Chronic hand eczema (CHE) is a multifactorial skin condition that significantly impacts patients’ quality of life, with substantial physical, psychological, and socioeconomic burdens. It is characterized by eczematous lesions on the hands and wrists, often accompanied by pain and itchiness. CHE is not merely a variant of atopic dermatitis (AD); it encompasses various subtypes, including irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), and protein contact dermatitis (PCD), which can overlap and complicate diagnosis and treatment.
Prevalence and Impact
CHE affects a significant portion of the population, with a lifetime prevalence estimated at 15%. It is more common in women and individuals in their early to mid-20s. Occupational exposures, such as those in hairdressing, housekeeping, metalworking, and healthcare, are key drivers of CHE, contributing to over 30% of cases. The condition can lead to prolonged sick leave, job loss, and even forced retirement. Psychologically, CHE is associated with increased rates of depression and anxiety, with symptom severity correlating with poorer mental health outcomes.
Diagnosis Challenges
Diagnosing CHE can be complex due to its heterogeneous nature and overlapping subtypes. Patch testing is considered the gold standard for identifying ACD, but its utility in CHE management is debated. While some guidelines advocate for routine patch testing in all CHE cases, others suggest a more selective approach due to practical limitations, including accessibility, cost, and the challenge of allergen avoidance. For instance, in Europe, routine patch testing is recommended but hindered by economic and accessibility constraints. In contrast, North America promotes a selective approach, reserving patch testing for cases with strong clinical suspicion of ACD or those unresponsive to standard therapies.
Treatment Landscape
Current treatments for CHE often involve repurposing therapies initially developed for AD. However, these treatments may not be as effective when CHE is driven by other mechanisms. The emergence of targeted therapies, such as delgocitinib—a topical pan-JAK inhibitor—offers new hope. Delgocitinib has demonstrated comparable efficacy to oral alitretinoin, a standard-of-care treatment in Canada and Europe, but unavailable in the US. This highlights the need for therapies specifically targeting the unique immunopathogenesis of CHE.
Future Directions
Given the multifactorial nature of CHE and the challenges in diagnosis and treatment, a global consensus on classifying and assessing CHE is crucial. Future research should focus on developing targeted therapies that address the underlying mechanisms of CHE, improving diagnostic tools, and enhancing patient education. Collaboration between clinicians, researchers, and industry leaders is essential to drive innovation and improve outcomes for patients with CHE.
In summary, chronic hand eczema is a distinct and complex condition that requires tailored diagnostic approaches and targeted treatments to effectively manage its multifactorial nature and reduce its significant burden on patients.
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