Hand Eczema: Diagnostic Approach and Management

Authors

  • Caroline Oktarina University of Indonesia image/svg+xml
  • Triana Agustin Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia–dr. Cipto Mangunkusumo National Central General Hospital, Indonesia.
  • Lili Legiawati Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia–dr. Cipto Mangunkusumo National Central General Hospital, Indonesia.
  • Windy Keumala Budianti Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia–dr. Cipto Mangunkusumo National Central General Hospital, Indonesia.

DOI:

https://doi.org/10.66344/jpad.v32i3.1952

Abstract

Hand eczema (HE) is a chronic inflammatory disorder of the hand with a prevalence of 14.5% worldwide. The incidence of HE has increased considerably during Coronavirus-19 (COVID-19) pandemic due to increased hand hygiene practice. Despite not affecting the mortality rate, HE can decrease the patient’s quality of life significantly and increase morbidity. In general, HE can be classified based on its onset, etiology, precipitating factors, and clinical morphology. The diagnosis of HE is established through history taking and physical examination, however, several diagnostic tests should be performed to identify the etiology and exclude the differential diagnosis, including dermoscopic examination, histopathological examination, patch test, and prick test. In addition to diagnostic tests, the severity of HE should also be established to determine the appropriate therapy and monitor the therapeutic responses. After HE is identified, comprehensive management should be provided immediately so that HE will not progress into a chronic disorder which will further decrease the patient’s quality of life.

References

1. Ulrich NH, Thyssen JP, Mizutani H, Nixon RL. Hand Eczema. In: Johansen J, Mahler V, Lepoittevin JP, Frosch P, editors. Contact Dermatitis. 1st ed. New York: Springer; 2019. p. 1-24.

2. Quaade AS, Simonsen AB, Halling AS, Thyssen JP, Johansen JD. Prevalence, incidence, and severity of hand eczema in the general population - A systematic review and meta-analysis. Contact Dermatitis. 2021;84:361-74.

3. Elsner P, Agner T. Hand eczema: treatment. J Eur Acad Dermatol Venereol. 2020;34 Suppl 1:13-21.

4. Blicharz L, Czuwara J, Samochocki Z, Goldust M, Chrostowska S, Olszewska M, et al. Hand eczema-A growing dermatological concern during the COVID-19 pandemic and possible treatments. Dermatol Ther. 2020;33:e13545.

5. Kendziora B, Guertler A, Stander L, Frey S, French LE, Wollenberg A, et al. Evaluation of hand hygiene and onset of hand eczema after the outbreak of SARS-CoV-2 in Munich. Eur J Dermatol. 2020;30:668-73.

6. Techasatian L, Thaowandee W, Chaiyarit J, Uppala R, Sitthikarnkha P, Paibool W, et al. Hand Hygiene Habits and Prevalence of Hand Eczema During the COVID-19 Pandemic. J Prim Care Community Health. 2021;12:21501327211018013.

7. Christopher PM, Roren RS, Tania C, Jayadi NN, Cucunawangsih C. Adverse Skin Reactions to Personal Protective Equipment Among Health-Care Workers During COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia. Int J Dermatol Venereol. 2020;3:211-8.

8. Agner T, Aalto-Korte K, Andersen KE, Foti C, Gimenez-Arnau A, Goncalo M, et al. Classification of hand eczema. J Eur Acad Dermatol Venereol. 2015;29:2417-22.

9. Agarwal US, Besarwal RK, Gupta R, Agarwal P, Napalia S. Hand eczema. Indian J Dermatol. 2014;59:213-24.

10. Lee GR, Maarouf M, Hendricks AK, Lee DE, Shi VY. Current and emerging therapies for hand eczema. Dermatol Ther. 2019;32:e12840.

11. Agner T, Elsner P. Hand eczema: epidemiology, prognosis and prevention. J Eur Acad Dermatol Venereol. 2020;34 Suppl 1:4-12.

12. Coenraads PJ. Hand eczema. N Engl J Med. 2012;367:1829-37.

13. Lakshmi C, Srinivas CR. Hand eczema: an update. Indian J Dermatol Venereol Leprol. 2012;78:569-82.

14. Salvador JFS, Mendaza FH, Garcés MH, Palacios-Martínez D, Camacho RS, Sanz RS, et al. Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. Actas Dermo-Sifiliográficas (English Edition). 2020;111:26-40.

15. Susitaival P, Flyvholm MA, Meding B, Kanerva L, Lindberg M, Svensson A, et al. Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure. Contact Dermatitis. 2003;49:70-6.

16. Marti-Margarit A, Manresa JM, Herdman M, Pujol R, Serra C, Flyvholm MA, et al. Valid screening questions useful to diagnose hand and forearm eczema are available in the Spanish language, a new tool for global research. Eur J Dermatol. 2015;25:145-55.

17. Kim HJ, Bang CH, Kim HO, Lee DH, Ko JY, Park EJ, et al. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema. Ann Dermatol. 2021;33:351-60.

18. Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, et al. Guidelines for diagnosis, prevention and treatment of hand eczema - short version. J Dtsch Dermatol Ges. 2015;13:77-84.

19. Yu X, Wei G, Shao C, Zhu M, Sun S, Zhang X. Analysis of dermoscopic characteristic for the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema. Medicine (Baltimore). 2021;100:e23828.

20. Errichetti E, Stinco G. Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema. J Dermatol. 2016;43:423-5.

21. Cetinarslan T, Turel Ermertcan A, Temiz P. Dermoscopic clues of palmoplantar hyperkeratotic eczema and palmoplantar psoriasis: A prospective, comparative study of 90 patients. J Dermatol. 2020;47:1157-65.

22. Park JY, Cho EB, Park EJ, Park HR, Kim KH, Kim KJ. The histopathological differentiation between palmar psoriasis and hand eczema: A retrospective review of 96 cases. J Am Acad Dermatol. 2017;77:130-5.

23. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy. 2013;3:3.

24. Agner T, Jungersted JM, Coenraads PJ, Diepgen T. Comparison of four methods for assessment of severity of hand eczema. Contact Dermatitis. 2013;69:107-11.

25. Held E, Skoet R, Johansen JD, Agner T. The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. Br J Dermatol. 2005;152:302-7.

26. Oosterhaven JAF, Schuttelaar MLA. Responsiveness and interpretability of the Hand Eczema Severity Index. Br J Dermatol. 2020;182:932-9.

27. Dulon M, Skudlik C, Nubling M, John SM, Nienhaus A. Validity and responsiveness of the Osnabruck Hand Eczema Severity Index (OHSI): a methodological study. Br J Dermatol. 2009;160:137-42.

28. Augustin M, Kuessner D, Purwins S, Hieke K, Posthumus J, Diepgen TL. Cost-of-illness of patients with chronic hand eczema in routine care: results from a multicentre study in Germany. Br J Dermatol. 2011;165:845-51.

29. Coenraads PJ, Van Der Walle H, Thestrup-Pedersen K, Ruzicka T, Dreno B, De La Loge C, et al. Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis. Br J Dermatol. 2005;152:296-301.

30. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210-6.

31. Rahmatina. Uji validitas and reliabilitas dermatology life quality index(DLQI) berbahasa Indonesia pada pasien poliklinik ilmu kesehatan kulit and kelamin rumah sakit Dr. Cipto Mangunkusumo [Thesis]. Jakarta: Universitas Indonesia; 2013.

32. Rani Z, Kazmi A, Sheikh R, Rashid A, Waseem J, Raza A. Efficacy, safety and tolerability of mometasone fuorate 0.1% ointment in chronic eczema. J Pak Assoc Dermatol. 2007;17:21-7.

33. Kazmi D, Shaukat S, Zahoor M, Afzal A, Rafat M, Gardezi S, et al. Comparison of efficacy and safety of topical 0.1% tacrolimus ointment versus 0.1% mometasone furoate ointment in mild to moderate chronic hand eczema. J Pakistan Assoc Dermatol. 2018;28:468-73.

34. Juntongjin P, Pongprasert R. Calcipotriol ointment shows comparable efficacy to topical steroids in chronic hand eczema. Dermatol Ther. 2019;32:e12956.

35. Worm M, Bauer A, Elsner P, Mahler V, Molin S, Nielsen TSS. Efficacy and safety of topical delgocitinib in patients with chronic hand eczema: data from a randomized, double-blind, vehicle-controlled phase IIa study. Br J Dermatol. 2020;182:1103-10.

36. Granlund H, Erkko P, Reitamo S. Comparison of the influence of cyclosporine and topical betamethasone-17,21-dipropionate treatment on quality of life in chronic hand eczema. Acta Derm Venereol. 1997;77:54-8.

37. Kim HL, Jung HJ, Park MY, Youn JI, Ahn JY. Clinical Efficacy of Oral Cyclosporine on Intractable Hand Eczema: A Retrospective Review of 16 Cases. Ann Dermatol. 2018;30:475-8.

38. Agarwal US, Besarwal RK. 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;79:101-3.

39. Song M, Lee HJ, Lee WK, Kim HS, Ko HC, Kim MB, et al. Acitretin as a Therapeutic Option for Chronic Hand Eczema. Ann Dermatol. 2017;29:385-7.

40. Thestrup-Pedersen K, Andersen KE, Menné T, Veien NK. Treatment of hyperkeratotic dermatitis of the palms (eczema keratoticum) with oral acitretin. A single-blind placebo-controlled study. Acta Derm Venereol. 2001;81:353-5.

41. Al-Dhubaibi MS, Settin AA. The effectiveness of alitretinoin for the treatment of chronic hand eczema: A meta-analysis. Int J Health Sci. 2018;12:70-9.

42. Luchsinger I, Vogler T, Schwieger-Briel A, Knöpfel N, Wälchli R, Weibel L, et al. Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis. J Eur Acad Dermatol Venereol. 2020;34:1037-42.

43. Ghosh N, Nasrin T, Mahmud H, Paul H. Efficacy and safety of low dose methotrexate in the treatment of chronic hand eczema. J Pak Assoc Dermatol. 2020;30:3-8.

44. Oosterhaven JAF, Voorberg AN, Romeijn GLE, de Bruin-Weller MS, Schuttelaar MLA. Effect of dupilumab on hand eczema in patients with atopic dermatitis: An observational study. J Dermatol. 2019;46:680-5.

45. Lee N, Chipalkatti N, Zancanaro P, Kachuk C, Dumont N, Rosmarin D. A Retrospective Review of Dupilumab for Hand Dermatitis. Dermatology. 2019;235:187-8.

46. Brass D, Fouweather T, Stocken DD, Macdonald C, Wilkinson J, Lloyd J, et al. An observer-blinded randomized controlled pilot trial comparing localized immersion psoralen-ultraviolet A with localized narrowband ultraviolet B for the treatment of palmar hand eczema. Br J Dermatol. 2018;179:63-71.

47. Christoffers WA, Coenraads PJ, Svensson A, Diepgen TL, Dickinson-Blok JL, Xia J, et al. Interventions for hand eczema. Cochrane Database Syst Rev. 2019;4:CD004055.

48. Politiek K, Christoffers WA, Coenraads PJ, Schuttelaar MA. Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study. Dermatol Ther. 2016;29:364-71.

49. Juntongjin P, Chunhakham P. Synergistic Effects of the 308-nm Excimer Light and Topical Calcipotriol for the Treatment of Chronic Hand Eczema: A Randomized Controlled Study. Dermatology. 2021;237:31-8.

50. Petersen AH, Johansen JD, Hald M. Hand eczema – prognosis and consequences: a 7-year follow-up study. Br J Dermatol. 2014;171:1428-33.

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Published

27.08.2022

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Review Articles

How to Cite

1.
Hand Eczema: Diagnostic Approach and Management. J Pak Assoc Dermatol [Internet]. 2022 Aug. 27 [cited 2026 Jul. 27];32(3):585-97. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/1952