those treated with disodium cromoglycate improved significantly and had significantly fewer blisters than the controls and the patients treated by diet. In an open, uncontrolled study, 55 out of 90 nickel-sensitive patients who had had a flare of dermatitis after oral challenge with nickel and adhered to the diet for at least 4 weeks improved or cleared.41 Forty of these patients reported a long-term improvement when followed up by questionnaire 1-2 years later.

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