COMPARISON OF CYCLOSPORINE AND TOPICAL BETAMETHASONE-17,21-DIPROPIONATE IN THE TREATMENT OF SEVERE CHRONIC HAND ECZEMA

Topical corticosteroids are the standard treatment for hand eczema, Ho wever, in chronic forms of the disease they are often ineffective or l ose their efficacy due to tachyphylaxis, In a previous open study cycl osporine showed efficacy in chronic hand eczema. The aim of this study was to compare oral cyclosporine at 3 mg/kg/day with topical 0.05% be tamethasone-17,21-dipropionate (BDP) cream in the treatment of chronic hand eczema, In a randomized, double-blind study 41 patients with chr onic hand eczema resistant to conventional treatment mere assigned to either cyclosporine or BDP for 6 weeks, Both cyclosporine and BDP impr oved the eczema, The total disease activity score decreased to 57% of baseline in the cyclosporine group (mean change -6, SD 4.3; p<0.001) a nd to 58% of baseline in the BDP group (mean change -5.7, SD 4; p<0.00 1) at the end of treatment, However, between the groups there was no s ignificant difference, Adverse events occurred in 68% of the patients during cyclosporine and in 56% during BDP treatment. With cyclosporine no case of hypertension or increase in serum creatinine above normal levels was recorded, In two patients the serum creatinine levels incre ased to values 30% above their own baseline values, Relapses occurred to the same extent in both groups, Cyclosporine at 3 mg/kg/day is as e ffective as topical BDP in the treatment of chronic hand eczema, Low-d ose cyclosporine could be useful as an alternative treatment for sever e chronic hand eczema in patients unresponsive to conventional treatme nt.