[Hand eczema: comprehensive management and therapeutic perspectives in primary care]

Hand eczema is a common inflammatory dermatosis in primary care, characterized by erythema, pruritus, scaling, fissures, and functional impairment. It encompasses various clinical and etiological forms, either acute or chronic, related to irritant, allergic, or atopic mechanisms. When the condition persists for more than three months or recurs at least twice within one year, it is defined as chronic hand eczema. This represents one of the most prevalent dermatoses, with substantial clinical, occupational, and psychosocial impact. Its multifactorial pathogenesis involves genetic predisposition, barrier dysfunction, and environmental exposures, particularly to occupational irritants and allergens. In primary care, the family physician plays a key role in the early recognition of hand eczema, patient education on skin care and preventive measures, and in identifying alarm signs that warrant referral to a dermatologist. A focused history and clinical examination enable diagnostic orientation and allow the initiation, from the first consultation, of appropriate topical treatment, emollient use, and protection against triggering factors. Referral should be considered in severe, refractory cases or those with significant functional or occupational impact, in order to assess advanced therapies such as phototherapy, alitretinoin, dupilumab, oral JAK inhibitors, or topical delgocitinib.