Chronic hand eczema (CHE) is an inflammation of the skin of the hand that is accompanied by redness, scaling, formation of papules and vesicles, hyperkeratosis, fissures, cracking, burning, itching, and swelling of the skin 1. Its one-year prevalence in the general population is estimated at about 10%.2 Hand eczema is considered chronic when the duration is greater than three months or it recurs at least twice a year. CHE has a negative impact on quality of life and is associated with substantial direct and indirect economic costs 3.

Hand eczema is typically classified according four etiological subtypes: irritant contact, allergic contact, protein contact, and atopic, and four clinical subtypes: hyperkeratotic, acute recurrent vesicular, nummular, and pulpitis 4. In patients with CHE, there is often a mixture of underlying atopy and irritants 3. Diagnosis requires a thorough examination including detailed patient history, signs and symptoms, atopic evaluation, for example by atopic score, patch test, and elimination of differential diagnoses 4.

Emollients and corticosteroids are often used as first-line agents for CHE treatment to reduce acute inflammation. Second-line agents include tacrolimus ointment, alitretinoin, cyclosporine A, and phytotherapy 4. Corticosteroids are a class of steroid hormones that are used for their anti-inflammatory and immunosuppressive properties. However, topical use is associated with various side effects, including telangiectasia, purpura, striae, allergic contact dermatitis, irritation, itching, dry skin, folliculitis, and thinning of the skin 5,6.

Traditional, complementary, and integrative medicine (TCIM), particularly Persian medicine (PM), has gained significant attention in the management of various dermatological diseases with potential benefits in recent literature 7,8. A recent systematic review highlighted the potential of herbal medicines in preventing and treating contact dermatitis. The review revealed that these remedies demonstrated promise by reducing inflammation and enhancing the body's antioxidant defense mechanisms 9. Due to the side effects of the aforementioned treatments 5,6, there is growing interest in the use of TCIM for managing CHE 10, 11, 12 and other types of dermatitis 13,14. Indeed, CHE is not a new phenomenon, and its management is well described in traditional medical texts 15.

In Persian medicine, Portulaca oleracea (purslane) is commonly used to treat skin ailments, including CHE 15, 16, 17. It is called as Khorfá or Bághlát-ál-hámghā in Persian literature 17,18. PM scholars believed that topical or systemic use of herbal agents with wet temperament (with different spelling; mizaj, mizadj, or mezaj) would be helpful to moisturize different organs affected by dry dystemperament 16,19. For instance, Avicenna recommended the use of purslane for such skin disorders because of its cold and wet nature (mizaj) which could eliminate the dryness of the affected skin besides its purgative property to spill inappropriate humor out of skin tissue deliberately 15.

P. oleracea is an succulent herbaceous plant of the Portulacaceae family that has many nutritious and antioxidant properties and also has shown many medicinal properties such as anti-inflammatory, neuroprotective, anti-diabetic, antimicrobial, anti-cancer, and anti-ulcer ones because of its flavonoids, alkaloids, and omega-3 fatty acids content 20, 21, 22. In addition, the preliminary safety of P. oleracea has been verified in a few pilot clinical trials 23.

Due to the high prevalence of CHE coupled with the complications of long-term use of corticosteroids, this study was performed to evaluate the efficacy and safety of standardized P. oleracea product in adults with symptoms and signs of mild or moderate chronic hand eczema.