Canadian Dermatology Panel Reaches Consensus on Hand Eczema Targets

Itchy, cracked, and painful hands can derail daily routines for people living with chronic hand eczema, yet clinicians have long lacked an agreed-upon way to measure whether treatment was working well enough to continue, adjust, or stop. A panel of Canadian dermatologists has now proposed a structured answer in the form of a treat-to-target (T2T) framework, published as a brief report in the Journal of the American Academy of Dermatology.¹

Filling a Gap in Hand Eczema Management

Treat-to-target models, which set defined response thresholds clinicians can use to guide ongoing management decisions, have already been adopted for conditions including psoriasis and atopic dermatitis. No such framework previously existed for chronic hand eczema, even as the number of approved and investigational therapies for the condition has expanded.

The scope of the condition helps explain the push for standardized targets. A multinational survey of more than 60,000 adults across Canada, France, Germany, Italy, Spain, and the UK found that an estimated 4.7% reported a physician diagnosis of chronic hand eczema in the prior year.² The same survey found the condition was more common among women, employed people, and urban residents, with prevalence peaking among adults age 30 to 39 years.

To address the lack of a standardized framework, a committee of seven Canadian dermatologists with expertise in chronic hand eczema convened in November 2025.¹ The group performed a targeted literature review and surveyed members on the clinician-rated scales and patient-reported outcome measures (PROMs) most commonly used in chronic hand eczema, along with appropriate timing for assessments. During a virtual meeting the following month, committee members proposed and voted on candidate criteria using a 5-point agreement scale, with consensus defined as agreement of 75% or higher.

Two-Tier Framework Pairs Clinician and Patient Measures

The committee landed on 2 T2T criteria, each combining a clinician-rated scale with a PROM, and each reached unanimous, 100% agreement during voting. For initial assessment, conducted 8 to 16 weeks after starting or changing treatment, the criteria called for at least a 1-point improvement on the Investigator's Global Assessment for Chronic Hand Eczema (IGA-CHE) along with at least a 3-point improvement on a pruritus numerical rating scale (NRS). On the initial vote, 4 panelists (57%) agreed and 3 (43%) strongly agreed with this criterion.

Maintenance criteria, assessed 16 to 32 weeks after initial targets were met, set a higher bar: an absolute IGA-CHE score of 0 or 1, corresponding to "clear" or "almost clear" skin, paired with an absolute pruritus NRS score of 0 or 1. This criterion drew even stronger support, with 2 panelists (29%) in agreement and 5 (71%) in strong agreement. The panel noted that if maintenance targets were not met or were met but later lost, clinicians should consider revisiting treatment using either the initial or maintenance criteria as appropriate.

Itch Scale Emerges as Preferred Patient-Reported Tool

The committee selected the IGA-CHE as its preferred clinician-rated scale because it functions as a single-item score that fits easily into routine visits and because it can be used interchangeably with the Physician's Global Assessment without requiring a rigid definition of "almost clear." For the patient-reported component, the pruritus NRS was favored since itch tends to be the symptom patients with chronic hand eczema find most bothersome. When pruritus did not apply to a particular patient's presentation, the panel deemed an NRS pain score or the Dermatology Life Quality Index acceptable substitutes.

Because this report described the output of an expert consensus process rather than an interventional trial, it did not enroll a patient cohort, and no patient demographic data were collected or reported. The framework instead reflects synthesized clinical expertise intended for later application across real-world patient populations. No clinical trial was registered in connection with this work, and the report listed patient consent and institutional review board approval as not applicable, consistent with its design as a consensus statement rather than a prospective study.

Panel Cites Limitations, Calls for Real-World Validation

The authors were direct about where the framework's evidence base falls short. They acknowledged that the proposed T2T criteria offer a pragmatic approach to optimizing the management of chronic hand eczema while pointing to several open questions, including the subjective nature of the outcome measures involved, the absence of validation in everyday clinical settings, and the framework's grounding in a specific geographic population. Those caveats suggest the targets may need further testing before they can be broadly applied outside Canadian dermatology practice.

For clinicians treating people with chronic hand eczema, the framework offers a starting point for structuring follow-up visits and treatment decisions around defined, patient-relevant benchmarks rather than open-ended assessment. Whether the criteria hold up across more diverse patient populations and practice settings remains to be seen as real-world data accumulate.

References

1. Yeung J, Gooderham M, Hong HC, et al. A practical framework for treating-to-target in chronic hand eczema. J Am Acad Dermatol. Published online May 7, 2026. doi:10.1016/j.jaad.2026.05.002
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