Cochrane · systematic review · CD004055
Interventions for hand eczema
Christoffers, WA, Coenraads, PJ, Svensson, Å, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SkinAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
34
current version
GRADE rated
26
No studies
8
Included studies
NR
No studies 8 · 23.5%Ungraded 0 · 0%Very low 0 · 0%Low 2 · 5.9%Moderate 19 · 55.9%High 5 · 14.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Corticosteroid creams/ointments: clobetasol propionate foam compared to vehicle foam for hand eczema
Population: participants with moderate to severe hand eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms Corticosteroid creams/ointments: clobetasol propionate foam vs vehicle foam | RR 1.43 [0.86, 2.4] | 1 study · 125 participants | Moderate Downgraded: imprecision |
Primary: participants with self‐rated good/excellent control of symptoms Corticosteroid creams/ointments: clobetasol propionate foam vs vehicle foam | RR 2.32 [1.38, 3.91] | 1 study · 125 participants | Moderate Downgraded: imprecision |
Primary: adverse events ‐ at least 1 adverse event Corticosteroid creams/ointments: clobetasol propionate foam vs vehicle foam | RR 2.24 [0.82, 6.06] | 1 study · 125 participants | Moderate Downgraded: imprecision |
Primary: adverse events ‐ any adverse event treatment‐related (application site pruritus) Corticosteroid creams/ointments: clobetasol propionate foam vs vehicle foam | RR 1.02 [0.06, 15.89] | 1 study · 125 participants | Moderate Downgraded: imprecision |
Secondary: reduction in severity, participant‐rated scoring Corticosteroid creams/ointments: clobetasol propionate foam vs vehicle foam | RR 1.57 [1.21, 2.04] | 1 study · 125 participants | Moderate Downgraded: imprecision |
Secondary: reduction in severity, investigator‐rated scoring ‐ improvement at least 2 grades Corticosteroid creams/ointments: clobetasol propionate foam vs vehicle foam | RR 1.47 [0.9, 2.39] | 1 study · 125 participants | Moderate Downgraded: imprecision |
Corticosteroid creams/ointments: mometasone furoate cream 3 times/week versus 2 times/week for hand eczema
Population: people (all patch‐tested) with hand eczema > 6 months that had cleared upon daily treatment for a maximum of 9 weeks with mometasone furoate cream
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms Corticosteroid creams/ointments: mometasone furoate cream 3 times/week vs 2 times/week | RR 1.23 [0.94, 1.61] | 1 study · 72 participants | Low Downgraded: risk of bias, imprecision |
Primary: participant‐rated good/excellent control of symptoms Not measured Corticosteroid creams/ointments: mometasone furoate cream 3 times/week vs 2 times/week | no estimate extracted | NR | No studies |
Primary: adverse events Corticosteroid creams/ointments: mometasone furoate cream 3 times/week vs 2 times/week | RR 1.76 [0.45, 6.83] | 1 study · 72 participants | Low Downgraded: risk of bias, imprecision |
Secondary: investigator‐rated reduction in severity Not measured Corticosteroid creams/ointments: mometasone furoate cream 3 times/week vs 2 times/week | no estimate extracted | NR | No studies |
Irradiation with UV light: local narrow‐band UVB compared to local PUVA for hand eczema
Population: people with hand eczema unresponsive to clobetasol propionate
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms Irradiation with UV light: local narrow‐band UVB vs local PUVA | RR 0.5 [0.22, 1.16] | 1 study · 60 participants | Moderate Downgraded: imprecision |
Primary: participant‐rated good/excellent control of symptoms Not measured Irradiation with UV light: local narrow‐band UVB vs local PUVA | no estimate extracted | NR | No studies |
Primary: adverse events ‐ reported adverse events, mainly erythema Irradiation with UV light: local narrow‐band UVB vs local PUVA | RR 19 [1.16, 312.42] | 1 study · 60 participants | Moderate Downgraded: imprecision |
Secondary: investigator‐rated reduction in severity in mTLSSd Irradiation with UV light: local narrow‐band UVB vs local PUVA | no estimate extracted | 1 study · 43 participants | Moderate Downgraded: imprecision |
Topical calcineurin inhibitors: tacrolimus 0.1% ointment compared to mometasone furoate ointment for vesicular hand eczema
Population: people with moderate to severe chronic relapsing dyshidrotic eczema on hands
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms ‐ Not measured Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs mometasone furoate ointment | no estimate extracted | NR | No studies |
Primary: participant‐rated good/excellent control of symptoms ‐ Not measured Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs mometasone furoate ointment | no estimate extracted | NR | No studies |
Primary: adverse events Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs mometasone furoate ointment | no estimate extracted | 1 study · 16 participants | Moderate Downgraded: imprecision |
Secondary: investigator‐rated reduction in severity ‐ DASIb Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs mometasone furoate ointment | no estimate extracted | 1 study · 16 participants | Moderate Downgraded: imprecision |
Topical calcineurin inhibitors: tacrolimus 0.1% ointment versus vehicle for hand eczema
Population: people with moderate to severe nickel sulphate‐induced allergic contact dermatitis based on clinical history (hand eczema) and proven by patch testing, resistant to topical corticosteroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs vehicle | RR 29 [1.9, 443.25] | 1 study · 28 participants | Moderate Downgraded: imprecision |
Primary: participant‐rated good/excellent control of symptoms Not measured Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs vehicle | no estimate extracted | NR | No studies |
Primary: adverse events ‐ burning/itching at application site Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs vehicle | RR 9 [0.53, 152.93] | 1 study · 28 participants | Moderate Downgraded: imprecision |
Secondary: investigator‐rated reduction in severity ‐ Not measured Topical calcineurin inhibitors: tacrolimus 0.1% ointment vs vehicle | no estimate extracted | NR | No studies |
Oral immunosuppressants: oral cyclosporin versus topical betamethasone dipropionate
Population: people with hand eczema, continuously for 6 months, significant disability, inadequate response to conventional treatment, confirmation by histopathology
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐ rated good/excellent control of symptomsb Oral immunosuppressants: oral cyclosporin vs topical betamethasone dipropionate | RR 1.88 [0.88, 3.99] | 1 study · 34 participants | Moderate Downgraded: imprecision |
Primary: participant‐rated good/excellent control of symptomsb Oral immunosuppressants: oral cyclosporin vs topical betamethasone dipropionate | RR 1.25 [0.69, 2.27] | 1 study · 34 participants | Moderate Downgraded: imprecision |
Primary: adverse events ‐ at least 1 adverse event Oral immunosuppressants: oral cyclosporin vs topical betamethasone dipropionate | RR 1.22 [0.8, 1.86] | 1 study · 55 participants | Moderate Downgraded: imprecision |
Secondary: investigator‐rated reduction in severityb Oral immunosuppressants: oral cyclosporin vs topical betamethasone dipropionate | no estimate extracted | 1 study · 34 participants | Moderate Downgraded: imprecision |
Oral retinoids: alitretinoin 30 mg versus placebo for hand eczema
Population: people with moderate to severe chronic hand eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms Oral retinoids: alitretinoin 30 mg vs placebo | RR 2.75 [2.2, 3.43] | 2 studies · 1210 participants | High |
Primary: participant‐rated good/excellent control of symptoms Folluw‐up: 48 weeks to 72 weeks Oral retinoids: alitretinoin 30 mg vs placebo | RR 2.75 [2.18, 3.48] | 2 studies · 1210 participants | High |
Primary: adverse events ‐ headache Folluw‐up: 48 weeks to 72 weeks Oral retinoids: alitretinoin 30 mg vs placebo | RR 3.43 [2.45, 4.81] | 2 studies · 1210 participants | High |
Secondary: investigator‐rated reduction in severity in TLSSc and mTLSSd Oral retinoids: alitretinoin 30 mg vs placebo | no estimate extracted | NR | No studies |
Oral retinoids: alitretinoin 10 mg versus placebo for hand eczema
Population: people with moderate to severe chronic hand eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary: investigator‐rated good/excellent control of symptoms Oral retinoids: alitretinoin 10 mg vs placebo | RR 1.58 [1.2, 2.07] | 2 studies · 781 participants | High |
Primary: participant‐rated good/excellent control of symptoms Oral retinoids: alitretinoin 10 mg vs placebo | RR 1.73 [1.25, 2.4] | 2 studies · 765 participants | High |
Primary: all adverse events Oral retinoids: alitretinoin 10 mg vs placebo | RR 1.01 [0.66, 1.55] | 1 study · 158 participants | Moderate Downgraded: imprecision |
Secondary: investigator‐rated reduction in severity of TLSSd Oral retinoids: alitretinoin 10 mg vs placebo | no estimate extracted | 1 study · 158 participants | Moderate Downgraded: imprecision |