Oral treatments

There are several types of oral medication that may be prescribed for the treatment of hand eczema including antibiotics, antihistamines, immunosuppressants, retinoids, or steroids. These are typically prescribed by dermatologists if topical treatments and lifestyle management are not sufficient to manage the condition.

Antibiotics

If your doctor believes that your eczema has become infected (redness, weeping, or blisters) as a result of bacterial invasion of damaged skin, they may decide to give you a short course of oral antibiotics and/or an antibiotic cream or ointment to clear up the infection. Some topical products may combine a cortisone cream with an antibiotic to reduce inflammation and fight infection at the same time.

Antihistamines

Antihistamine pills may sometimes be prescribed for short periods of time to help reduce the itch of eczema at night and help break patterns of sleeplessness. Antihistamines that have a sedative effect are generally taken just before bedtime and may cause some drowsiness the next day. This should be taken into account when driving or operating machinery. Antihistamine creams are not effective in treating eczema.

Immunosuppressants

Immunosuppressant pills (eg, ciclosporin, azathioprine), like oral steroid pills, dampen down the body’s immune responses. However, they may be used for somewhat longer periods of time than oral steroids, depending on how well

they are tolerated. These products are associated with side effects, and patients using them will require regular blood tests and visits to the doctor during treatment.

Retinoids

Retinoid pills (eg, alitretinoin, acitretin) are sometimes prescribed for hand eczema and contain substances chemically related to vitamin A. Alitretinoin is a new treatment recently approved in some countries for patients with severe long-standing eczema of the hands that is unresponsive to treatment with stronger, more potent steroid creams. Retinoid therapy can cause birth defects when used in pregnant women, so special precautions to avoid pregnancy are required when using this class of drugs in women who are of child-bearing potential.

Steroids

Steroid pills (eg, prednisolone) are sometimes used to treat severe eczema when topical treatments are not effective. Steroids calm down the body’s immune response and are only suitable for use over short periods of time because of the potential side effects of such therapy.