Chronic Hand Eczema: Breaking Out of the Atopic Dermatitis Umbrella

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Chronic hand eczema (CHE) is increasingly recognized as a distinct and underdiagnosed condition in the United States. International data suggest that it affects a significant portion of the population but is often misclassified under broader dermatitis categories. CHE has varied etiologies, including irritant, allergic, and atopic triggers, and disproportionately affects working adults. In this conversation with The Dermatologist, Jeff Yu, MD, discusses the importance of recognizing CHE as a separate entity, the role of patch testing in diagnosis, and emerging treatment options. His insights reflect a growing effort to improve diagnostic accuracy and expand access to targeted therapies for this burdensome condition.

Dr Yu is a board-certified dermatologist and fellowship-trained adult and pediatric dermatologist with expertise in allergic skin diseases. He completed his dermatology residency at the Medical College of Wisconsin, where he served as chief resident, and his pediatric dermatology fellowship at the Children’s Hospital of Philadelphia. Dr Yu is currently the president of the American Contact Dermatitis Society, serves on the board of the Pediatric Dermatology Research Alliance, and is a member of the North American Contact Dermatitis Group. He has authored numerous peer-reviewed publications in leading dermatology journals, in addition to being an associate editor for Pediatric Dermatology and serving on the Dermatitis editorial board.

The Dermatologist: How common is CHE?

Dr Yu: CHE is a lot more common than we think it is because it really has not been a recognized entity in the United States, at least until recently. There are several studies that have looked at the prevalence of CHE, and most of them tend to be done in countries outside of the US, especially in the European Union. In a large Danish study, about a quarter of all survey respondents had experienced CHE at some point in their life.¹ In another big multinational study, they found that about 5% of the people surveyed across many nations had been diagnosed with CHE in the last year.² CHE tends to affect more women than men and those who are working more than those who are unemployed, and it tends to be more common in urban areas. So, I do think that we are probably underrecognizing and underdiagnosing CHE, especially here in the US.

The Dermatologist: How has our understanding of CHE evolved, and what does this mean for treatment?

Dr Yu: In the US, we are slowly beginning to appreciate that CHE is a separate entity from what we traditionally thought of as atopic dermatitis manifesting on the hands. For example, with medical coding, we are still lumping CHE together with atopic dermatitis or dermatitis-related rashes. Our European colleagues have long appreciated that these are different, and CHE does have a significant impact on life. It can be clinically heterogeneous, meaning that sometimes it might be due to atopic dermatitis of the hands, but it can certainly also be caused by irritant dermatitis. For example, consider someone who works in the restaurant or health care industry where they are frequently washing their hands, which are often wet, causing irritant dermatitis. Or it could be an allergic reaction to something they come in contact with, which we see a lot. Unlike similar rashes elsewhere on your body, your hands are probably one of the most critical parts of you that interacts with not just your job, but also with others, so it can lead to significant occupational and social disruption.

Changing the way that we typically think about diagnosing hand eczema has led to a heightened interest in developing novel and effective therapies to combat this. There are many case reports and several studies out now with existing therapies for atopic dermatitis that work well with CHE, such as dupilumab and ruxolitinib. But, more importantly, the first and only US Food and Drug Administration-approved drug for CHE, delgocitinib, was just given the green light. I am excited to see how this drug, as well as other drugs, impact the way that we as dermatologists think about and treat CHE.

The Dermatologist: Where does patch testing fit into the assessment and management of CHE?

Dr Yu: That is a great question. I am a patch testing dermatologist, and I am also the president of the American Contact Dermatitis Society, so I do have some bias about the importance of patch testing and diagnosing the causes of CHE. We know from published studies that about 10% to 20% of patients with CHE have allergic contact dermatitis. And the only way to really diagnose allergic contact dermatitis is by patch testing, which is a laborious in-office process. Now, there are some national databases of patch testing data that do get published every year or so, and in one of the studies from the North American Contact Dermatitis Group, which I am a part of, patients with hand eczema were much more likely to have a positive patch testing reaction compared to those without. Do I think every person with CHE needs to be patch tested? I do not. And I also do not think that we, as dermatologists and as a country, have the capabilities of patch testing everybody. But I do think patch testing is warranted if we have an inkling of suspicion that it could be occupational—for example, individuals who are in high-risk industries, such as hairdressers, nail technicians, florists, nurses, and physicians—or if there is a clear external factor that is exacerbating hand dermatitis. If a patient is saying that their hands flare up every time they paint or every time they garden, I think patch testing is helpful.

In the US right now, high-quality patch testing is fairly limited because only a few dermatologists in specialized centers are capable of offering the comprehensive patch testing that is often needed to diagnose CHE. For example, when I was practicing in Boston, in the entire city there were probably 4 of us who did patch testing out of probably hundreds of dermatologists. Looking at smaller-sized cities or even more rural states, I think a patch testing dermatologist is few and far between. So, I do not think widespread testing is available, but if you can patch test and there is an inkling of suspicion, I would recommend that you do it.

The Dermatologist: Are there any differences with CHE in pediatric vs adult patients?

Dr Yu: There are some important differences. I am also a board-certified pediatric dermatologist, so I do see a lot of children who come in with complaints of rashes on their hands. I think CHE, at least in my practice, is more common in adults than kids. Adults are much more likely to be working, and they are much more likely to be washing their hands frequently compared to children. Adults have much more of a propensity toward irritant dermatitis or allergic dermatitis causing their CHE. In pediatric patients, I see a lot more who have atopic dermatitis, with eczema on their hands and elsewhere on their body. But I have definitely seen a lot of kids with allergic contact dermatitis on their hands as well, probably partially because of the type of clinics and patients I tend to see in my day-to-day practice. In kids, there are other disorders that happen almost only in children, which we do not see as much in adults. One of the most common causes of hand rashes and peeling on the hands and feet of children is juvenile palmoplantar dermatosis, which happens in adolescents and young teenagers. We really do not see it in adults, and this may be due to the maturation of the skin barrier as kids get older. So, I do think there are various etiologies to CHE in children vs adults.

The Dermatologist: What are the quality of life implications for patients with CHE?

Dr Yu: CHE has a significant negative quality of life implication that affects a child’s or adult's social, functional, and psychological well-being. I have seen patients who have what looks like an unimpressive fissure on their finger, but having had personal experience with this, it is extremely tender and painful, especially when you try to do anything with your hands. From buttoning your jeans, to zipping up your jacket, to even just washing your hands before a meal, what looks like relatively minor cuts and scrapes on your fingertips can be hugely distressful. CHE is defined as having eczema on your hands for at least 3 months, or 2 or more flares in a year, so this is something that can impact every moment in a person’s life. I think that, as dermatologists, we should pay more attention to diagnosing CHE. With the highly effective therapies we have now, which are often steroid-sparing and very safe to use topically on your hands, I think we should, as a group, be more cognizant about how to effectively diagnose and treat these patients, so we can reduce the psychosocial and economic impact that CHE can have on someone's daily life.

Disclosure: The author has served on advisory boards for Arcutis, Astria, Incyte, Janssen Pharmaceuticals, Leo Pharma, and Sanofi; has been a consultant for Dermavant, iRhthym, and O’Glacee and a research investigator for AbbVie, Eli Lilly and Company, Pfizer, Smart Practice, and Sol-Gel; and receives royalties from UpToDate.

References

1. Thein D, Maul JT, Ribero S, Silverberg JI, Egeberg A, Thyssen JP. Prevalence and characteristics of chronic hand eczema among adults in Denmark: a general population-based study. Contact Dermatitis. 2025;92(5):358-366. doi:10.1111/cod.14732
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