You are evaluating a 33-year-old woman complaining of dry hands. She is a cleaning lady who has had the slow progression of erythema and edema, which has evolved into fissuring and crusting on the palmar aspect of the hand and wrist. She has been using gloves at work, with minimal improvement, and has started using lubricating creams. Her past medical history is significant only for seasonal allergic rhinitis. The hands appear to be the only areas involved. The rest of her physical examination is normal. What is the most appropriate treatment for this patient at this time? (AIIMS May 2012)
|A||Cephalexin 250 mg orally 4 times a day for 7–10 days|
|B||High-potency topical steroids|
|C||Hydroxyzine, 25 mg orally every 6 hours|
|D||Oral prednisone (1 mg/kg) tapered over 2–3 weeks|
|E||Topical retinoic acid|
High-potency topical steroids
1). This patient has irritant contact dermatitis.
2). Most patients have a history of atopy.
3). Contact dermatitis usually resolves with removal of the offending agent or with barrier protection (e.g., gloves) of the involved area.
4). When crusting and fissuring are present, lubricating creams are helpful.
5). Adjunctive therapies include high-potency topical steroids while the dermatitis runs its course.
6). For patients who fail topical steroids, systemic therapy with oral prednisone will usually suffice.
7). Hydroxyzine, an oral antihistamine, is useful when pruritus is a predominant complaint or when the lesion is thought to be due to scratching or rubbing, as in lichen simplex chronicus.
8). Empirical antibiotics are not useful in the absence of signs of infection.
Topical retinoic acid is an irritant and will worsen the skin inflammation and discomfort.