The chronic hand eczema (CHE) management landscape is rapidly evolving with emerging evidence supporting the efficacy and safety of new treatments, some of which are not included in current guidelines. Preventive measures remain a cornerstone in the management of CHE across all etiological and morphological subtypes. The array of topical therapies for CHE is expanding with mounting evidence for newer agents that directly target the underlying pathophysiology of CHE compared to older agents that are more broadly anti-inflammatory. Phototherapy remains an effective option for CHE, but access and inconvenience remain barriers in many regions. Several advances in targeted systemic therapies for CHE have been made, with some agents approved for the treatment of moderate-to-severe atopic dermatitis exhibiting efficacy in hand and foot eczema, while other agents have evidence specifically for efficacy in CHE. With this evolving treatment landscape, an updated algorithm for the management of CHE is proposed.
ThyssenJPSchuttelaarMLAAlfonsoJH, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermatitis. 2022;86(5):357-378. doi:10.1111/cod.14035
2.
SilverbergJIGuttman-YasskyEAgnerT, et al. Chronic hand eczema guidelines from an Expert Panel of the International Eczema Council. Dermat Contact Atopic Occup Drug. 2021;32(5):319-326. doi:10.1097/DER.0000000000000659
3.
QuaadeASAlinaghiFDietzJBNErichsenCYJohansenJD.Chronic hand eczema: a prevalent disease in the general population associated with reduced quality of life and poor overall health measures. Contact Dermatitis. 2023;89(6):453-463. doi:10.1111/cod.14407
4.
ApfelbacherCMolinSWeisshaarE, et al. Characteristics and provision of care in patients with chronic hand eczema: updated data from the CARPE registry. Acta Derm Venereol. 2014;94(2):163-167. doi:10.2340/00015555-1632
5.
SkayemCSalleRMarquieA, et al. Perceived stress, disease burden and quality of life in patients with chronic hand eczema: a French national study. J Eur Acad Dermatol Venereol. 2024;38(6):e521-e524. doi:10.1111/jdv.19714
6.
CrépyMNMolinSGiménez-ArnauA, et al. Association and impact of chronic hand eczema on occupatoinal and household/leisure activities—results from the multinational CHECK study. Contact Dermatitis. 2024;91(Suppl 1):61. doi:10.1111/cod.14662
BauerABransRBrehlerR, et al. S2k guideline diagnosis, prevention, and therapy of hand eczema. J Dtsch Dermatol Ges. 2023;21(9):1054-1074. doi:10.1111/ddg.15179
9.
LyndeCGuentherLDiepgenTL, et al. Canadian hand dermatitis management guidelines. J Cutan Med Surg. 2010;14(6):267-284. doi:10.2310/7750.2010.09094
10.
VilelaLLagreliusMBerglindIAMidanderKSchenkLJulanderA.Water, soap, and hand-disinfectant exposure during the COVID-19 pandemic and self-reported hand eczema in frontline workers: a cross-sectional study. Contact Dermatitis. 2024;91(1):22-29. doi:10.1111/cod.14540
11.
KüttingBBaumeisterTWeistenhöferWPfahlbergAUterWDrexlerH.Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year. Br J Dermatol. 2010;162(2):362-370. doi:10.1111/j.1365-2133.2009.09485.x
12.
ThyssenJPSilverbergJIGuttman-YasskyE.Chronic hand eczema understanding has ramifications on clinical management. J Eur Acad Dermatol Venereol. 2020;34(8):e429-e430. doi:10.1111/jdv.16375
13.
ChristoffersWACoenraadsPJSvenssonÅ, et al. Interventions for hand eczema. Cochrane Database Syst Rev. 2019;4(4):CD004055. doi:10.1002/14651858.CD004055.pub2
14.
EgebergASchlapbachCHaugaardJH, et al. Adverse events from topical corticosteroid use in chronic hand eczema — findings from the Danish Skin Cohort. JAAD Int. 2023;14:77-83. doi:10.1016/j.jdin.2023.11.004
15.
KahnJSGrossman-KranselerJSZancanaroPGriffithsDDumontNRosmarinD.Topical crisaborole in the treatment of atopic hand dermatitis: a retrospective chart review. Dermat Contact Atopic Occup Drug. 2021;32(6):e141-e143. doi:10.1097/DER.0000000000000793
BissonnetteRAgnerTTaylorJSMolinSGuttman-YasskyE.Hand eczema. Part 2: prevention, management, and treatment. J Am Acad Dermatol. 2025;93(5):1213-1224. doi:10.1016/j.jaad.2024.09.049
18.
Stern RS, PUVA Follow Up Study. The risk of melanoma in association with long-term exposure to PUVA. J Am Acad Dermatol. 2001;44(5):755-761. doi:10.1067/mjd.2001.114576
19.
Product Monograph: HANZEMA (alitretinoin capsules). Dr. Reddy’s Laboratories Inc. Published online October 20, 2022. Accessed December 3, 2024. https://pdf.hres.ca/dpd_pm/00067982.PDF
20.
RuzickaTLyndeCWJemecGBE, et al. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008;158(4):808-817. doi:10.1111/j.1365-2133.2008.08487.x
21.
WittmannMSmithILBrownST, et al. Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema: the ALPHA RCT. Health Technol Assess Winch Engl. 2024;28(59):1-123. doi:10.3310/TWQC0141
22.
TanJMaariCNigenSBolducCBissonnetteR.Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis. J Dermatol Treat. 2015;26(4):373-375. doi:10.3109/09546634.2014.952608
23.
SongMLeeHJLeeWK, et al. Acitretin as a therapeutic option for chronic hand eczema. Ann Dermatol. 2017;29(3):385-387. doi:10.5021/ad.2017.29.3.385
24.
Thestrup-PedersenKAndersenKEMennéTVeienNK.Treatment of hyperkeratotic dermatitis of the palms (eczema keratoticum) with oral acitretin. A single-blind placebo-controlled study. Acta Derm Venereol. 2001;81(5):353-355. doi:10.1080/000155501317140089
25.
BissonnetteRWarrenRBPinterA, et al. Efficacy and safety of delgocitinib cream in adults with moderate to severe chronic hand eczema (DELTA 1 and DELTA 2): results from multicentre, randomised, controlled, double-blind, phase 3 trials. Lancet. 2024;404(10451):461-473. doi:10.1016/S0140-6736(24)01027-4
26.
BissonnetteRWormMWarrenR, et al. Efficacy and safety of delgocitinib cream in adults with moderate to severe Chronic Hand Eczema: pooled results of the Phase 3 DELTA 1 and 2 trials. Poster presented at: American Academy of Dermatology, March8, 2024, San Diego, CA.
27.
Giménez-ArnauAMPinterASondermannW, et al. Efficacy and safety of topical delgocitinib cream versus oral alitretinoin capsules in adults with severe chronic hand eczema (DELTA FORCE): a 24-week, randomised, head-to-head, phase 3 trial. Lancet. 2025;405(10490):1676-1688. doi: 10.1016/S0140-6736(25)00001-7.
28.
MolinSBaselgaENavarro-TriviñoF, et al. The DELTA TEEN phase 3 trial: efficacy and safety of delgocitinib cream in adolescents with moderate to severe chronic hand eczema. Presented at: European Association of Dermatology and Venereology (EADV) Congress, 17-20September2025; Paris, France. Late-breaking session D2T01.
29.
SmithHDLallyJSMoyARyan-WolfJDe BenedettoA.Topical ruxolitinib 1.5% (JAK1/JAK2 inhibitor) improves clinical and patient-reported outcomes in moderate to severe chronic hand dermatitis: data from a small open-label trial. JEADV Clin Pract. 2024;3(4):1016-1026. doi:10.1002/jvc2.381
30.
ZirwasMFowlerJFTsianakasA, et al. Efficacy and safety of ruxolitinib cream for the treatment of moderate to severe chronic hand eczema: results from a 16-week, multicenter, randomized, double-blind study. J Am Acad Dermatol. 2026;94(1):32-40. doi:10.1016/j.jaad.2025.08.081
31.
Incyte Corporation. Topical Ruxolitinib Evaluation in Chronic Hand Eczema Study 1 (TRuE-CHE1): a phase 3, double-blind, randomized, 16-week, vehicle-controlled, efficacy and safety study of ruxolitinib cream followed by an open-label extension period in adults with chronic hand eczema. clinicaltrials.gov. 2022. Accessed October 3, 2025. https://clinicaltrials.gov/study/NCT05219864
32.
Incyte Corporation. Topical Ruxolitinib Evaluation in Chronic Hand Eczema Study 2 (TRuE-CHE2): a phase 3, double-blind, randomized, 16-week, vehicle controlled, efficacy and safety study of ruxolitinib cream followed by an open-label extension period in adults with chronic hand eczema. clinicaltrials.gov. 2022. Accessed October 3, 2025. https://clinicaltrials.gov/study/NCT05233410
33.
DubinCDel DucaEGuttman-YasskyE.Drugs for the treatment of chronic hand eczema: successes and key challenges. Ther Clin Risk Manag. 2020;16:1319-1332. doi:10.2147/TCRM.S292504
34.
TancrediVBuononatoDCaccavaleS, et al. New perspectives in the management of chronic hand eczema: lessons from pathogenesis. Int J Mol Sci. 2023;25(1):362. doi:10.3390/ijms25010362
35.
QuaadeASSimonsenABHallingASThyssenJPJohansenJD.Prevalence, incidence, and severity of hand eczema in the general population—a systematic review and meta-analysis. Contact Dermatitis. 2021;84(6):361-374. doi:10.1111/cod.13804
36.
VoorbergANRomeijnGLEde Bruin-WellerMSSchuttelaarMLA. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis-52 week results from the Dutch BioDay Registry. Contact Dermatitis. 2022;87(2):185-191. doi:10.1111/cod.14104
37.
SimpsonELSilverbergJIWormM, et al. Dupilumab treatment improves signs, symptoms, quality of life, and work productivity in patients with atopic hand and foot dermatitis: results from a phase 3, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2024;90(6):1190-1199. doi:10.1016/j.jaad.2023.12.066
38.
VoorbergANKamphuisEChristoffersWASchuttelaarMLA. Efficacy and safety of dupilumab in patients with severe chronic hand eczema with inadequate response or intolerance to alitretinoin: a randomized, double-blind, placebo-controlled phase IIb proof-of-concept study. Br J Dermatol. 2023;189(4):400-409. doi:10.1093/bjd/ljad156
39.
University Hospital, Toulouse. Dupeczemain: double blind placebo-controlled randomized multicenter study assessing the efficacy and safety of dupilumab in moderate to severe chronic hands eczema refractory to highly potent topical corticosteroids. clinicaltrials.gov. 2024. Accessed October 3, 2025. https://clinicaltrials.gov/study/NCT03861455
40.
PaganiniCMaffeiVVellucciL, et al. Efficacy and safety of dupilumab in the treatment of hand eczema: a retrospective study. J Clin Med. 2024;13(7):1876. doi:10.3390/jcm13071876
41.
Navarro-TriviñoFJGalán-GutiérrezMHitaJCARuiz-VillaverdeRDomínguez-CruzJPereyra-RodríguezJJ.Real-world clinical experience of dupilumab in the treatment of chronic palmo-plantar eczema in patients with moderate-severe atopic dermatitis: 52-week follow-up. Dermat Contact Atopic Occup Drug. 2024;35(Suppl 1):S55-S61. doi:10.1089/derm.2023.0220
42.
LEO Pharma. A 32-week trial to evaluate the efficacy and safety of tralokinumab in subjects with moderate-to-severe atopic hand eczema who are candidates for systemic therapy (ADHAND). clinicaltrials.gov. 2025. Accessed October 3, 2025. https://clinicaltrials.gov/study/NCT05958407
43.
ParmarNVHammadiAA.Successful treatment of dyshidrotic palmoplantar eczema with tralokinumab. Australas J Dermatol. 2024;65(6):e176-e177. doi:10.1111/ajd.14268
44.
MuraseJEChovatiyaRStrowdL, et al. 381 Improved and cleared facial and hand dermatitis with lebrikizumab in patients with moderate-to-severe atopic dermatitis. Br J Dermatol. 2023;188(Suppl 3):ljad162.009. doi:10.1093/bjd/ljad162.009
45.
QuaadeASWangXSølbergJBK, et al. Circulating biomarkers are associated with disease severity of chronic hand eczema and atopic dermatitis. Br J Dermatol. 2023;189(1):114-124. doi:10.1093/bjd/ljad110
46.
QuaadeASWangXSølbergJBK, et al. Inflammatory plasma signature of chronic hand eczema: associations with aetiological and clinical subtypes. J Eur Acad Dermatol Venereol. 2024;38(6):1101-1111. doi:10.1111/jdv.19742
47.
SimpsonELRahawiKHuX, et al. Effect of upadacitinib on atopic hand eczema in patients with moderate-to-severe atopic dermatitis: results from two randomized phase 3 trials. J Eur Acad Dermatol Venereol. 2023;37(9):1863-1870. doi:10.1111/jdv.19194
48.
Innovaderm Research Inc. A randomized, double-blind, placebo-controlled, phase 2 study to evaluate the efficacy, safety, and tolerability of abrocitinib in subjects with moderate to severe chronic hand eczema refractory to corticosteroid therapy. clinicaltrials.gov. 2025. Accessed October 3, 2025. https://clinicaltrials.gov/study/NCT06283550
49.
KamphuisELomanLHanHLRomeijnGLEPolitiekKSchuttelaarMLA. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: results from the BioDay registry. Contact Dermatitis. 2023;88(5):351-362. doi:10.1111/cod.14276
50.
KamphuisEBoesjesCMLomanL, et al. Real-world experience of abrocitinib treatment in patients with atopic dermatitis and hand eczema: up to 28-week results from the BioDay Registry. Acta Derm Venereol. 2024;104:adv19454. doi:10.2340/actadv.v104.19454
51.
LiYTanXNieSTianXWuZ.Real-world experience of abrocitinib on difficult-to-treat hand eczema in Chinese patients. Acta Derm Venereol. 2024;104:adv39822. doi:10.2340/actadv.v104.39822
52.
ZalewskiASzepietowskiJC.Topical and systemic JAK inhibitors in hand eczema—a narrative review. Expert Rev Clin Immunol. 2023;19(4):365-373. doi:10.1080/1744666X.2023.2174526
53.
JimenezPASofenHLBissonnetteR, et al. Oral spleen tyrosine kinase/Janus kinase inhibitor gusacitinib for the treatment of chronic hand eczema: results of a randomized phase 2 study. J Am Acad Dermatol. 2023;89(2):235-242. doi:10.1016/j.jaad.2023.04.027
ThyssenJP.Treatment of chronic hand eczema with oral roflumilast (HERO)—a randomized controlled trial. clinicaltrials.gov. 2023. Accessed October 3, 2025. https://clinicaltrials.gov/study/NCT05682859
56.
EbellMHSiwekJWeissBD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Am Board Fam Med. 2004;17(1):59-67. doi:10.3122/jabfm.17.1.59
57.
GranlundHErkkoPErikssonEReitamoS.Comparison of cyclosporine and topical betamethasone-17,21-dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol. 1996;76(5):371-376. doi:10.2340/0001555576371376
58.
AgarwalUSBesarwalRK.Topical clobetasol propionate 0.05% cream alone and in combination with azathioprine in patients with chronic hand eczema: an observer blinded randomized comparative trial. Indian J Dermatol Venereol Leprol. 2013;79(1):101-103. doi:10.4103/0378-6323.104679
