Atopic dermatitis and psoriasis: two different immune diseases or one spectrum?  |  However, different expressions of immunological patterns9 and genetical phenotypes might be considered in the future. Since hand eczema may be a chronic disease with a severe impact on quality of life, intensive physician–patient communication, but also active patient self‐management play an important role to achieve adherence to treatment regimen like in other chronic skin diseases. Alitretinoin is more effective than placebo in controlling symptoms, but advantages over other treatments need evaluating. It can start in childhood as part of an in-built tendency to eczema, but is commonest in teenagers and adults. J Am Acad Dermatol. I FINALLY managed to rid myself of the annoying patches of eczema on my hands so I am very excited to share these tips with you! Azathioprine is an immunosuppressant introduced in the 1960s that is approved in combination with other immunosuppressants for the prevention of graft rejection and the treatment of several autoimmune diseases. Eczema on the hands and fingers is a common condition. Hand eczema is a highly prevalent, multietiological disease with a wide spectrum of severity and chronicity. If you suspect that you have some form of eczema, see a doctor to get your condition diagnosed and treated. Soak your hands in lukewarm water for 5-10 minutes and then pat them dry. Hand eczema: treatment P. Elsner1* , T. Agner2 1Department of Dermatology, University Hospital Jena, Jena, Germany 2Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark *Correspondence: P. Elsner. 4. Hautarzt. Patients are prospectively assessed by dermatological examination and patient questionnaire, and socio‐economic data and data on diagnostics, skin status, severity and treatment of chronic hand eczema and atopy criteria are repeatedly evaluated.  |  A double‐blind RCT, The US FDA ‘black box’ warning for topical calcineurin inhibitors: an ongoing controversy, Topical vitamin D3 derivatives in treating hyperkeratotic palmoplantar eczema: a report of five patients, Successful treatment of refractory chronic hand eczema with calcipotriol/betamethasone ointment: a report of three cases, Calcipotriol ointment shows comparable efficacy to topical steroids in chronic hand eczema, Highly increased urinary 1‐hydroxypyrene excretion rate in patients with atopic dermatitis treated with topical coal tar, Coal tar, pine tar and sulfonated shale oil preparations: comparative activity, efficacy and safety, Efficacy and tolerability of pale sulfonated shale oil cream 4% in the treatment of mild to moderate atopic eczema in children: a multicentre, randomized vehicle‐controlled trial, Treatment of severe recalcitrant dermatoses of the palms and soles with PUVA‐bath versus PUVA‐cream therapy, Narrowband UVB and cream psoralen‐UVA combination therapy for plaque‐type psoriasis, Comparison of oral psoralen‐UV‐A with a portable tanning unit at home vs hospital‐administered bath psoralen‐UV‐A in patients with chronic hand eczema: an open‐label randomized controlled trial of efficacy, Chronic hand eczema in Germany: 5‐year follow‐up data from the CARPE registry, Efficacy and safety of oral alitretinoin (9‐cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double‐blind, placebo‐controlled, multicentre trial, A phase 3, randomized, double‐blind, placebo‐controlled study evaluating the efficacy and safety of alitretinoin (BAL4079) in the treatment of severe chronic hand eczema refractory to potent topical corticosteroid therapy, Efficacy and tolerability of alitretinoin for chronic hand eczema under daily practice conditions: results of the TOCCATA open study comprising 680 patients, Impact on quality of life of alitretinoin in severe chronic hand eczema: FUGETTA real‐world study, Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real‐world observational study, Ultraviolet therapy in patients with chronic hand eczema, Veien NK. It may interfere with activities both at work and in the home and can be associated with social and psychological distress.1,2 The chronic form, chronic hand dermatitis (CHD) affects up to 10% of the population, which can have a considerable societal impact.2 Canadian Guidelines for the management of chronic hand dermatitis have been published to help guide management of this burdensome condition.3This article p… This may mean taking time off work for engineers, cooks, hairdressers and others. Consistently with the marketing approval, the ESCD guidelines recommend the use of alitretinoin for treating severe, chronic hand eczema that does not respond, or responds inadequately, to topical corticosteroids.6 As all retinoids, however, alitretinoin is teratogenic which limits its use in women of child‐bearing age. 2019 Apr 26;4(4):CD004055. Oosterhaven et al.66 published a retrospective review of 30 adult patients with severe chronic hand eczema who were treated with azathioprine. In contrast to alitretinoin, acitretin is not approved for the treatment of hand eczema, but efficacy in the management of patients with hyperkeratotic hand eczema has been reported. If no clinical response is observed within 8 weeks, cyclosporine should be withdrawn.1 An increased risk for skin cancer may result under long‐term use; thus, UV protection is recommended. To date, for different endotypes of atopic dermatitis,10 targeted endotype‐specific treatment has been suggested.11, 12 That is why in the future therapy might be pattern‐oriented including the characteristics of the specific immunology and genetics of hand dermatitis. Especially in irritant hand eczema, application of topical glucocorticosteroids has been subject to debate, with some authors reporting no benefit29, 30 denied by others.31 Since no specific therapies exist to enhance epidermal barrier recovery, especially the ultrapotent topical corticosteroids inhibiting epidermal lipid synthesis32 should be avoided in irritant dermatitis.  |  For over 50 years, topical corticosteroids have been the mainstay of the topical treatment of hand eczema. For more information on hand eczema, please see our Hand eczema factsheet Learn about our remote access options, Department of Dermatology, University Hospital Jena, Jena, Germany, Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. . Due to the possible risk that tar is a possible carcinogen and the proven urinary excretion of 1‐hydroxypyrene in patients with atopic dermatitis treated with topical coal tar,44 the use of coal tar for the treatment of hand dermatitis has been widely discontinued in recent years. Unterlassene Notfallbehandlung eines akuten allergischen Kontaktekzems. 1) combining topical, physical (UV light) and systemic options depending on the severity of the disease. NIH Before beginning pharmacologic interventions, lifestyle changes should first be recommended. This approach, however, is limited by the fact that patients may need to use their hands in everyday life not wishing to leave greasy marks on objects of their environment. They should be … The aetiology is manifold from endogenous disease (atopy) to exogenous factors (irritant and/or allergic contact dermatitis) that frequently overlap.2, 3 Clinical manifestations may be diverse, from vesiculous and erosive to hyperkeratotic and desquamative. Phototherapy can be effective in the treatment of chronic hand eczema. Dupilumab became the first biologic to receive approval, while the anti‐IL‐13 monoclonal antibodies lebrikizumab and tralokinumab, which target different IL‐13 epitopes with potentially different effects, are currently in advanced‐stage trials.71, Dupilumab is a fully human monoclonal antibody directed against the interleukin (IL)‐4 receptor α (IL‐4Rα) subunit inhibiting the signalling of the type 2 cytokines IL‐4 and IL‐13 approved for use in the treatment of adult patients with moderate‐to‐severe atopic dermatitis since 2017.72, Oosterhaven et al.73 reported about a patient with a long‐standing combination of very severe chronic atopic hand eczema and moderate‐to‐severe atopic dermatitis who had been treated with several systemic drugs. Botulinum toxin has been used with success in the treatment of dyshidrotic hand eczema. Topical corticosteroids and UV phototherapy were two of the major standard treatments, but evidence is insufficient to support one specific treatment over another. Finally, 12 (44%) patients were clear of hand eczema. Tacrolimus and pimecrolimus are calcineurin antagonists that inhibit the transcription of inflammatory cytokines released from T cells and mast cells via binding to FK‐binding protein and blocking calcineurin phosphatase activity.33. Photodermatol Photoimmunol Photomed. Current and emerging biologic and small molecule therapies for atopic dermatitis, Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current, Multicenter study ‘Medical‐Occupational Rehabilitation Procedure Skin–optimizing and quality assurance of inpatient‐management (ROQ)’, Guideline on the management of hand eczema ICD‐10 Code: L20. Although a number of systemic compounds for the treatment of hand eczema have become available over the years, topical therapy should always be part of a treatment regimen, even with systemic therapies (Fig. Considering that the hands are human ‘tools’ in many professions, behavioural aspects have to be considered in the management of the disease more than it may be the case with other skin diseases. Finally, in chronic hyperkeratotic hand eczema, keratolytic, anti‐proliferative and moisturizing effects are needed with keratolytic ointments (containing salicylic acid up to 20% if necessary, urea 10–20%) and lipid‐rich ointments, including water‐in‐oil and oil‐in‐water emulsions, to be used.24 The efficacy and safety of topical base preparations in the management of hand eczema should be studied using the same stringent criteria as for specific pharmacological therapies; unfortunately, only few preparations are evaluated in studies and registered as medical devices.25 Basic topical therapy may be underestimated by patients and physicians as ‘bland’ and without active ingredients.1 The result of such an attitude may be a reduced adherence, application that is inadequate or in insufficient quantity, ultimately compromising treatment.26 This underscores the need of patient education interventions in the management of hand eczema.27 Base therapy should be continued even after the visible signs of hand eczema have subsided, because the epidermal barrier damage will take longer to be restored. Emollients have been shown to be useful in reducing eczema activity and in the primary prevention of hand eczema. Similar efficacy was reported in a later study (HANDEL) from the United States.54 Data from real‐world clinical use are consistent with those from clinical trials.55-57 According to the Cochrane review,4 alitretinoin 30 mg achieved investigator‐rated control in 432 compared with 157 participants per 1000 with placebo. Would you like email updates of new search results? In a recent proof‐of‐concept study79 comparing topical delgocitinib vs. placebo (vehicle), 91 patients were randomized. 1. The treatment of xerosis cutis is a mainstay in the early forms of atopic and irritant hand dermatitis.21 Basic topical therapy helps to reduce inflammation and itching, has corticosteroid‐sparing effects and promotes epidermal barrier recovery. Hand eczema, and CHE can profoundly affect everyday living and one’s quality of life. 2012 Nov 8;367(19):1829-37. doi: 10.1056/NEJMcp1104084. 2. The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Hautarzt. Safety was assessed for all patients during a follow‐up period of 4 weeks, and responders were observed for relapse for 24 weeks after the end of therapy. Coconut Oil. Evaluation of skin problems and dermatology life quality index in health care workers who use personal protection measures during Home Remedies for Treating Hand Eczema. Calcineurin inhibitors (tacrolimus and pimecrolimus) have some evidence to show efficacy in hand eczema and can be used as a steroid-sparing agent [4]. Hand dermatitis often has unique causes, commonly job-related and can require specific testing and treatments. Eczema can be treated so that the lesions are able to heal. While wet dressings may sound simple, a … New therapeutic principles such as biologics and topical Janus Kinase inhibitors may be available for the management of hand eczema patients in the near future. Hand dermatitis may be a short-lived, transient problem. This is why, in cases of occupational hand dermatitis, rehabilitation programs provide that patients are routinely off work for a minimum of 6 weeks.14 Acute hand eczema should be treated promptly, effectively and thoroughly in order to prevent the condition from becoming chronic.15, 16 Chronic hand eczema may require a stagewise treatment approach (Fig. Similar results were shown for participant‐rated control (high‐certainty evidence). Both regimens seem to be comparably effective,47, 48 with the advantage of PUVA‐cream therapy to reduce organizational efforts and expenses. Moisturisers (emollients)are an essential part of treating hand dermatitis. The median time to relapse, defined as recurrence of 75% of initial signs and symptoms, was 5.5–6.2 months in the absence of anti‐eczema medication. L30, The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. Special Issue: Chronic Hand Eczema: Disease Awareness and Treatment Options. Hand dermatitis (HD) can have a significant impact on quality of life of those affected. The therapeutic algorithms encompassing topical, physical and systemic treatments proposed in the guidelines should be followed actively in order to prevent chronicity and relapses that may severely impair patients’ wellbeing. 3. PUVA is effective as a systemic treatment. Over-the-counter (OTC) hydrocortisone cream can temporarily relieve redness and itching. The efficacy of topical timolol for the treatment of recalcitrant fissures and erosions in patients with chronic hand eczema was supported in a short communication published in the Journal of the American Academy of Dermatology.. A dermatologist at a skin clinic in Nashik, India, Manoj Pawar, MD, described the use of topical timolol in a 45-year-old man with chronic persistent hand eczema. HHS These substances may also have an impact on the management of hand eczema. This review discusses the spectrum of therapeutic options for hand eczema, the evidence for their efficacy and safety, and proposes a stepwise approach of intensity of treatment depending on disease severity and chronicity. The treatment, called PUVA, is traditionally administered at a hospital. Light therapy has the particular advantage for the patients that, in contrast to systemic therapeutics, no systemic side effects are to be expected in many cases despite high efficacy. Botulinum toxin has been used with success in the treatment of dyshidrotic hand eczema. was study investigator and/or consultant for Leo, Novartis, Pfizer and Perre Fabre and received speaker's honoraria from Galderma, Leo, Novartis, Pierre Fabre and Sanofi. Bath-PUVA treatment, UVB and Grenz rays can also suppress hand eczema. While the spectrum of therapeutic options for hand eczema has expanded in recent years, the condition remains a challenge for dermatologists and patients alike. Thus, the management of hand eczema has to extend beyond mere pharmacological or physical treatment, and requires an encompassing approach including removal or avoidance of causative factors, behavioural changes and social support. Be sure to read the label to determine which moisturizer has the least amount of water. The aroma can help facilitate sleep, when itching is often at its worst. Its use in the management of hand dermatitis is thus limited to cases of atopic hand dermatitis; otherwise, the use would be off‐label. In numerous experimental studies, basic topical therapy has been shown to promote the healing of eczema, without any specific pharmacological treatment.22, 23 For acute and frequently oozing hand eczema, basic topical therapy should have drying, astringent and antibacterial effects; hand baths and soaks, moisturizing or moist dressings and hydrophilic creams or gels are indicated. Treatment was well‐tolerated, with dose‐dependent adverse effects comprising headache, mucocutaneous events, hyperlipidaemia, and decreased free thyroxine and thyroid‐stimulating hormone. The Janus kinase (JAK)–signal transducer and activator of transcription (STAT) pathways modulate multiple important immune pathways, including Th2 {IL‐4, IL‐5, IL‐6, IL‐10, IL‐13, IL‐31, CCL [chemokine (C‐C motif) ligand] 18}, Th22 (IL‐22, S100As), Th1 [IL‐2, IFN‐γ and TNF (tumour necrosis factor)‐β] and Th17 (IL‐17A, IL‐17F, IL‐21, IL‐22, IL‐23R).76 They are currently assessed for use in a number of dermatological conditions such as psoriasis, atopic dermatitis, alopecia areata, vilitigo, dermatomyositis and graft‐versus‐host disease.77 Since they are small molecules, they may penetrate the epidermal barrier thus being of potential not only for systemic, but also for topical use in hand eczema. Treatment of chronic palmoplantar eczema with local bath-PUVA therapy. 4 Tips to treat hand eczema. ‐19 pandemic These self-care habits can help you manage dermatitis and feel better: 1. Wet dressings are an effective method to treat severe eczema and often reduce symptoms in several hours to days. Hand eczema is a common skin disease that tends to become chronic and may interfere with many types of work. Anecdotal evidence exists on its use in hyperkeratotic hand eczema that may mimic palmar psoriasis41, 42; its use for this condition would be also off‐label. Comparison of oral psoralen-UV-A with a portable tanning unit at home vs hospital-administered bath psoralen-UV-A in patients with chronic hand eczema: an open-label randomized controlled trial of efficacy. Their long‐term or frequent use is not indicated in hand eczema due to their well‐known side effects such as osteoporosis, osteonecrosis, glaucoma, cataracts, hypothalamic‐pituitary‐adrenal axis suppression, hyperglycaemia, hypertension and immunosuppression.50 Nevertheless, according to German registry data, a significant percentage of patients with chronic hand eczema seem to be treated with systemic corticosteroids in contrast to current guidelines.51, Alitretinoin is an endogenous vitamin A derivative which binds with high affinity in a saturable manner to all 6 known retinoid receptors (RAR‐α, RAR‐β, RAR‐γ, RXR‐α, RXR‐β and RXR‐γ).52 It is the only approved systemic treatment licensed specifically for hand eczema. Topical therapies should consider the appropriate choice of vehicles, suitable pharmaceutical vehicle depending on the condition of the skin and the acuteness of the eczema.20 Generally, the principles ‘moist on moist’ and ‘greasy on dry’ propose to use hydrating vehicles on acute lesions of hand eczema and lipid‐rich vehicles on chronic ones. Thus, the aspect of possible adherence to topical treatments has to be considered. Look for symptoms of hand eczema. Working off-campus? It may cause itchy, dry, scaly patches of skin that crack and flake. Oral antihistamines, such as diphenhydramine, may help reduce itching. Merely exogenous types of hand dermatitis may heal without any specific treatment under these conditions, but it has to be remembered that the recovery of the epidermal barrier takes many weeks. HECSI‐75 was achieved by 28 (60%).75. At 12 months, 100% of patients treated with acitretin achieved clearance/almost clearance compared to 40% of patients treated with methotrexate.68 A similar retrospective study reported that after 8–12 weeks of treatment, 36.8% of patients treated with methotrexate for hand eczema showed a good effect of treatment.70 Regarding the subtypes, a good effect was achieved in hyperkeratotic hand eczema in 47.6% compared with 25.0% in the non‐hyperkeratotic subgroup. Considering their long history of use, it seems odd that the recent Cochrane review identified only nine studies that evaluated topical corticosteroids as the main intervention.4 Clobetasol propionate 0.05% foam and mometasone furoate cream probably improve control of symptoms, but the evidence was rated as moderate and low certainty, respectively.4 The present ESCD guidelines recommend topical corticosteroids as first‐line treatment in the management of hand eczema, but they point to the fact that as they may be very effective in the short term, they may inhibit epidermal barrier repair and cause skin atrophy, thus interfering with recovery in the long term.6 For long‐term use, topical glucocorticosteroids with an improved therapeutic index (TIX, ratio between desired effects and especially atrophogenic side effects) should be considered.28 Adherence to topical glucocorticosteroids in practice may be impaired by widespread steroid phobia. Worsening of the dermatitis occurred in two patients (7%). Hand eczema is a highly prevalent, multietiological disease with a wide spectrum of severity and chronicity. In dermatology, it is used off‐label for a variety of diseases, especially autoimmune bullous diseases, because of its steroid‐saving effect, although the evidence varies widely.63 Azathioprine is a prodrug metabolized to 6‐mercaptopurine Mercaptopurine is further metabolized via three metabolic pathways, including 6‐thioguanine nucleotides (6‐TGN), which are responsible for most of the immunosuppressive activity of thiopurines, but also cause their bone marrow toxicity.64 Further side effects may include gastrointestinal disturbances and infections.65. N Engl J Med. If a flare-up makes the skin on your hands crack and bleed, try the “soak and smear” technique. 2009 May 7;151(19):35-7. Methotrexate has been widely used in dermatology for the treatment of psoriasis and psoriasis arthritis where its efficacy is well established.67 The evidence for its use in hand eczema is limited. The combination of retinoid therapy with PUVA therapy in hand dermatitis is possible as frequently practised in psoriasis, but it has not been systematically studied.58. Overall tolerability was good. USA.gov. Severity of hand eczema, compliance to treatment, patients' information level, adherence to preventive behaviours, and the protective behaviour score were evaluated at baseline, and at the 4th and 8th week. Although topical corticosteroids are the mainstay of treatment, few studies of their rational use, efficacy and side-effects have been conducted. Treatment is focused on protecting your hands from further damage and from an infection. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. If you do not receive an email within 10 minutes, your email address may not be registered, It is common and can affect about one in every 20 people. 2010 Aug 31;10:8. doi: 10.1186/1471-5945-10-8. E-mail: elsner@derma-jena.de Abstract Hand eczema is a highly prevalent, multietiological disease with a wide spectrum of severity and chronicity. An Australia/New Zealand Clinical narrative, Journal of the European Academy of Dermatology and Venereology. To help your hands heal, your dermatologist may also include a moisturizer, barrier repair cream, or cortisone cream in your treatment plan. Strict pregnancy prevention 1 month before, during and for 1 month after cessation of treatment is necessary. Photodermatol Photoimmunol Photomed. However, sulfonated shale oil preparations seem to have a better safety profile45 and have been proven to be efficacious in mild‐to‐moderate atopic eczema in children46; thus, they might be tried for topical therapy of hand dermatitis, although no studies on their efficacy and safety in hand dermatitis are available. Cochrane Database Syst Rev. In a double‐blind study with 41 patients, cyclosporine 3 mg/kg/day for 6 weeks was as effective as topical betamethasone dipropionate, leading to a 57% reduction in hand eczema severity score.62 According to the ESCD guidelines, cyclosporine may be considered for hand eczema patients with long‐term need for treatment if first‐ and second‐line therapy has been insufficient or contraindicated.6 Therapy with cyclosporine should be conducted for up to 6 months at the minimum effective dose, followed by 3 months’ tapering. Severe acute flares of hand dermatitis are treated with prednisone (systemic steroids) for 2–4 weeks. It has been reported in case series of patients with unresponsive hand dermatitis68 and other types of recalcitrant eczema.69 In a retrospective chart review study, 17 patients were treated systemically with acitretin and/or methotrexate.68 Of these 17 patients, four patients received courses of both acitretin and methotrexate independently after failing the alternative treatment course. Add 10 drops to 1 tablespoon of coconut oil or almond oil, and gently rub into the skin. A dermatologist is a physician who is specialized in skin disorders. A period of four to six weeks should involve 3–4 radiation sessions. by the atopy score,7 patch testing and the exclusion of differential diagnoses. Efficacy of corticosteroids in acute experimental irritant contact dermatitis? Ultraviolet light is sometimes used to treat extreme eczema. However, not all dermatologists or dermatology clinics offer this form of therapy, and it involves extended periods of treatment for the patient. The most frequently reported side effect is headaches that are mostly transitory and well controllable by NSAIDs; in addition, triglycerides, cholesterol, liver enzymes and TSH should be monitored. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. If you’re wondering how to treat eczema on hands or any other part of the body, there are several natural eczema remedies. The primary efficacy parameter was physician global assessment of overall CHE severity, with response defined as clear or almost clear hands. You may have eczema if you notice any of the following symptoms on your hands or fingers: Redness Itching Pain Extreme dryness Cracks Blisters The authors reported that after treatment with dupilumab, the Investigator's Global Assessment (IGA) of patients with hand dermatitis decreased by 1.54 points from 3.26 to 1.72, with 40.0% achieving an IGA of 0 and 1.74, In an observational prospective study, 47 adult patients with hand eczema and atopic dermatitis were treated with dupilumab at a 600 mg loading dose, followed by 300 mg every 2 weeks.75 Primary outcome was a minimum improvement of 75% on the hand eczema severity index after 16 weeks (HECSI‐75). As you can see from Mark’s story, finding the cause often takes time, detective work, and expertise. Over 12 weeks, her hand eczema improved from ‘very severe’ and a hand eczema severity index (HECSI) score of 244 (of 360) to ‘almost clear’ with a HECSI score of 11.73, In a retrospective chart review, the outcome of 38 dupilumab‐treated patients with hand dermatitis was evaluated.74 From the publication, it is unclear if these were only patients with atopic dermatitis, or if also other aetiologies were included. However, in some people, it lasts for years and can have a great impact on daily life. Protection of the hands is very important for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. This review takes into account these aspects with a view on the guidelines for the management of hand eczema that have been developed by various groups over the years (Table 1) and the recent Cochrane review on treatments for hand eczema.4 The latter clearly stated the current deficits of our knowledge on the treatment of hand eczema4: the quality of studies was frequently poor, and the duration of treatment was short, generally only up to 4 months, which is inconsistent with the need for a long‐term management in chronic hand eczema defined as ‘an eczematous process that lasts for more than three months or relapses twice or more often per year’.5 Most of the guidelines (Table 1) take a similar approach to the hierarchy of treatments with some differences especially regarding the availability or reimbursement conditions of specific drugs. Reduce symptoms in several hours to days eczema were included in the treatment of hand eczema is a key in... 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