A New Alternative in the Treatment of Hand Eczema: Topical Pimecrolimus

Backgorund and Design: Hand eczema is the most common form of occupational dermatoses. Because of chronic and relapsing course, therapy is a problem for both physician and patient. New treatment alternatives have been investigated because of side effects of long-term topical corticosteroids use. In this study, we aimed to evaluate the efficacy of pimecrolimus 1% cream, an ascomisin derivative successfully used for atopic dermatitis, in the treatment of hand eczema. Material and Method: In this placebo-controlled, randomized study, pimecrolimus 1% cream was applied on one hand and placebo on the other hand of 25 patients twice daily for 8 weeks. Response to the therapy was assessed clinically at 2., 4., 6. and 8. weeks of the therapy. In the clinical assessment, erythema, desquamation, lichenification, edema, vesiculation and fissuring were scored between 0-4. Same scoring system was used also for the pruritus symptom of the patients. Side effects during the therapy were also recorded. The patients were followed for 8 additional weeks after the end of the therapy. Results: Nine male and 15 female patients with ages ranging from 18 to 63 (mean 35.79) completed the study. Of the patients, 14 were housewives, 4 were health workers, 3 were teachers, 1 was policeman, 1 was farmer and 1 was a haberdasher. The duration of disease ranged between 6 months and 20 years (mean 4.9 years). Diagnosis of irritant contact dermatitis was made in 13 patients and allergic contact dermatitis in 11 patients. Pimecrolimus 1% cream was well tolerated in all patients and no side effect was observed. The clinical score of pimecrolimus-applied hand improved significantly when compared with placebo applied hand (p=0.04). Conclusion: It is concluded that topical pimecrolimus cream appears to be an effective and easily appliable treatment alternative for all manifestations of hand eczema except for vesiculation, without any rebound and tachyphylaxis.