Chronic Hand Eczema (CHE): A Narrative Review.

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Chronic hand eczema (CHE) is a prevalent and difficult skin condition defined by persistent hand dermatitis lasting over three months or recurring at least twice annually.
• It is multifactorial, influenced by genetics, environmental triggers like irritants and allergens, and complex immune responses, particularly Th1/Th2 cell activity.
• CHE significantly impacts patients' quality of life, presenting with symptoms such as redness, scaling, and itching.

Purpose of the Study:

• To review the current understanding of chronic hand eczema, including its pathogenesis, clinical presentation, and management.
• To highlight emerging therapeutic strategies and molecular targets for severe cases of CHE.
• To emphasize the need for patient-centered approaches in managing this chronic condition.

Main Methods:

• Literature review of chronic hand eczema, encompassing pathogenesis, clinical features, and treatment modalities.
• Analysis of current and emerging systemic therapies, including Janus kinase (JAK) inhibitors and biologics.
• Identification of key molecular targets such as interleukins (IL-4, IL-13), JAK-STAT pathway, phosphodiesterase 4 (PDE4), and chemokines.

Main Results:

• CHE pathogenesis involves intricate immune mechanisms, with Th1/Th2 cell responses playing a key role.
• Traditional treatments include emollients and topical corticosteroids, while severe cases are increasingly managed with systemic therapies.
• Emerging treatments target molecular pathways like IL-4/IL-13, JAK-STAT, PDE4, and chemoattractant chemokines.

Conclusions:

• Effective management of CHE is challenging due to its chronic nature and variable treatment responses.
• New systemic therapies and targeted molecular approaches represent significant advancements in treating severe CHE.
• Future strategies focus on patient-centered care, integrating emerging treatments for improved outcomes.