Practical Considerations for the Recognition and Assessment of Chronic Hand Eczema

Abstract

Chronic hand eczema (CHE) is a common inflammatory skin disease with considerable heterogeneity with respect to etiology and morphology. Medical history, physical examination, assessment of risk factors such as occupation, irritant and/or allergen exposures, and atopic comorbidities, are important steps in the diagnosis of CHE. An evaluation of the impact of CHE on quality of life and functioning is also important to appreciate the personal impact of this chronic and potentially debilitating disease. Skin biopsy and microbiological testing are generally not useful, and limited access to patch testing in Canada requires that clinicians prioritize and triage patients for patch testing to confirm a diagnosis of allergic contact CHE. Lack of a universally accepted classification system and standardized outcome measures for CHE poses challenges with respect to the interpretation of clinical trials for different CHE treatments. Several clinician- and patient-reported assessment scales have been validated for use in CHE, but only a few were specifically developed for hand eczema. Either the Investigator’s Global Assessment-CHE or the Physician’s Global Assessment and the pruritus or pain Numerical Rating Scale is a reasonable approach to the clinical implementation of CHE assessment tools, which can be used to monitor symptoms over time.