key: cord-309195-0scmephx
authors: Blicharz, Leszek; Czuwara, Joanna; Samochocki, Zbigniew; Goldust, Mohamad; Chrostowska, Sylwia; Olszewska, Małgorzata; Rudnicka, Lidia
title: Hand eczema ‐ a growing dermatological concern during the COVID‐19 pandemic and possible treatments
date: 2020-05-08
journal: Dermatol Ther
DOI: 10.1111/dth.13545
sha: 
doc_id: 309195
cord_uid: 0scmephx

nan

Hand eczema (HE) is a relapsing and chronic condition of a heterogenous etiology. Irritant contact dermatitis is the most frequent cause, followed by atopic dermatitis, allergic contact dermatitis and other forms of eczematous disorders. In many patients several of these entities overlap, which creates diagnostic and therapeutic challenges. 3 Regardless of HE etiology, exposure to detergents and soaps, frequent hand washing (>20 times/day) and the use of occlusive gloves are all well-known risk factors of disease onset This article is protected by copyright. All rights reserved. and/or exacerbation. 3, 4 The necessity to use these measures during the COVID-19 pandemic may increase the frequency of HE.

HE may be an occupational disease. In developed societies, it is most frequently diagnosed in the workers of the healthcare, cleaning services, farming, and industry sectors. 5 It can be speculated that the relative prevalence of occupational HE will rise in healthcare professionals, while it is likely to remain similar in farming and slightly decrease in the workers of other sectors due to workplace restrictions. In view of the above, we believe that primary prevention of HE should be intensively promoted during the COVID-19 pandemic. Evidence-based interventions include using moisturizers in combination with barrier creams and constant education on skin protection. 4 In case of active HE, a detailed history must always be taken, and additional examination such as patch skin testing or atopy score should be considered to identify underlying contact allergy or atopic dermatitis. 6 The treatment of HE varies based on the severity of symptoms and disease phase (acute, chronic), with emollients and moisturizers being the baseline. Topical steroids such as clobetasol propionate and mometasone furoate are usually the first-choice anti-inflammatory agents, though they may interfere with the skin barrier regeneration and thus their long-term This article is protected by copyright. All rights reserved.

use must be closely monitored. Topical calcineurin inhibitors, i.e. tacrolimus and pimecrolimus, are deprived of these side-effects and are recommended in patients who are likely to require prolonged treatment. In the case of HE refractory to topical corticosteroids, PUVA-therapy may be introduced. 6 Lastly, systemic agents should be considered in severe cases refractory to topical treatment.

Therapeutic options include short courses of systemic steroids during disease exacerbations, oral retinoids, e.g. alitretinoin, acitretin, and immunosuppressants such as methotrexate, azathioprine, and cyclosporine A. 6 Despite the lack of evidence on the increased risk of severe COVID-19 in immunocompromised patients, 7, 8 we believe that the first-line systemic treatment should involve oral retinoids followed by immunosuppressants in recalcitrant cases.

However, because of the insignificant possibility of deteriorating the outcome of COVID-19 and good effect in most cases, topical therapy should be preferred in HE.

This article is protected by copyright. All rights reserved.

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