Impaired work productivity in adults with Chronic Hand Eczema: A survey of patients in a large integrated healthcare system in the United States

Introduction Chronic Hand Eczema (CHE) is an inflammatory skin disease of the hands associated with recurring flares and substantial productivity and activity impairment. Treatments used in CHE include topical corticosteroids (TCS), other topicals, systemic treatments, and phototherapy. This survey aimed to determine work productivity impacts on employed patients with CHE undergoing treatment in a large integrated US healthcare system. Methods Between March and May 2026, an online cross-sectional survey was administered to employed adult patients receiving care within the Duke University Health System. Patients with a diagnosis of eczema or dermatitis were identified by using ICD-10-CM codes (L20, L23, L24, L25, L30) from electronic medical records and contacted through Epic MyChart. The study sample included patients with CHE, defined as hand/wrist eczema that persisted for ≥3 months or recurred ≥2 times within the past 12 months, who provided informed consent and completed the survey. The survey assessed sociodemographic, clinical, and occupational characteristics; self-assessed CHE severity; and work productivity as measured by the Work Productivity and Activity Impairment (WPAI) questionnaire. Descriptive statistics were used to describe patient characteristics and WPAI scores (absenteeism, presenteeism, overall work productivity impairment, and activity impairment). Results Among 301 patients (78.4% female, mean age 38.5 [standard deviation (SD) 12.3] years, 62.8% White, and 25.2% Black), most had a college degree (65.8%) and were employed full-time (77.1%). In addition, 41.5% worked in healthcare, and 50.5% reported a household income ≥$75,000/year. The most common CHE subtypes were irritant contact hand eczema (54.5%), atopic hand eczema (51.5%), allergic contact dermatitis (35.2%), and vesicular/dyshidrotic dermatitis (27.9%). Current CHE severity was rated as moderate by 36.2%, severe by 8.7%, or very severe by 2.0%. Over half of patients reported frequent washing/sanitizing of hands/wrists on a typical workday (times/day: 10-20: 39.5%, 21-40: 11.6%, ≥41: 6.0%). Patients handled potential irritants other than soap/sanitizer often (16.9%) or always (8.0%). Nearly all (95.7%) patients reported prior/current treatment with TCS; 50.5% had used TCS within the past week. Patients worked an average of 31.4 hours (SD, 17.1) in the past week; 41 (13.6%) missed ≥1 hour of work in the past week due to CHE. Patients missed a mean of 3.0% (SD, 11.7, median, 0.0) of work time (absenteeism) and experienced a mean of 30.9% (SD, 37.5, median, 10.0) impairment while working (presenteeism) due to CHE. In addition, the mean percentage of daily impairment in non-work activities due to CHE was 21.9% (SD, 23.0, median, 20.0). Mean work impairment or productivity loss due to CHE was 31.8% (SD, 37.9, median, 11.2). Overall, 42.2% of all patients and 38.6% of patients with self-assessed moderate to very severe CHE (n=140) perceived their CHE as caused or worsened by their workplace/occupation. Among all patients, 42.2% reported that household/leisure activities caused or worsened their eczema and 11.0% had changed jobs/work roles because of CHE. Conclusion Despite routine care, including TCS, CHE had a substantial impact on work productivity and daily activities among employed patients. These findings highlight the occupational burden of CHE, including reduced productivity, missed work, and employment-based changes.