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Hand Eczema — SCE Dermatology MCQ

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ModerateInflammatory DermatosesHand EczemaSCE Dermatology

A 40-year-old woman has severe chronic hand eczema. Despite multiple treatments she continues to have frequent flares. Her dermatologist discusses the concept of 'reactive' versus 'proactive' treatment approaches. In the context of hand eczema, what does proactive treatment involve?

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Correct answer: B — Applying a topical anti-inflammatory (corticosteroid or TCI) to previously affected skin at reduced frequency (e.g. twice weekly) even when clear to prevent flares

Proactive maintenance treatment for hand eczema involves applying a topical anti-inflammatory agent (moderate-potent topical corticosteroid or topical calcineurin inhibitor) to previously affected sites at reduced frequency (typically twice weekly) even during apparent remission. This approach, supported by evidence from AD studies and increasingly applied to hand eczema, significantly reduces relapse frequency compared to reactive (flare-only) treatment. The proactive approach addresses subclinical inflammation that persists even when skin appears clear. Combined with continuous emollient use, soap substitution, and skin protection, proactive therapy provides the best long-term hand eczema control.

Reference: BAD 2019; NICE TA177; EADV AD Guidelines