Implications for clinical practice

The treatment seems harmless, but is not proven to be effective.

In adults with hyperkeratotic hand eczema, does dithranol lead to an improvement in patient- and doctor-rated sign scores, and longer remission periods upon clearance, when compared with topical corticosteroids?

No systematic review was found, and no trial (controlled or uncontrolled) of dithranol for any type of hand eczema could be identified. Trials may be detected in older (pre-1977) literature.

In adults with relapsing vesicular hand eczema based on contact allergy to nickel, does dietary intervention or oral therapy with chelating agents lead to an improvement in patient- and doctor-rated sign scores, when compared with topical corticosteroids?

In adults with dyshidrotic hand eczema, does iontophoresis lead to an improvement of patient- and doctor-rated scores compared with topical steroids or UVB/PUVA irradiation?

We identified six trials: two RCTs, one CCT and three open studies. All studies were small, performed in nickel-sensitive patients with hand eczema. Four studies used a nickel-chelating compound and two a low-nickel diet. None of the studies compared the intervention with topical corticosteroids. One multicentre RCT on triethylenetetramine found no significant improvement of hand eczema. The other RCT on disulfiram (tetraethylthiuramdisulphide) found only very limited evidence in favour of this treatment. One controlled trial found no evidence that a low-nickel diet improves dyshidrotic hand eczema.

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