Implications for clinical practice

The choice for an optimal topical steroid treatment schedule cannot be derived from the current literature on hand eczema trials. Evidence from studies on other eczematous diseases may have to be considered.

In adults with chronic hand eczema, are oral immunosuppressive agents (ciclosporin, methotrexate, mycophenolate mofetil) better in maintaining a long-term (more than 6 months) reduction of patient- and doctor-rated scores than topical corticosteroids?

Two RCTs were identified, one of which showed that ciclosporin was effective, but not better than topical corticosteroids in terms of clinical signs.6 The other RCT, studying the same patients, also showed no comparative advantage of ciclosporin over topical steroids in terms of quality of life.7

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