A Patient–Physician Lens on the Real Burden of CHE

Chronic hand eczema (CHE) continues to be a prevalent yet frequently underestimated dermatologic condition. Defined as eczema involving the hands for more than 3 consecutive months or recurring at least twice per year, CHE affects an estimated 8.9% to 15% of individuals over a lifetime.¹ Despite this significant prevalence, the real-world experience of CHE often reveals a disconnect between clinical expectations and patient reality. A recent Patient–Physician Perspective in Dermatology and Therapy presents a detailed narrative from a lifelong CHE patient alongside a commentary from Christopher Bunick, MD, PhD, associate professor of dermatology at Yale School of Medicine in New Haven, Connecticut, and Dermatology Times Editor in Chief, offering an instructive look at both disease burden and modern management considerations.²

"While discussing the science of CHE and its emerging therapies has garnered much of the attention of dermatology over the past 2 years, this article was a recalibration of focus on what matters most: our patients and their well-being," Bunick told Dermatology Times. "Personal stories from patients hold so much power, and I truly believe they are invaluable learning opportunities to grow as a caring and empathetic clinician."

The patient, Monique, describes decades of living with a condition that began in infancy and progressively worsened throughout childhood and adulthood. Her eczema was characterized by fissuring, erythema, lichenification, pain, and chronic discomfort that interfered with daily activities, including typing, bathing, and social interaction. Beyond the physical symptoms, she recounts the emotional burden vividly, stating, “It was gross… I felt like I was gross. I felt like an itchy little monster—that’s how I saw myself” The visibility of her disease prompted persistent embarrassment, leading her to hide her hands, avoid peer activities, and withdraw socially. These patterns followed her from the classroom into the workplace, contributing to isolation and diminished self-confidence.

Monique’s experience also highlights common challenges in CHE care pathways. For years she cycled through similar treatments without significant improvement, often told she might eventually “grow out of it.” Specialty referral was delayed, and when she finally saw a dermatologist, the recommendations initially mirrored what she had been prescribed repeatedly throughout childhood. As she describes it, “The definition of insanity is doing the same thing over and over again and expecting different results.” This repeated pattern of insufficient interventions left her feeling unheard and unsure of how to advocate for herself. A turning point occurred only when she documented the severity of her condition with photographs and insisted on re-evaluation, ultimately leading to a more effective therapeutic plan.

The accompanying physician commentary interprets Monique’s story through a clinical lens, emphasizing how CHE can disrupt identity, social functioning, and emotional wellbeing. Bunick observes that patients often feel defined by their disease when the visibility of their hands draws continual attention to their symptoms. Shame and embarrassment can drive avoidance behaviors, resulting in significant loneliness. CHE is also associated with high rates of depression, anxiety, and even suicidal ideation, underscoring the importance of incorporating mental health considerations into routine dermatologic care. Clinically, the commentary urges providers to ask about emotional impact and daily functioning rather than focusing solely on visible disease activity. It also stresses the clinician’s role as an advocate who helps patients navigate the complexity of CHE subtypes and treatments.

The patient-physician commentary further outlines how the pathophysiology of CHE complicates diagnosis and management. CHE is heterogeneous, involving multiple etiologic forms such as irritant or allergic contact dermatitis, atopic dermatitis, or protein contact dermatitis. Morphologic presentations—including hyperkeratotic, vesicular, nummular, and fingertip pulpitis patterns—may overlap, and more than half of patients exhibit more than 1 subtype simultaneously. Immunologically, CHE may involve Th1, Th2, Th17, or Th22 pathways, making it difficult to determine etiology by visual inspection alone. This complexity reinforces the need for individualized assessment and multimodal treatment strategies.

Therapeutic options have evolved in recent years, moving beyond long-term reliance on topical corticosteroids. While steroids remain useful, they often fail to deliver sustained relief and carry a risk of cutaneous atrophy and pigmentary changes. The publication notes growing interest in JAK/STAT pathway inhibition, including topical delgocitinib, the first FDA-approved non-steroidal topical specifically indicated for moderate to severe CHE, and other topical or systemic JAK inhibitors that have shown promise in addressing refractory disease. These emerging therapies provide new opportunities for improved disease control, particularly for patients with overlapping immune signatures.

Ultimately, this dual perspective serves as a reminder that CHE is not merely a chronic inflammatory disorder but a condition with far-reaching psychosocial and functional implications. Integrating patient narratives into clinical understanding encourages more empathetic communication, earlier recognition of emotional distress, and adoption of evidence-based treatments aligned with disease complexity. Through both testimony and analysis, the article calls for a more engaged, supportive, and nuanced approach to CHE management—one that prioritizes not only clear skin but also patient dignity, wellbeing, and quality of life.

References

1. Ghezzi G, Falcidia C, Paolino G, Mercuri SR, Narcisi A, Costanzo A, Valenti M. Chronic hand eczema (CHE): A narrative review. Dermatol Ther (Heidelb). 2025 Apr;15(4):771-795. doi: 10.1007/s13555-025-01365-7. Epub 2025 Mar 10.
2. Tooks M, Bunick CG. Empathy for the patient with chronic hand eczema. Dermatol Ther (Heidelb). Published online December 6, 2025. doi:10.1007/s13555-025-01597-7