Key points

• In general, there is a lack of evidence of comparative advantage for the three most established treatment modalities for hand eczema - topical corticosteroids, topical coal tar and PUVA/UVB.

• Although widely prescribed, there is a lack of evidence of a steroid-sparing effect of emollients.

• There is insufficient clinical evidence for a choice between short bursts of potent topical steroids versus continuous application of mild steroids.

• PUVA and UVB are effective, but there is no evidence of a clinical advantage of one modality over the other.

• There is insufficient evidence for effectiveness of currently marketed retinoids.

• There is insufficient evidence for a comparative advantage of radiotherapy (x rays).

• There is insufficient evidence for oral immunosuppressants as maintenance therapy.

• There is insufficient evidence for low-nickel diet or chelating agents in hand eczema accompanied by nickel allergy.

• Of all the trials that were identified, very few conform to modern quality criteria for an RCT.

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