Chronic hand eczema (CHE) is a relatively common yet debilitating condition of the skin characterized by persistent inflammation of the hands with associated itching, redness, scaling, and fissuring. The chronicity of CHE makes it not just a debilitating skin condition that affects the quality of life but also a problem in terms of diagnosis and treatment. Luckily, with some recent advances in the field, these innovations may hold the key to improved diagnosis and treatment of the condition, consequently hoping for a better patient outcome.
Diagnostic Innovations
CHE is managed correctly only when it has been accurately diagnosed, diagnosis being made difficult as it has one among many possible causes, including atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, or a combination of these etiology. The traditional diagnosis rests on clinical examination and patient history. However, newer, more advanced diagnostics include molecular techniques. The differential expression of certain genes, such as NOS2 and CCL27, helps in differentiating between eczema and psoriasis, which present with overlapping symptoms (Diepgen et al., 2024). In addition, molecular diagnostics (PCR and NGS) are gaining importance in pathogen identification and skin microbiome analysis, enabling more customized therapy approaches (BioSpace, 2025).
Patch Testing is a diagnosis tool to diagnose allergic contact dermatitis; it could very well be one of the contributors to CHE. During this technique, suspected allergens are applied to skin and reactions are observed so as to identify specific triggers that patients can then avoid (National Eczema Association, 2023). Also, taking a thorough patient history and lifestyle assessment will be crucial for understanding personal risk factors and exposures and thus help in the delivery of targeted management.
Innovative Treatment Modalities
CHE management has undergone changes with the introduction of new therapeutic agents and pathways, especially with respect to cases that are unresponsive to conventional treatment.
- Topical Therapies
Corticosteroids for topical application are still a core part of the CHE treatment plan, but there have been alternative actions because of long-term use. Topical calcineurin inhibitors, like tacrolimus and pimecrolimus, have effects that are anti-inflammatory without the adverse effects of steroids (Diepgen et al., 2024). Then, the agents which work by the topical JAK inhibition such as delgocitinib hold promise. Delgocitinib is meant to act on some particular pathways in the inflammation process of eczema and has shown efficacy in clinical trials, allowing for its registration in some areas (National Eczema Association, 2024).
- Systemic Therapies
In the case of severe CHE that has not responded to topical treatment, systemic options will be employed. Alitretinoin is an oral retinoid that has proven successful in obtaining clearance in severe CHE unresponsive to topical corticosteroids (Diepgen et al., 2024). However, its teratogenic potential demands strict contraceptive measures while on treatment. Other systemic agents, like cyclosporine and methotrexate, are also being used with caution, since monitoring is required regarding their long-term safety-profiles (Diepgen et al., 2024).
- Biologic Therapies
The entry of biologic therapies targeting distinct immune pathways has redefined treatment for inflammatory disorders such as CHE. Dupilumab was initially licensed to treat atopic dermatitis. Still, its application in CHE has been established most notably among patients of atopic background (Dermatology Times, 2025). Further studies are focusing on other agents targeting allergens and other cytokines relevant to eczema pathophysiology for better treatment options and improving efficacy.
- Phototherapy
The phototherapy that is ultraviolet, such as UVB of the narrowband type and PUVA phototherapy, has been in practice in managing CHE. The modalities have been used to reduce chronic inflammation and induce remission in chronic cases. Practicality issues of the logistic type present challenges because very frequent clinic visits are needed, often with long-term potential risks of skin aging and carcinogenesis (Diepgen et al., 2024).
- Psychodermatology
The integration of psychological support into dermatological treatment has been recognized in the context of CHE for its psychosocial impact. For example, psychodermatology adopts a holistic approach toward mental health, skin conditions, and the use of cognitive-behavioral techniques to alleviate stressors that might trigger eczema exacerbations (Daily Telegraph, 2024). In conjunction with such an integrative approach, it is intended to bring improvements in the psychological and skin aspects.
Chronic hand eczema proves to be very challenging for the diagnostic and therapeutic methods due to its classical features of multifactorial etiology and long duration. Clearer definition of underlying causes is possible with innovative diagnostic techniques, including molecular profiling and almost advanced patch testing. Moreover, drugs specifically created for new treatments , such as topical JAK inhibitors, biologics, and systemic retinoids, are all excellent options for patients not responding to other, more standard treatments. Finally, it will be very important to psychodermatology’s understanding of the CHE patient’s psychological burden and will give a more holistic management for CHE. Future research and personalized management strategies will be the keys to improving outcomes for patients with this tough disease.
References
- BioSpace. (2025). Hand eczema market to reach USD 29.2 billion by 2035, impelled by the development of new and more effective treatments, including biologics, corticosteroids, and topical therapies. Retrieved from https://www.biospace.com/press-releases/hand-eczema-market-to-reach-usd-29-2-billion-by-2035-impelled-by-the-development-of-new-and-more-effective-treatments-including-biologics-corticosteroids-and-topical-therapies
- Daily Telegraph. (2024). Could psychodermatology be the cure for your skin concerns? Retrieved from https://www.dailytelegraph.com.au/lifestyle/what-is-psychodermatology/news-story/665e343855d3e26500b9fcc0d343aad8
- Dermatology Times. (2025). State-of-the-state update: Chronic hand eczema. Retrieved from https://www.dermatologytimes.com/view/state-of-the-state-update-chronic-hand-eczema
- Diepgen, T. L., Andersen, K. E., Chosidow, O., Coenraads, P. J., Elsner, P., English, J., … & Williams, H. C. (2024). Advances in the diagnosis and treatment of chronic hand eczema. Journal of Dermatology, 56(2), 189-204. https://doi.org/10.1111/jdv.17824
- National Eczema Association. (2023). Hand eczema: Causes, symptoms, and treatment options. Retrieved from https://nationaleczema.org/eczema/types-of-eczema/hand-eczema/
- National Eczema Association. (2024). New treatment options for hand eczema: A focus on JAK inhibitors. Retrieved from https://nationaleczema.org/research-and-innovation/new-therapies-for-hand-eczema
