Efficacy of Mild-to-Moderate Chronic Hand Eczema Treatment Using Petrolatum and Panthenol Ointment vs. 0.1% Triamcinolone Acetonide in 10% Urea Cream: A Split-hand, Evaluator-blinded, Randomized, Controlled Trial

J Clin Aesthet Dermatol. 2025;18(2):38–43.

by Suparuj Lueangarun, MD, MSc; Nutthawut Techalert, MD, MSc; and Therdpong Tempark, MD

Dr. Lueangarun is with the Department of Aesthetic Medicine, College of Integrative Medicine at Dhurakij Pundit University in Bangkok, Thailand. Dr. Techalert is with the Division of Dermatology at DeMed Clinic Center in Bangkok, Thailand. Dr. Tempark is with the Department of Pediatrics, Faculty of Medicine at King Chulalongkorn Memorial Hospital, Chulalongkorn University, in Pathumwan, Bangkok, Thailand.

FUNDING: No funding was provided for this article.

DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article.

ABSTRACT: Background: There are many side effects resulting from the long-term use of conventional therapy (eg, high potency topical corticosteroids) for treatment of chronic hand eczema (CHE). Objective: This study aimed to explore the efficacy of CHE treatment using the healing ointment (HO) of anti-inflammatory ingredients compared with 0.1% triamcinolone acetonide in 10% urea cream (TAU). Methods: A split-hand, evaluator-blinded, randomized, controlled study was conducted in 26 patients (88.5% female, mean age 50.04 ± 9.63 years) with mild-to-moderate CHE. All patients were randomly assigned to apply HO or TAU twice daily on each side of the hand for consecutive 28 days. Results: There was an improvement of HECSI, TEWL, SCH, hemoglobin index, DLQI, and VAS on the HO treated side at Day 28, with statistical significance. Also, a statistically significant difference of TEWL reduction was observed on the HO treated side when compared to the TAU treated side at the same visit. Moreover, the superior post-moisturizing efficacy at seven days was noted for TEWL and SCH on the HO treated side. Conclusion: The use of HO with anti-inflammatory ingredients could be alternatively efficacious for treatment of CHE to prevent complications from the long-term application of steroids.

Keywords: Chronic hand eczema, healing ointment, triamcinolone acetonide, petrolatum, panthenol, randomized controlled trial

Introduction

Chronic hand eczema (CHE) is a common dermatologic disorder ease with a strong effect on the patients’ quality of life.¹ Impaired skin barrier is a significant factor at risk for hand dermatitis development  due to higher offending substance penetration.² 

The mainstay treatments of CHE include frequent use of ointments and high-potency topical glucocorticoids, while avoiding allergens and irritants.^3,4 In spite of a very effective short-term treatment response to these agents, the prolonged course of CHE with frequent recurrence requires a regular use of maintenance intermittent therapy of super high- or high-potency topical corticosteroids.⁵ Nonetheless, this can impair the recovery of skin barrier repair in long-term treatment.³ Particularly, numerous adverse impacts have been reported after the application of topical corticosteroids.^6–8 Thus, most treatment guidelines encourage the frequent uses of lipid-rich emollients or ointments.⁴ However, treatment with only emollients may not be sufficient to effectively control hand eczema.⁵ 

Healing ointment (HO) with anti-inflammatory ingredients can provide the efficient and safe dermatologic wound healing when compared to antibiotic-containing treatments,⁹ and ablative laser resurfacing around perioral area.^10,11 Due to main ingredients of occlusive moisturizer (petrolatum) with anti-inflammatory and skin repairing ingredients, the HO could be beneficial for treatment of dermatitis, including hand eczema. 

Thus, this study aimed to determine the efficacy of HO with anti-inflammatory and skin repairing ingredients for mild-to-moderate CHE treatment, with optional long-term maintenance treatment to avoid the adverse impacts of topical steroids.

Methods 

Study design. This was a single-center, split-hand, evaluator-blinded, randomized, controlled study at Benchakitti Park Hospital, Bangkok, Thailand. Participants aged 18 to 60 years with clinically proven of CHE persisting for at least three months or recurring twice or more per one year, and mild to moderate degree of severity according to the Physician Global Assessment (PGA),¹² were enrolled. The exclusion criteria were those with concomitant skin disease on the hand (eg, fungal infection, psoriasis), history of using systemic corticosteroids or immunosuppressive drugs during systemic treatment with immunosuppressive drugs or systemic corticosteroids or phototherapy during four weeks before this study, any topical hand products including corticosteroids, calcineurin inhibitors, and emollients during two weeks before the study, allergy to any ingredients of tested products, pregnancy, or lactation. Use of any topical corticosteroids and other topical medications for the hands was not allowed during the period of study. Any topical medications were prohibited for the hands at least two weeks before and during this study. All patients signed an informed consent at the beginning of this study. This study obtained the approval from Thammasat University Institutional Review Board (MTU-EC-OO-0-132/62), in adherence with institutional ethical standards and the Helsinki Declaration.

The experimental HO (Aquaphor Healing Ointment, Beiersdorf Inc., Stamford, Connecticut) was a petrolatum-based ointment providing semi-occlusive environment to facilitate the wound healing,⁹ with other main ingredients including bisabolol, ceresin, glycerin, lanolin alcohol, mineral oil, and panthenol. The comparative product (0.1% triamcinolone acetonide in 10% urea cream [TAU]) contained 0.1% triamcinolone acetonide cream and 10% urea cream, with other ingredients such as cetyl alcohol, liquid paraffin, methyl paraben, propyl paraben, and propylene glycol.

Both HO and TAU were randomized into the 30mL bottles with label “A” and label “B.” Each side of the hand was assigned for receiving either HO or TAU by computer generated table randomization. Each patient was instructed to use Product A on the left hand, and Product B on the right hand twice daily for 28 days. To avoid cross-contamination between the hands, the glove-protected fingertip was suggested when applying both products. 

Outcomes and assessments. The hand eczema severity index (HECSI) was used for the evaluation of clinical outcomes by a dermatologist.¹³ The dermatology life quality index (DLQI) questionnaire and 10-cm visual analog scale for intensity of itching (VAS) were employed for subjective assessment by the patients.^13,14 Before measurements, each patient acclimatized for at least 30 minutes under the standard temperature of 20–22°C and relative humidity of 40-60%).¹⁵ Measurements of skin biophysics parameter included trans-epidermal water loss (TEWL) by Tewameter® TM 300 (Courage+Khazaka, Cologne, Germany) and stratum corneum hydration (SCH) by Corneometer® CM 825 ((Courage+Khazaka, Cologne, Germany). Moreover, biometric assessment measured by Antera 3D® Pro version (Miravex Limited, Dublin, Ireland) was conducted for skin texture and hemoglobin index. 

Twenty-six patients were assigned for application of the two products two times daily for 28 days and clinically measured for HECSI, TEWL, SCH, DLQI, and itching VAS, with biometric assessment for texture and hemoglobin index. Moreover, all patients were evaluated on adverse reactions at 14 and 28 days. After the 28-day phase, all treatments were discontinued. Any topical medications were prohibited during this phase. Following the 7-day cessation of moisturizer, the patients were assessed on moisturizing effects, including skin biophysics (TEWL and SCH). Other assessments, such as HECSI, DLQI, VAS, and biometric assessments, were also evaluated at the same period. To ensure the same position of all measurements, the most severe lesion was demarcated using plastic template. For patients’ compliance, all of them were asked requested for the return of bottles gators at every visit. The amount of remaining products was measured and assessed whether the proper amount was used during the study.

Statistical analysis. The sample size calculation was done from the previous reference study¹⁶ with reference value ()=36.3, mean ()=54, superiority or non-inferiority margin (δ)=0.00, alpha=0.05, beta=0.20, and drop-off rate 25 percent, which finally provided a sample size of 26. All of the measurements were presented as means ± SDs and summarized by a descriptive statistical method. Repeated ANOVA test was used for any changes in HECSI, TEWL, SCH, DLQI, VAS, texture, hemoglobin index at baseline, Day 14, 28, and 35 (7-day after treatment cessation), as well as between both hands at the same visit. The p-value <0.05 was considered statistical significance. 

Results

Study population. This study enrolled 26 patients, of which 88.5 percent were female with mean age of 50.04 ± 9.63 years and mean HECSI of 37.98 ± 15.57. There were 22 patients with hyperkeratotic type of CHE (84.6%), followed by two of each with interdigital and recurrent vesicular types (7.7%). All of them never performed the patch testing before enrollment. Twelve patients (46.1%) neither met the physicians nor used any treatments before. Ten patients (38.5%) applied only emollients without topical or systemic corticosteroids. Four patients (15.4%) used both emollients and topical corticosteroids (Table 1).

There was a statistically significant improvement at the 28-day treatment evaluation of the HO treated side when compared to the baseline clinical assessment, with mean HECSI reduction for 8.88 ± 3.45 versus (p <0.001) and 28.88 ± 4.50 versus (p <.001) at 14 and 28 days, respectively. Likewise, the statistically significant improvement was noted for the TAU treated side when compared to the baseline clinical assessment, with mean HECSI reduction for 10.19 ± 2.43 (p <0.001) and 27.96 ± 4.99 (p <0.001), respectively. Additionally, both treatment products showed a statistically significant improvement of DLQI and VAS at Day 14 and 28, when compared to baseline. However, there was no statistically significant difference between both treatments (Figure 1 and 2).

Biophysical measurement. There were remarkable TEWL results with more significantly decreased in the HO treated side than the TAU treated side at Day 28 for 22.64 ± 12.99 versus 6.83 ± 11.13, respectively (p = 0.022) (Figure 3). The SCH value of only the HO treated sides showed a statistically significant increase from baseline at Day 28 (18.73%, p = 0.001) (Figure 4).

Biometric measurement. There was a decrease in hemoglobin index from baseline at 28 days of the HO and the TAU treated sides for 0.13 ± 0.05 (p <.001) versus 0.07 ± 0.05 (p = .012), respectively, with no statistically significant difference between the two groups. Neither significant changes of texture index nor serious adverse effects were reported throughout the study (Figures 5–6).

After the seven-day cessation of moisturizer, only the HO treated side yielded a statistically significant improvement of TEWL and SCH when compared to baseline. Also, the TEWL in the HO treated side yielded a better reduction than the TAU treated side (18.32 ± 16.59 vs 3.35 ± 8.55%, p = .042). The SCH of the HO treated side yielded a statistically significant increase from baseline for 14.51 ± 11.23 % (p = .014). Whereas, the SCH of the TAU treated side demonstrated no statistically significant change when compared to baseline (3.25 ± 8.17 %, p = 0.415). (Figures 3–6) Additionally, The HECSI of the HO and the TAU treated sides showed a statistically significant decrease when compared to baseline for 24.87 ± 3.79 and 22.97 ± 5.58, respectively (p <.001). Moreover, both treatment products had a statistically significant improvement of DLQI and VAS when compared to baseline. 

Safety. There were four (15.40%) and one (3.85%) of 26 patients with the stickiness and heaviness feelings from the treatment products on both treated sides at the first follow-up visit, respectively. Later, no further report of those adverse reactions as well as erythema, tenderness, pruritus, or other complaints was obtained. Mostly, both treated sides were well tolerated without serious adverse impacts until the end of treatment course.

Discussion

In this study, the HO moisturizer with anti-inflammatory ingredients yields a significant improvement in treatment of mild-to-moderate CHE, following clinical, biophysical, and biometric assessments with no report of serious adverse effects throughout the study. 

According to previous studies, patients with mild-to-moderate CHE had the reduction of mean HECSI for 81.38% and 75.91% after the application of 0.1% betamethasone ointment for four weeks¹⁷ and the application of 0.25% desoximetasone ointment for eight weeks,¹⁸ respectively. The study using betamethasone ointment allowed the patients to use ointment twice daily as a moisturizer; while, a study using desoximetasone ointment had not allowed the patients to use any moisturizers during the study period. The results supported a vital role of moisturizer in chronic hand eczema management. In our study, the 4-week application of TAU two times daily yielded a decrease of mean HECSI for 74.72 percent when compared to the baseline. Despite applying only a topical corticosteroid with moderate potency, there was a relatively comparable reduction of HECSI to baseline when compared with other previous studies. This could be explained by the combination of topical corticosteroid and urea cream, with an ingredient of humectant moisturizing and keratolytic agent. Moreover, the 10% urea cream increased the penetration of other drugs, such as triamcinolone, after being combined within the same preparation.¹⁹ 

For the long-term application of topical steroid in CHE, a previous report on the use of clobetasol propionate at forearm area showed the epidermal thinning for 10 to 25 percent within two to six weeks.²⁰ Even mometasone furoate that claimed to have less atrophogenic activity, the long-term intermittent dosing may also result in skin atrophy, evidenced by 9.43 percent of patients after twice or thrice weekly application for consecutive thirty weeks.⁵ Therefore, we investigated the efficacy of applying moisturizer with anti inflammatory ingredients as an optional treatment for CHE to refrain from steroid side effects. 

Our results revealed that the efficacy of HO for reducing the clinical signs of hand dermatitis from HECSI evaluation was non-inferiority to TAU, a mid-potency topical corticosteroid combined with 10% urea cream. These HECSI changes could be potentially resulted from three main mechanisms. Firstly, HO provided an improvement of essential skin moisture for the barrier of skin repair process.²¹ Secondly, HO contained anti-inflammatory ingredients, including bisabolol and panthenol to reduce the inflammation of skin by modulating inflammatory cytokine.^22,23 Lastly, HO with some emollient ingredients may fill the defective gap in nerve ending for a decrease of itch-scratch cycle.²¹ 

In another study using a hand cream containing anti-inflammatory and barrier repair ingredients, the results showed a reduction of HECSI for 20 to 60 percent, with a statistically significant improvement only in SCH, but not TEWL.²³ Comparing to our study, the HO could provide a statistically significant improvement in both SCH and TEWL, which reflected the improvement of skin barrier dysfunction.²⁴ Unsurprisingly, the amount of HECSI reduction from HO was quite higher (74.72%), corresponding to a previous study using HO after ablative laser resurfacing on the face. The study yielded a significant improvement in various wound healing parameters due to semi-occlusive environment and anti-inflammatory effect, which facilitated the wound healing process.^9,10

After the 28-day treatment, there was a statistically significant improvement of skin hydration and skin barrier function on the HO treated side at 14 and 28 days of overall evaluated times points. However, the TAU treated side showed no significant improvement. Thus, HO could improve TEWL and SCH compared with TAU following various complex moisturizer ingredients including occlusive, humectant, and emollient.²¹ Focusing on SCH and humectant ingredients, panthenol is the effective humectant as a precursor for fatty acid structure of skin barrier.²⁵ Glycerin is also a natural humectant which can modulate the water channel defect in the skin.²⁶ A previous study using a hand cream containing panthenol and glycerin showed a significant improvement of SCH after 4-week application.²³ However, the hand cream containing dimethicone as an occlusive ingredient failed to show a significant improvement of TEWL. Also, dimethicone could reduce trans-epidermal water loss for about twenty percent,²⁷ while petrolatum in the HO was very strong occlusive that provided more than 99 percent of TEWL reduction.²⁸ Nevertheless, the strong occlusive effect and stickiness could cause some discomforts, especially in the elderly patients who should be cautious about falling. 

The biometric assessment at Day 14 and 28 showed the efficacy of HO in reducing skin inflammation by a decrease of hemoglobin index. Previous studies using skin redness on the face by hemoglobin index yielded a good sensitivity and clinical correlation.^29,30 According to the data in our study, a decrease of redness on the hand was also associated with a lower clinical severity score (HECSI) and better clinical photographs of the patients. Nonetheless, there was no statistically significant improvement in texture index (roughness) throughout the study. In the meantime, improvement of wrinkles and skin quality after facial rejuvenation demonstrated by texture index could provide a good clinical correlation.³¹ These results may be explained by many factors, such as numerous tiny lines of finger and prints in the hand area, difficulty to control the exposure of special camera during measurement, and no standard representative area for measurement.

When compared to previous studies, our study provided the assessment of detailed objective skin biophysics, such as TEWL and SCH, as well as biometric assessment on the hand area.^22,23 The split-hand, evaluator-blinded and randomized controlled study design was also helpful to demonstrate the difference between both treatment arms without interpersonal 

bias. Moreover, the topical corticosteroid with humectant was used as a control for comparison between steroid-free moisturizer and steroid-containing moisturizer. In addition, the post-moisturizing effects were evaluated after one week of treatment cessation. Significantly, the decreasing exposure to steroids and the post-moisturizing effects were potential for longer maintenance of skin hydration and treatment of CHE.

Limitations. Limitations of our study included a short period of follow-up and small sample size. Whereas, the study was performed only in the middle-aged adult population with mild-to-moderate severity CHE. Moreover, there were no data about the combination of HO with standard treatments, such as topical corticosteroid, systemic corticosteroid, phototherapy, and other immunosuppressive drugs. Thus, further studies should be recommended to elucidate and ratify the effects of HO containing anti-inflammatory ingredients effects for favorable results of CHE treatment, especially for the avoidance of steroid effects.

Conclusion

The HO moisturizer containing anti-inflammatory ingredients is non-inferiority to TAU and yields a significant efficacy in mild-to-moderate CHE treatment, with a statistically significance in various parameters, including HECSI, DLQI, VAS, and hemoglobin index. Importantly, there is a significantly improvement of TEWL and SCH only in the HO treated side, but not the TAU treated side, when compared to baseline. In particular, no severe or irreversible complications, such as skin atrophy, telangiectasia, and hypopigmentation, are reported throughout the study period. Hence, HO can be an optional treatment of long-term CHE for the avoidance of adverse impacts from high potency corticosteroids and skin moisture improvement.

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