5 Things to Know About Chronic Hand Eczema and Its Evolving Treatment Landscape

Hands cannot be tucked under a sleeve, rested for a week, or excused from a shift. That constant exposure—mechanical, chemical, and social—helps explain why chronic hand eczema (CHE) behaves differently from eczema elsewhere on the body and why the US had no treatment approved specifically for it until 2025.

Here are 5 things every dermatologist should know about chronic hand eczema and its growing treatment space.

1. CHE Is Defined by Time, Not Just Location

CHE is diagnosed when hand eczema persists beyond 3 months or recurs at least twice within a year.¹ Median duration runs 11 to 16 years, and symptoms flare rather than resolve cleanly, so patients often manage the condition across a decade or more of working life.

The multinational CHECK survey of 60,131 adults in Canada, France, Germany, Italy, Spain, and the UK put the annual prevalence of self-reported physician-diagnosed CHE—defined per European Society of Contact Dermatitis criteria—at 4.7% (95% CI, 4.6%-4.9%), significantly higher in women than in men (5.6% vs 3.8%; P < .001) and in employed vs unemployed people (5.3% vs 3.3%; P < .001).² Prevalence peaked at 6.5% between ages 30 and 39 years.

2. CHE Is Not Simply Atopic Dermatitis of the Hands

The RWEAL retrospective chart review of 1939 adults with moderate to severe CHE, drawn from 292 physicians in 6 countries, found multiple etiological subtypes, with irritant contact dermatitis the most frequent at 40.1%, followed by atopic dermatitis at 33.1% and allergic contact dermatitis at 27.5%.³ A history of atopic dermatitis was documented in 43.8% of patients, meaning most had none at all.

“Many patients had no atopic condition besides CHE, and no history of atopic dermatitis, indicating that CHE is not simply atopic dermatitis of the hands,” the researchers wrote. Molecular evidence points the same way: tape stripping of lesional skin from 66 adults with moderate to severe CHE found that those without comorbid atopic dermatitis skewed toward type 1 immune signaling, while those with it showed a stronger type 2 pattern.⁴

3. Atopic Dermatitis Is Still the Strongest Single Risk Factor

Distinct does not mean unrelated. A systematic review and meta-analysis found that atopic dermatitis was associated with a substantially higher lifetime prevalence of hand eczema (OR, 4.06; 95% CI, 2.72-6.06) and 1-year prevalence (OR, 4.29; 95% CI, 3.13-5.88), along with elevated lifetime risk of occupational hand eczema (OR, 2.81; 95% CI, 2.08-3.79).⁵

Atopic hand dermatitis is increasingly treated as its own entity within CHE, shaped by what is likely a distinct interplay of environmental triggers, genetic predisposition, and immune dysfunction.⁶ Identifying it means catching subtle differences from conditions that mimic CHE on the hands, such as psoriasis, tinea, and palmoplantar pustulosis—a differential complex enough that misdiagnosis itself may contribute to chronicity.¹

4. The Heaviest Burden Lands at Work

Among 507 individuals surveyed in a US managed care organization, work time missed did not differ significantly between those with and without CHE, but impairment while working did (mean, 26.86% vs 12.68%; P < .001), as did overall work impairment (29.33% vs 6.85%; P < .001). Among 500 Dutch adults with CHE, 40.8% reported working through the condition in the past year, and 22.7% did so when they should have rested, fearing job loss.

Annual societal costs per patient across European studies ranged from €1813 to €7738, with indirect costs accounting for roughly half or more; a systematic review found up to 57% took sick leave and up to 25% left or changed jobs. In a European multicenter study, patients with hand eczema reported significantly greater clinical depression, anxiety disorder, and suicidal ideation than those with other common skin diseases.

5. Topical Steroids Are No Longer the Only Option

Topical corticosteroids remained the mainstay for decades despite documented limits. In survey data from the Danish Skin Cohort, 84.8% of 724 adults reported at least 1 adverse event from using them for CHE, most commonly skin atrophy, and 76% preferred a nonsteroidal option. In a separate multicenter study of 819 patients, 12.5% were refractory to topical corticosteroid therapy altogether.

That changed on July 23, 2025, when the FDA approved d≈o; LEO Pharma) cream 20 mg/g, a topical pan–Janus kinase inhibitor, as the first US treatment indicated specifically for moderate to severe CHE in adults with an inadequate response to topical corticosteroids or for whom they are not advisable.⁷ Approval rested on DELTA 1 (NCT04871711) and DELTA 2 (NCT04872101), 2 completed phase 3 vehicle-controlled trials enrolling 960 adults.⁸

The completed head-to-head phase 3 DELTA FORCE trial (NCT05259722) then tested the cream against oral alitretinoin, the only systemic drug approved for severe CHE where it is available.⁹ Among 513 adults randomly assigned, the least-squares mean Hand Eczema Severity Index score fell 67.6 points with delgocitinib vs 51.5 with alitretinoin by week 12 (difference, −16.1; 95% CI, −23.3 to −8.9; P < .0001), and adverse events occurred in 49% vs 76% of patients.

For payers and clinicians, CHE warrants a work-up rather than a reflexive prescription, because patch testing, an occupational history, and subtype identification determine which of the newly widened options fits. Pinpointing the cause often takes time and detective work, and lasting relief depends on finding and avoiding a specific trigger as much as on the drug applied over it.¹⁰

References

1. Molin S, Guttman-Yassky E, Thyssen JP, Bewley A. Chronic hand eczema, real world, and patient centricity: a narrative review. Acta Derm Venereol. 2025;105:adv42596. doi:10.2340/actadv.v105.42596
2. Apfelbacher C, Bewley A, Molin S, et al. Prevalence of chronic hand eczema in adults: a cross-sectional survey of over 60 000 respondents from the general population of Canada, France, Germany, Italy, Spain and the UK. Br J Dermatol. 2025;192(6):1047-1054. doi:10.1093/bjd/ljaf020
3. Fargnoli MC, Molin S, Bewley A, et al. Moderate to severe chronic hand eczema in clinical practice: etiological subtypes, clinical signs and symptoms, and comorbidities—results from the RWEAL study. J Dermatolog Treat. 2026;37(1):2603121. doi:10.1080/09546634.2025.2603121
4. Bar J, Del Duca E, David E, et al. Skin tape stripping reveals distinct biomarker profiles in chronic hand eczema of patients with and without comorbid atopic dermatitis. Allergy. 2025;80(8):2271-2285. doi:10.1111/all.16466
5. Ruff SMD, Engebretsen KA, Zachariae C, et al. The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis. Br J Dermatol. 2018;178(4):879-888. doi:10.1111/bjd.16147
6. Port LR, Brunner PM. Management of atopic hand dermatitis. Immunol Allergy Clin North Am. 2026;46(3):543-549. doi:10.1016/j.iac.2026.04.013
7. LEO Pharma announces FDA approval of ANZUPGO (delgocitinib) cream in the U.S. News release. LEO Pharma. July 23, 2025. Accessed August 21, 2026. https://www.businesswire.com/news/home/20250723974453/en/LEO-Pharma-Announces-FDA-Approval-of-ANZUPGO-delgocitinib-Cream-in-the-U.S
8. Shaw M. FDA approves delgocitinib for moderate to severe hand eczema. AJMC^®. July 24, 2025. Accessed August 21, 2026. https://www.ajmc.com/view/fda-approves-delgocitinib-for-moderate-to-severe-hand-eczema
9. Giménez-Arnau AM, Pinter A, Sondermann W, et al. Efficacy and safety of topical delgocitinib cream versus oral alitretinoin capsules in adults with severe chronic hand eczema (DELTA FORCE): a 24-week, randomised, head-to-head, phase 3 trial. Lancet. 2025;405(10490):1676-1688. doi:10.1016/S0140-6736(25)00001-7
10. Dry, scaly, and painful hands could be hand eczema. American Academy of Dermatology. Accessed August 21, 2026. https://www.aad.org/public/diseases/eczema/types/hand-eczema