A new expert consensus, published in the American Journal of Clinical Dermatology, provides a comprehensive framework for the diagnosis and management of chronic hand eczema (CHE) in the US.1 Despite its high prevalence, significant occupational impact, and profound effects on quality of life (QOL), CHE remains underrecognized and undertreated in the country, in part due to heterogeneous clinical presentations, overlapping etiologies, and the absence of standardized diagnostic codes or national guidelines.2
Clinical Evaluation
To begin, the team of experts, led by Jonathan Silverberg, MD, PhD, MPH, emphasized that CHE is a multifactorial, relapsing disease with substantial functional, psychosocial, and economic burden. Symptoms such as pruritus, pain, fissuring, and burning frequently impair hand function and occupational performance, contributing to absenteeism, job changes, and reduced productivity. Disease severity closely correlates with QOL impairment, reinforcing the need for timely diagnosis and effective long-term management strategies.
Diagnosis of CHE is anchored in a detailed patient history and careful physical examination. Clinicians are encouraged to obtain structured information on the following:
- Disease onset
- Disease course
- Occupational exposures
- Hobby-related exposures
- Prior treatments
- Comorbid atopic dermatitis
-
Psychosocial impact
Physical examination should document lesion morphology, distribution, severity, and chronicity, as CHE may involve erythema, vesicles, scaling, hyperkeratosis, fissures, or lichenification. Importantly, morphology alone cannot reliably identify disease etiology, as clinical subtypes frequently overlap and evolve over time. Click here to read the full article.
