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Hands-on education, diagnosing and treating CHE

The text 'Hands-on Education: Diagnosing and Treating CHE'. Graphic showing a person holding up their hand with visible eczema, alongside the text 'Hands-on Education: Diagnosing and Treating CHE'.

Actor portrayal. For illustrative purposes only.

THE CHALLENGE OF DIAGNOSING CHE

Patients with chronic hand eczema (CHE) may present with multiple subtypes and each subtype has unique immune signatures1,2

CHE is not just atopic dermatitis (AD) of the hands2

Venn diagram showing the overlap of eczema subtypes: irritant contact dermatitis, atopic dermatitis, and allergic contact dermatitis, with percentages of CHE cases.
aPercentages are from a CHE patient registry of 1163 patients across 95 centers in Germany.1

CHE SUBTYPES

Chronic hand eczema is often multifactorial, and the relationship between clinical patterns and etiological diagnoses is not a simple one.
Mixed forms of subtypes may exist in which more than one etiological and morphological subtype are present. Additionally, there is no reliable correlation between morphology and etiology; etiology cannot be diagnosed based solely on the appearance of hands.4,5

ETIOLOGICAL SUBTYPES INCLUDE4

IRRITANT CONTACT DERMATITIS (ICD)

  • Prolonged, repeated irritant exposure (e.g., detergents)
  • No relevant contact allergen identified

ATOPIC DERMATITIS (AD)

  • Typically, a medical history of atopic dermatitis
  • Predisposes patients to develop ICD
  • May have AD elsewhere

ALLERGIC CONTACT DERMATITIS (ACD)

  • Hand eczema caused by relevanta contact allergens (e.g., metals, fragrances)
  • Identified by a positive patch test

PROTEIN CONTACT DERMATITIS

  • Hand eczema in patients chronically exposed to proteinsb (e.g., latex, animal hair)
  • Identified by a positive prick test

MORPHOLOGICAL SUBTYPES INCLUDE4

HYPERKERATOTIC HAND ECZEMA

  • Typically palmar 
  • More common in men
  • Associated with tobacco smoking

ACUTE, RECURRENT VESICULAR HAND ECZEMA

  • Typically, palmar/fingers
  • Intensely pruritic
  • Associated with different etiologies

NUMMULAR HAND ECZEMA

  • Typically on the dorsal hands
  • Coin-shaped lesions
  • Often associated with allergic dermatitis

PULPITIS

  • Found on the fingertips
  • Often caused by irritants, but may be related to atopic dermatitis or ACD

aRelevant means that there is a current exposure of the hands to the allergen, bfood, latex, and any other biologic material.4

More than 50% of patients with chronic hand eczema can have more than 1 additional diagnosed subtype.6

CHE PATHOPHYSIOLOGY

Close-up illustration showing cracked skin, representing the disruption of the skin barrier in chronic hand eczema.

Chronic hand eczema is associated with dysregulation of inflammatory responses, disruption of the skin barrier, and alterations in the skin microbiome.7

Illustration depicting overlapping immune pathways involved in chronic hand eczema pathogenesis, driven by JAK-STAT signaling.

Its pathogenesis is further complicated because of the potential for overlapping immune pathways, which are driven by JAK-STAT signaling.2,7

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Illustration depicting overlapping immune pathways involved in chronic hand eczema pathogenesis, driven by JAK-STAT signaling.

WHEN THE STANDARD OF CARE IS NOT ENOUGH

Currently, topical corticosteroids (TCSs) are recommended as the short-term, first-line treatment for chronic hand eczema.3
 

Yet, for long-term intermittent use, their efficacy is limited, and TCSs have been associated with adverse events.2,3
 

Additionally, therapies targeting the type 2 immune response may not be effective in all CHE subtypes.2
 

Clearly, there is a significant unmet need for an FDA-approved treatment developed specifically for chronic hand eczema—one that is well tolerated for the long term and is effective across all subtypes.2

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CHE=chronic hand eczema; JAK-STAT=Janus kinase signal transducer and activator of transcription.

References: 1. Apfelbacher C, et al. Acta Derm Venereol. 2014;94(2):163-167. doi:10.2340/00015555-1632 2. Dubin C, et al. Ther Clin Risk Manag. 2020;16:1319-1332. doi:10.2147/TCRM.S292504 3. Diepgen TL, et al. J Dtsch Dermatol Ges. 2009;7(suppl 3):S1-S16. doi:10.1111/j.1610-0387.2009.07061.x 4. Thyssen JP, et al. Contact Dermatitis. 2022;86(5):357-378. doi:10.1111/cod.14035 5. Tauber M, et al. J Eur Acad Dermatol Venereol. 2024;38(6):997-998. doi:10.1111/jdv.20023 6. Agner T, et al. J Eur Acad Dermatol Venereol. 2015;29(12):2417-2422. doi:10.1111/jdv.13308 7. Lee GR, et al. Dermatol Ther. 2019;32(3):e12840. doi:10.1111/dth.12840