Chronic hand eczema (CHE) is an inflammatory skin disease localized to the hands and wrists that lasts for more than 3 months or relapses at least twice per year. The diagnosis, treatment, and management of CHE presents clinical challenges owing to its multifactorial etiology, heterogeneous presentation, and the absence of a standardized classification system. In the USA there are no specific International Classification of Disease-10 (ICD-10) diagnostic codes, which makes tracking the diagnosis and resultant treatments difficult. Topical delgocitinib is currently the only Food and Drug Administration approved medication for CHE, for patients who have not responded adequately to, or are unable to use, topical corticosteroids. This article provides an overview of the diagnostic and therapeutic considerations of CHE, while presenting practical recommendations to help improve management of the disease within the USA. Diagnostic assessments focusing on detailed patient history and physical examination are proposed, followed by a multi-step approach to treatment. The importance of both clinician, and patient, reported outcome measures are emphasized, to encompass not only disease presentation and severity, but also the impact on patient quality of life.
Silverberg et al. (Sun,) studied this question.