Canadian Guidelines for the Management of Hand Eczema

Dr. Guenther

At the 2010 Dermatology Update meeting held in Vancouver BC, November  4-7, 2010, Dr. Guenther presented the new Canadian guidelines for the management of hand eczema. This is the first time Canada has had guidelines for this very common, often difficult to treat condition. Dr. Guenther was a member of the expert panel who developed the guidelines and an author of the guidelines that were recently published in the Journal of Cutaneous Medicine and Surgery. Prevention through avoidance of irritants, allergens and prolonged exposure to water and wearing gloves is important. Frequent application of moisturizers can help restore the skin barrier, decrease itching and decrease the number of flares. Topical steroids are usually the first line of therapy. The strength of the steroid depends on the severity of the disease. Topical steroids are safe in the short-term or intermittently long-term. Although phototherapy may be used for hand eczema that does not improve with topical steroids, it is not widely available. A new vitamin A derivative, alitretinoin (Toctino®) recently became available to treat refractory hand eczema. Dr. Guenther participated in some of the clinical trials that led to approval of this compound.  This medication should be taken once daily with food for a 12-24 week treatment course. After a treatment course, almost half of patients are clear or almost clear and many of these patients do not relapse after treatment is discontinued.