Controlled trials dating back to 1977 were located by searching the Cochrane Library, Medline, Embase, Pascal and Jicst-Eplus. In addition, a hand-search was performed on any trial (including uncontrolled trials but excluding single case reports) in major English, German, French, Italian and Dutch dermatology journals.
Because of the tendency of hand eczema to develop a chronic or relapsing course, all questions below deal with chronic hand eczema. In the context of this chapter, chronicity can arbitrarily be defined as more than 6 months' duration. Because prescription topical corticosteroids are the most common treatment at present, they are the major comparator in the questions below.
In adults with chronic hand eczema, do topical corticosteroids lead to better patient-and doctor-rated reduction in symptom scores than topical coal tar preparations?
No systematic review was found, and no trial (controlled or uncontrolled) could be identified. Trials may be detected in older (pre-1977) literature.
In adults with chronic hand eczema, do short bursts of potent topical corticosteroids (class 3 or 4) lead to better patient- and doctor-rated scores than continuous mild (class 1 or 2) topical steroids?
We found no studies comparing the effect of short bursts of strong (class 3 or 4) topical steroids (for example twice weekly, or weekends only) with continuous application of milder (class
1 or 2) topical steroids. One randomised controlled trial (RCT) compared three-times-weekly application versus weekend application of the same steroid, with limited evidence that the three-times-weekly application was better.
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