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Hand eczema can present with frequent outbreaks or just be a persistent chronic problem and difficult to shift. For the patient this can be a major handicap impacting on family life, work, hobbies, sleep and social activities.
Hand eczema can be part of more widespread eczema elsewhere on the skin, or just localised to the hands and sometimes just the hands and feet.
Most cases of hand eczema are caused by atopic/endogenous eczema. This starts as eczema as a young child in the skin creases which may naturally settle after a few years or return in adult life – often on the face and hands. An inherited poor skin barrier function and an abnormal immune response underpin this life-long condition.
Hand eczema can also be caused by coming into skin contact with irritant chemicals or contact allergens.
Allergy patch testing with a Dermatologist can help identify contact allergens that drive some cases of hand eczema. Identifying and avoiding contact allergens or contact irritants can allow some hand eczemas to settle and resolve completely.
Some cases of hand eczema are a mixture of all three causative factors (atopic, irritant and allergy). So even when avoiding known allergens and irritants, the hand eczema may still come and go or persist.
Emollients and potent topical steroids are the primary treatment for hand eczema. Persistent or more severe types can be treated with courses of PUVA phototherapy in a hospital setting or with tablets. Tablet treatments may cause side-effects and most require on-going blood test monitoring and regular review by a Dermatologist.
Delgocitinib cream is a new pan-JAK inhibitor recently licenced in the UK and Europe for the treatment of hand eczema that has not responded to potent topical steroids. Clinical trials show that up to 70% of patients see their hand eczema substantially improves over a 12-week period and 30% see their hand eczema return to normal skin. It is expected that most patients will need to use this cream now and again to prevent the eczema returning.
Delgocitinib cream is available on private prescription from a Dermatologist and is awaiting NICE approval for NHS hospital prescribing.
For patients that are concerned about tablet treatments or where tablet treatment may be unwise, then this cream offers a safer alternative where potent topical steroids have been unhelpful.
Not all scaly, red itchy skin conditions of the hand are eczema. Dermatologists are well placed to make the correct diagnosis and advice on the correct treatment. Dermatology advice on how to mange eczema, including identifying and avoiding contact irritants and undergoing investigations such as contact allergy patch testing as well, are all still important aspects of managing this sometimes debilitation condition.
It is expected that 1 to 3 tubes per year would be needed to effectively control chronic persistent hand eczema.
*This excludes consultation costs and contact allergy patch testing costs, if recommended by your Dermatologist.
