Interventions for hand eczema.

Area of Science:

• Dermatology
• Evidence-based medicine
• Systematic review and meta-analysis

Background:

• Hand eczema is a chronic, relapsing skin condition causing itch, social stigma, and employment issues.
• Numerous treatments exist, but their effectiveness for hand eczema remains largely unproven.
• This review aims to assess interventions for adult and pediatric hand eczema.

Purpose of the Study:

• To evaluate the efficacy and safety of topical and systemic treatments for hand eczema.
• To synthesize evidence from randomized controlled trials (RCTs) to inform clinical practice.

Main Methods:

• Searched multiple databases up to April 2018 for relevant RCTs.
• Included RCTs comparing any intervention for hand eczema against placebo, vehicle, or active treatments.
• Primary outcomes included symptom control (participant- and investigator-rated) and adverse events.

Main Results:

• Sixty RCTs involving 5469 participants were included; most studies were short-term and had high heterogeneity.
• Alitretinoin demonstrated high-certainty evidence of effectiveness compared to placebo for symptom control.
• Evidence for topical corticosteroids and phototherapy was insufficient to support superiority, and topical calcineurin inhibitors showed uncertain effects.

Conclusions:

• Alitretinoin is effective for hand eczema, but comparative effectiveness against other treatments requires further evaluation.
• Current evidence for topical corticosteroids and phototherapy is limited, necessitating cautious interpretation.
• High-quality, long-term, head-to-head studies are needed, alongside standardized definitions and outcome measures for hand eczema.