Eczema and Dermatitis: A Comprehensive Approach to Treatment and Itch Relief

Eczema and Dermatitis: What Are They and Why Is Treatment Important?

Eczema and dermatitis are chronic inflammatory skin conditions that affect a significant portion of the population and can substantially impair quality of life. Chronic hand eczema (CHE) is estimated to affect up to 14.5% of the population, leading to missed days at work or school, reduced productivity, and impaired occupational performance [3]. These conditions are characterized by itching, redness, flaking, blistering, and cracking, causing significant discomfort and emotional distress.

Beyond physical symptoms, eczema can have serious health-related quality of life (HRQoL) consequences [4]. The goal of treating eczema and dermatitis is not only to eliminate visible manifestations, but also to restore skin functionality and improve the patient's overall well-being [2].

Diagnosis and Identification of Causes: The Key to Success

Effective treatment of eczema begins with accurate diagnosis and identification of potential causes. It is important to take a detailed medical history, paying special attention to potential exposure to irritants and allergens [2]. During the diagnostic process, a dermatologist may perform the following examinations:

• Allergy testing (patch testing): Considered the standard method for identifying contact allergens [2].
• Differential diagnosis: Especially in elderly individuals, other conditions with similar symptoms, such as scabies, bullous pemphigoid, and mycosis fungoides, must be ruled out [5].
• Analysis of comorbidities: In elderly patients, contact dermatitis may be associated with concomitant conditions (e.g., leg ulcers) or medications (e.g., antihypertensives) [5].

Understanding individual factors that provoke flare-ups allows for the development of a personalized treatment and prevention plan.

Traditional and Modern Approaches to Therapy

For many years, standard treatment for eczema included the use of topical emollients and topical steroids [3]. However, today the therapeutic arsenal has expanded significantly:

• Emollients and moisturizing creams: Form the basis of skin care for eczema, helping to restore the skin barrier and reduce dryness [3, 5].
• Topical corticosteroids: Potent or super-potent topical steroids are often prescribed for patients with moderate symptoms [2, 3]. However, in elderly individuals, their use requires caution due to potential side effects such as skin atrophy, development of diabetes, and hypertension [5].
• Systemic medications: In cases of severe and chronic eczema, systemic agents may be prescribed [3]. These include, for example, low-dose methotrexate, which can be effective, particularly in elderly patients [5].
• Phototherapy: May be recommended in certain cases, especially when other treatments do not yield the desired result [5].

It is important to note that each new treatment method, when necessary, should be considered as an addition to or superimposed upon previous therapy [2].

New Horizons: Innovative Drugs and Mechanisms of Action

Thanks to new therapeutic targets and advances in drug development, it is increasingly possible to manage eczema by targeting its underlying mechanisms [3].

• Delgocitinib cream (JAK inhibitor): This pan-Janus kinase (JAK) inhibitor has demonstrated significant improvements in health-related quality of life in patients with moderate-to-severe chronic hand eczema [4]. Phase IIb and III studies have shown a dose-dependent effect, efficacy, and good tolerability of delgocitinib cream [4, 7].
• Biologics: New biologic drugs are emerging for the treatment of atopic eczema, offering new prospects for patients [6].
• Topical Janus kinase inhibitors: In the near future, patients with hand eczema may benefit from novel therapeutic principles such as topical JAK inhibitors [6].
• Dexyane Med: In one study, the combination of Dexyane Med with topical corticosteroids showed marked improvement in patients with chronic hand eczema and contact eczema [1].

These innovations offer new possibilities for patients suffering from eczema, especially in cases where standard treatments prove insufficient.

Specifics of Treatment for Chronic Hand and Foot Eczema

Chronic hand and foot eczema is a common yet difficult-to-treat condition, often causing dissatisfaction with available therapy options [2]. The primary goal of treatment is the restoration of functionality, while skin clearance is a secondary objective [2].

For moderately severe symptoms (e.g., DLQI ≥ 10), starting with potent or super-potent topical corticosteroids is recommended [2]. The management of chronic hand eczema requires not only diagnostic and therapeutic skills, but also excellent communication skills from the physician, given that it is a multi-etiological disease with a wide spectrum of severity and chronicity [6].

Comprehensive Approach and Patient Support

Managing eczema goes beyond mere pharmacological or physical treatment. It requires a comprehensive approach that includes:

• Elimination or avoidance of causative factors [2].
• Behavioral modification [2].
• Social support [2].
• Early discussion of individual treatment outcomes and goals with patients [2].

Special attention should be paid to elderly individuals, for whom eczema is one of the most frequent reasons for visiting a dermatologist [5]. They may develop new-onset atopic dermatitis, and the role of environmental pollution in these cases is even being discussed [5]. Managing eczema in the elderly is challenging, and while emollients and dermocorticosteroids help, potential side effects of topical corticosteroids in this vulnerable population must be considered [5].

Currently, there is little evidence determining optimal treatment sequences or combinations, highlighting the need for a personalized approach for each patient [2].

References

1. What's new in the treatment of eczemas. PubMed
2. Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. PubMed
3. A Review of Existing and New Treatments for the Management of Hand Eczema. PubMed
4. Effect of Delgocitinib Cream on Health-Related Quality of Life in Patients With Moderate to Severe Chronic Hand Eczema. PubMed
5. Eczema in elderly people. PubMed
6. Hand eczema: treatment. PubMed
7. The pan-JAK inhibitor delgocitinib in a cream formulation demonstrates dose response in chronic hand eczema in a 16-week randomized phase IIb trial. PubMed

The information provided in the article is for reference purposes only and cannot replace an in-person consultation with a qualified medical professional. Self-treatment can be harmful to your health.