Test Your Knowledge: Chronic Hand Eczema

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Chronic Hand Eczema (CHE) is a heterogeneous, long-lasting inflammatory skin disease with varying clinical presentations, complicating diagnosis and management. The condition can significantly impact quality of life, with visible symptoms leading to psychosocial and socioeconomic burdens. Use the quiz below to test your knowledge on a few pearls of the condition.

Test Your Knowledge

“I know what you're thinking, chronic hand eczema? Don't you mean atopic dermatitis or allergic current topic dermatitis or irritant contact dermatitis? Is that even a disease? The short answer is yes, but the long answer is that really, it's an entity that we all see every day. It creates a huge burden for patients, and frankly, is quite common,” said Raj Chovatiya, MD, PhD, clinical associate professor at the Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, Illinois. “But it'sone we don't really give much thought to, other than the fact that we really wish that we had better understandingof the pathophysiology and potentially what types of therapeutics might cause relief for patients.”

Case-Based Questionnaire

Using the provided information, use your knowledge to best treat the patient in this case study.

The patient, a healthcare worker, has a rash on their palm and back of hand.They state it is itchy and gets worse when at work, but typically improves with time away from work. They have no relevant medical history of skin problems.

Many cases of hand eczema are multi-factorial, such as this case in which both irritant contact dermatitis from frequent hand washing and allergic contact dermatitis to gloves were contributing to the dermatitis. While it would have been reasonable to pursue patch testing at the first visit, many patients prefer an attempt at empiric therapy before going through the inconvenience of a patch test.

High potency topical steroids can affect barrier function of the skin even when there is no visible atrophy, which can exacerbate susceptibility to irritants and allergens. Thus, when high potency topical steroids are not adequately effective, switching to an agent that does not impair barrier function, such as a topical JAK inhibitor, can be very helpful.

Matthew Zirwas, MD, a board-certified dermatologist based at DOCS Dermatology in Columbus, Ohio. He has specialized in contact dermatitis, pruritus, atopic, and seborrheic dermatitis for the last 20 years, and emphasizes the importance of figuring out the real, practical, take-home messages from medical literature.

References

1. European Commission approves LEO Pharma’s Anzupgo(delgocitinib) cream for adults with moderate to severe chronic hand eczema (CHE). News release. LEO Pharma. September 23, 2024. Accessed October 23, 2024. https://www.leo-pharma.com/media-center/news/2024-european-commission-approves-leo-pharma-anzupgo#:~:text=BALLERUP%2C%20Denmark%2C%20September%2023%2C,eczema%20(CHE)%20for%20whom%20topical
2. FDA accepts LEO Pharma’s filing of delgocitinib cream new drug application for the treatment of chronic hand eczema. News release. Business Wire. September 23, 2024. Accessed October 23, 2024. https://www.businesswire.com/news/home/20240923600460/en/FDA-Accepts-LEO-Pharma%E2%80%99s-Filing-of-Delgocitinib-Cream-New-Drug-Application-for-the-Treatment-of-Chronic-Hand-Eczema