Chronic hand eczema needs more than topical steroids | Fall Clinical Derm 2026

Topical corticosteroids remain a reasonable first-line treatment for chronic hand eczema, but they are poorly suited to the long-term control the condition requires, according to Lawrence Eichenfield, M.D., chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego and professor of dermatology and pediatrics at UC San Diego School of Medicine.

Chronic hand eczema is a disease that lasts three months or longer or returns multiple times in a year. It has several causes, including atopic dermatitis, irritant and allergic contact dermatitis, and hyperkeratotic forms that overlap with psoriasis.

“There are these different subsets of hand eczema, which include allergic, irritant, protein contact, and then sometimes hyperkeratotic hand eczema that overlaps with psoriasis,” Eichenfield explained. “While topical steroids can make sense as a first-line agent because they are highly potent, the problem is that the data shows that they’re not especially good for sustained disease control.”

Potent steroids constrict blood vessels, and over time that can thin the skin and weaken its barrier, he explained. Patients often cycle on and off potent steroids to avoid side effects, which leaves the disease inadequately controlled. In one large study he cited, more than 60% of patients with chronic hand eczema were using high-potency steroids.

A recent U.S. guideline statement still lists steroids as an acceptable first-line option but recommends limiting use to about four weeks, Eichenfield said. Patients who respond poorly, or who respond but can’t maintain control, should move to a nonsteroidal treatment.

The side effects add to that burden. Thinner skin loses more water, leaving hands—which are constantly washed and exposed to chemicals at home and at work—more vulnerable. Poorly controlled disease leads to cracks and fissures that can let bacteria in. Some patients develop an allergy to the steroids themselves, and others experience flares when they stop using potent steroids after long periods. These problems often look the same as active eczema, with cracking, scaling and pain, making them hard to tell apart, Eichenfield noted.