Quality of Life and Daily Functioning Impairment Among Working Adults with Chronic Hand Eczema in a Large Integrated Healthcare System in the United States

Introduction Chronic Hand Eczema (CHE) is a fluctuating and recurring inflammatory skin disease characterized by redness, scaling, cracking, pain, and itching of hands. This study assessed dermatology-specific quality of life and the impact of CHE on daily functioning among patients receiving care within the Duke University Health System. Methods Invitations to complete an online cross-sectional survey were sent to patients with ≥1 ICD-10 codes consistent with eczema or atopic dermatitis between March and May 2026. Screening questions were used to limit eligibility to patients reporting part-time or full-time employment and eczema/atopic dermatitis on hand(s) and/or wrist(s) that persisted for ≥3 months or recurred ≥2 times within the past 12 months. Dermatology-specific quality of life was assessed using the Dermatology Life Quality Index (DLQI) and disease-specific functional impact using the Hand Eczema Impact Scale (HEIS). Higher scores indicate greater negative impacts. Results A total of 301 adults with CHE completed the survey. The mean (SD) age was 38.5 (12.3) years, 78.4% were female, 62.8% identified as White, and 25.2% identified as Black or African American. Mean age at symptom onset was 20.2 (SD 14.0) years. More than half (52.5%) reported that their hand/wrist eczema was currently clear or almost clear, 36.2% reported moderate severity, and 10.7% reported severe or very severe CHE. Nearly all respondents (99.0%) reported use of topical therapies. Among the majority (71.8%) reporting use of only topical corticosteroids (TCS), 15.7% reported skin clearance after treatment. The mean DLQI total score was 6.7 (SD 6.1) out of 30. Overall, 21.9% of respondents reported DLQI scores indicating a very large (11-20) or extremely large (21-30) effect of CHE on quality of life. The greatest impairment was observed in the DLQI Symptoms and Feelings subscale (mean 2.6, SD 1.7) followed by Daily Activities (mean 1.4, SD 1.6) out of 6. The mean HEIS total score was 1.2 (SD 0.9) out of 4. Among HEIS domains, the highest mean scores were observed for Embarrassment (1.6, SD 1.3), Frustration (1.6, SD 1.2), and Proximal Daily Activity Limitations (1.4, SD 1.0). Both DLQI and HEIS scores increased progressively with worsening self-reported current CHE severity. Mean DLQI scores ranged from 2.5 (SD 2.8) among respondents reporting clear skin to 14.2 (SD 6.5) among those reporting very severe disease, while mean HEIS scores increased from 0.4 (SD 0.4) to 2.3 (SD 0.5) across the same severity categories (p=0.0001). Among respondents who had only ever used TCS, mean DLQI scores were lowest among those reporting clearance of eczema with treatment (2.8, SD 3.5) and highest among those reporting that their eczema did not improve with treatment (8.4, SD 7.2) (p=0.0001). Conclusions This is the first study reporting on quality of life and functional impairments among working adults with CHE treated at a large health system in the US. The findings revealed that despite more than half of respondents reporting clear or almost clear skin at the time of survey, a substantial proportion continued to experience meaningful impairments, underscoring the psychosocial burden of chronic hand eczema despite extensive use of topical therapy.