Chronic hand eczema: Common questions and practical recommendations from the EADV Contact Dermatitis Task Force

Chronic hand eczema (CHE) is a prevalent and complex skin condition that can significantly affect patients' quality of life (QoL) and social and occupational functioning. In this review structured as questions and answers format, we aimed to target the main topics of CHE including etiopathogenetic-epidemiologic background, clinical findings, differential diagnosis/diagnostic assessment, course-prognosis and scoring, impact on QoL and psycho-socio-economic status, prevention and treatment. CHE may result from irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), atopic dermatitis (AD) or other unclassified causes and is often related to occupational exposure, especially in environments with frequent water exposure. CHE can manifest in various forms, with distinct clinical and aetiological subtypes, which helps both in diagnosis and treatment. The epidemiology of CHE is probably widely underreported, but it has a higher incidence in women, though it tends to be more severe in men. Genetic predisposition plays a role, but environmental factors, particularly in occupational settings, are key contributors. Pathogenetically, CHE involves different but overall similar immune responses depending on the subtype, including both Th1, Th2 and innate immune system reactions, alongside to chronic skin barrier dysfunction. The impact of CHE on QoL is comparable to other chronic conditions, with significant psycho-social and economic consequences, including work absenteeism and increased healthcare costs. Preventive strategies focus on avoiding trigger factors and promoting proper hand care, while treatment involves a combination of topical and systemic therapies. Non-pharmacological measures like moisturizers, topical corticosteroids and calcineurin inhibitors are common treatments. Recent advances in the development of biologics, including JAK inhibitors, show promise for moderate to severe cases, although their safety and efficacy remain under investigation. While current treatments aim to manage symptoms, there is an urgent need for further research into the pathogenesis of CHE to enable the development of more targeted and effective long-term therapies.