Chronic hand eczema (CHE) is a frequent, often persistent inflammatory condition characterized by erythema, scaling, fissures and substantial discomfort of the hands. This condition occurs in both occupational and non-occupational settings and commonly follows a long, relapsing course that interferes with daily tasks, work performance, and impacts quality of life. The causes for CHE develop through a combination of genetic susceptibility, barrier disruption, immune activation, environmental irritants or allergens, and psychosocial stress.1 Despite the prevalence of chronic hand eczema and the availability of advanced treatments, many patients still experience inadequate disease control and persistent symptoms. Balato and colleagues, from the European Academy of Dermatology & Venereology Contact Dermatitis Task Force, published a comprehensive manuscript addressing frequent clinical questions and discussing topics such as the etiopathogenetic and epidemiologic background, clinical features, differential diagnosis, diagnostic workup, disease course, prognosis and scoring, the impact on quality of life and psychosocial and economic status, preventive strategies, and both established and emerging treatments for CHE. Among the newer pharmacological options are crisaborole, roflumilast, apremilast, AFX5931, dupilumab, tralokinumab, and lebrikizumab. The authors highlight that some of these agents are approved for other conditions but have demonstrated efficacy when used off-label in chronic hand eczema, while others have recently received approval or are expected to receive approval soon, specifically for this indication.2 Growing evidence shows that CHE cannot be adequately understood or treated through a purely dermatologic lens. Multiple studies now document that CHE carries a substantial psychiatric and psychosocial burden, with patients experiencing significantly elevated rates of anxiety, depression, social anxiety and avoidance behaviours3 A recent meta-analysis strengthens this conclusion, demonstrating that individuals with hand eczema consistently exhibit moderate-to-severe quality-of-life impairment and higher anxiety scores compared with healthy controls4 Psychosocial distress can be out of proportion to clinical severity. When taken together, these data show that CHE is not merely a localized skin inflammatory disorder but a biopsychosocial condition in which psychological state, stress biology, immune activation and skin barrier integrity continually interact. This perspective supports reshaping CHE management to routinely include psychosocial screening tools, stress-reduction strategies, referral to cognitive-behavioural interventions and evaluation of how comorbid anxiety or depression may influence the response to advanced systemic therapies such as JAK inhibitors or biologics. Dermatologists have the unique opportunity to provide early mental health referral and psychoeducation for these patients.5 Grammar and spelling were checked using Grammarly. No AI tools were used to generate or modify the scientific content of the manuscript. Katlein França receives book royalties from Springer, Wiley Blackwell and Nova Science Publisher, and is a medical board reviewer for the Health.com website. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Katlein França (Wed,) studied this question.