Chronic Hand Eczema Guidance Highlights Diagnostic Gaps, Emerging Therapies

People living with chronic hand eczema (CHE) often face persistent itching, pain, fissures, and occupational disruption that can interfere with daily functioning long after symptoms first appear. New expert recommendations published in the American Journal of Clinical Dermatology outlined practical approaches to diagnosing and managing CHE in the US, where the condition has historically lacked standardized guidance and approved therapies.¹

The review article, authored by a multidisciplinary panel of dermatologists and eczema experts, summarized current evidence on diagnosis, severity assessment, subtype classification, and treatment strategies for CHE. The authors emphasized that CHE remained difficult to diagnose and manage because of its heterogeneous presentation, overlapping etiologies, and the absence of dedicated International Classification of Diseases, Tenth Revision (ICD-10) codes in the US.

CHE affects millions of people worldwide and remains one of the most common inflammatory skin conditions involving the hands, particularly among workers with frequent exposure to irritants, allergens, or repeated handwashing. Epidemiologic data cited in a 2024 review showed that hand eczema carries an estimated 1-year prevalence of approximately 10% in the general population, with women disproportionately affected because of occupational and household exposures.² Researchers also noted that many cases progress to chronic disease, defined as eczema persisting for more than 3 months or recurring multiple times annually, underscoring the substantial clinical and quality-of-life burden associated with CHE in the US and globally.

Chronic Hand Eczema Burden Extends Beyond Skin Symptoms

Symptoms commonly included pruritus, burning, pain, fissuring, scaling, and lichenification, all of which could impair hand function and limit occupational participation.¹ The present review highlighted that CHE is among the most common occupational skin diseases, particularly affecting people employed in cleaning services, construction, health care, hairdressing, and other professions involving repeated exposure to irritants or allergens.

The authors cited evidence showing that up to 57% of people with CHE took sick leave because of disease severity and approximately one-quarter experienced job loss or occupational changes related to their condition. US societal costs were estimated at roughly $5425 per patient annually.

“CHE must be recognized as a common and debilitating condition which requires timely diagnosis and treatment to maximize patient outcomes and alleviate QoL burdens,” the authors wrote.

Diagnostic Challenges Complicate Chronic Hand Eczema Management

Diagnosing CHE required a detailed medical history and full-body skin examination, according to the panel, with particular attention to occupational exposures, hobbies, allergen contact, and comorbid atopic dermatitis.

The authors noted that more than half of patients may have multiple CHE subtypes simultaneously, making classification difficult. Morphologic patterns alone could not reliably determine etiology, and overlap with psoriasis and allergic contact dermatitis frequently complicated diagnosis.

Several clinician- and patient-reported outcome measures were recommended to improve consistency in disease assessment. Among them were the Investigator Global Assessment for CHE (IGA-CHE), the Hand Eczema Severity Index (HECSI), itch numerical rating scales, pain scores, and quality-of-life measures such as the Dermatology Life Quality Index.

Patch testing remained the gold standard for identifying contact allergens, although the authors acknowledged that access to testing varied widely across the US. They recommended considering patch testing for people with disease lasting longer than 3 months, treatment-refractory disease, suspected allergic contact dermatitis, or occupational exposures.

Importantly, the panel cautioned against delaying treatment while diagnostic testing was underway.

“Early treatment of CHE is recommended to limit the disease’s impact on the patient,” the authors stated.

Delgocitinib Emerged as a Key Advancement in CHE Treatment

The review highlighted the limited US treatment landscape for CHE. At the time of publication, topical delgocitinib was the only FDA-approved therapy specifically indicated for CHE in people who had not adequately responded to or could not use topical corticosteroids.³

In pooled phase 3 trial data cited by the authors, 24% of participants treated with topical delgocitinib achieved an IGA-CHE score of clear or almost clear with at least a 2-grade improvement after 16 weeks compared with 8.4% of participants receiving vehicle treatment (P < .001). Nearly half of participants receiving delgocitinib achieved a 75% improvement in HECSI scores compared with 21% receiving vehicle treatment.

The panel also noted rapid symptom improvements, with itch reduction beginning on day 1 and pain improvement by day 3.

Although topical corticosteroids remained a common first-line therapy, the authors warned against prolonged continuous use because of adverse effects including skin atrophy, impaired skin barrier recovery, and topical steroid withdrawal. They cited survey data showing that approximately 84.8% of people using topical corticosteroids for CHE experienced at least 1 adverse event.

The article additionally reviewed off-label and investigational approaches, including calcineurin inhibitors, phosphodiesterase-4 inhibitors, biologics, oral Janus kinase inhibitors, phototherapy, and systemic retinoids such as alitretinoin, which is approved in Europe and Canada but not in the US.

Pediatric Chronic Hand Eczema Remains Understudied

The authors also identified major evidence gaps in pediatric and adolescent CHE. They noted that no formal US guidelines currently exist for children despite CHE being relatively common in pediatric populations.

Atopic dermatitis and allergic contact dermatitis were described as the most common pediatric subtypes. The panel reported that clinicians generally relied on topical corticosteroids and calcineurin inhibitors because of limited pediatric safety and efficacy data for systemic therapies.

However, the authors highlighted recent phase 3 findings from the DELTA TEEN trial evaluating topical delgocitinib in adolescents aged 12 to 17 years with moderate-to-severe CHE. According to the review, the study met its primary endpoint and demonstrated significant improvement compared with vehicle treatment.

Study Limitations Reflect Broader Evidence Gaps

The publication was a narrative expert review rather than a randomized clinical study, and many therapeutic recommendations relied on limited clinical trial evidence, retrospective analyses, or extrapolation from atopic dermatitis research.

The authors acknowledged that randomized controlled trials remained sparse for many CHE therapies, particularly in pediatric populations and across specific CHE subtypes. They also noted variability in patch-testing practices, differences between US and European diagnostic approaches, and the absence of universally accepted CHE classification systems.

Still, the panel argued that the proposed diagnostic workflow and treatment algorithm may help clinicians navigate a disease area that has historically lacked standardized guidance in the US.

“Recognizing and addressing CHE promptly is crucial to improving patient well-being and [quality of life],” the authors concluded.

References

1. Silverberg JI, Cohen D, Guttman-Yassky E, et al. Expert recommendations for the diagnosis and management of chronic hand eczema in the United States. Am J Clin Dermatol. 2026;27:227-245. doi:10.1007/s40257-026-01008-3

2. Weisshaar E. Chronic hand eczema. Am J Clin Dermatol. 2024;25(6):909-926. doi:10.1007/s40257-024-00890-z

3. Shaw ML. FDA approves delgocitinib for moderate to severe hand eczema. AJMC^®. July 24, 2025. Accessed May 29, 2026. https://www.ajmc.com/view/fda-approves-delgocitinib-for-moderate-to-severe-hand-eczema