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Diagnosis and Management of Pediatric Chronic Hand Eczema: The PeDRA CACHES Survey
Michael A Haft1,2, Helen H Park1,2, Stephanie S Lee1,2
1Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92130, USA.
Insights
Pediatric hand eczema (P-CHE) diagnosis and treatment vary among North American dermatologists. This study provides the first characterization of P-CHE practices, guiding future research and management strategies.
Area of Science:
- Dermatology
- Pediatric Dermatology
- Epidemiology
Background:
- Chronic hand eczema (CHE) significantly affects quality of life.
- Limited literature exists on pediatric CHE (P-CHE) in North America, including epidemiology and management.
- Understanding P-CHE is crucial for improving patient outcomes.
Purpose of the Study:
- To assess diagnostic and therapeutic practices for P-CHE in the US and Canada.
- To gather data on clinician and patient demographics related to P-CHE.
- To establish a foundation for future P-CHE research.
Main Methods:
- A survey was distributed to pediatric dermatologists via the Pediatric Dermatology Research Alliance (PeDRA) from June 2021 to January 2022.
- Data collected included diagnostic methods, therapeutic agent selection, and patient population demographics.
- Twenty-one completed surveys provided insights into current clinical practices.
Main Results:
- Common P-CHE diagnoses include irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis.
- Contact allergy patch testing and bacterial hand cultures are frequently used diagnostic tools.
- Topical corticosteroids are the primary treatment, with dupilumab preferred for systemic therapy.
Conclusions:
- This study presents the first characterization of P-CHE among pediatric dermatologists in the US and Canada.
- Findings can inform the design of future investigations into P-CHE epidemiology, morphology, nomenclature, and management.
- This research highlights the need for standardized approaches to P-CHE evaluation and treatment.
Background:
Chronic hand eczema (CHE) significantly impacts quality of life. Published literature on pediatric CHE (P-CHE) in North America including knowledge on epidemiology and standard evaluation and management is limited.
Objective:
Our objective was to assess diagnostic practices when evaluating patients with P-CHE in the US and Canada, produce data on therapeutic agent prescribing practices for the disorder, and lay the foundation for future studies.
Methods:
We surveyed pediatric dermatologists to collect data on clinician and patient population demographics, diagnostic methods, therapeutic agent selection, among other statistics. From June 2021 to January 2022, a survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA).
Results:
Fifty PeDRA members responded stating that they would be interested in participating, and 21 surveys were completed. For patients with P-CHE, providers most often utilize the diagnoses of irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis. Contact allergy patch testing and bacterial hand culture are the most used tests for workup. Nearly all utilize topical corticosteroids as first line therapy. Most responders report that they have treated fewer than six patients with systemic agents and prefer dupilumab as first-line systemic therapy.
Conclusions:
This is the first characterization of P-CHE among pediatric dermatologists in the United States and Canada. This assessment may prove useful in designing further investigations including prospective studies of P-CHE epidemiology, morphology, nomenclature, and management.
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