CHE Experts Provide Framework for Diagnosis, Management, and Care in the United States

A new expert consensus, published in the American Journal of Clinical Dermatology, provides a comprehensive framework for the diagnosis and management of chronic hand eczema (CHE) in the US.¹ Despite its high prevalence, significant occupational impact, and profound effects on quality of life (QOL), CHE remains underrecognized and undertreated in the country, in part due to heterogeneous clinical presentations, overlapping etiologies, and the absence of standardized diagnostic codes or national guidelines.²

Clinical Evaluation

To begin, the team of experts, led by Jonathan Silverberg, MD, PhD, MPH, emphasized that CHE is a multifactorial, relapsing disease with substantial functional, psychosocial, and economic burden. Symptoms such as pruritus, pain, fissuring, and burning frequently impair hand function and occupational performance, contributing to absenteeism, job changes, and reduced productivity. Disease severity closely correlates with QOL impairment, reinforcing the need for timely diagnosis and effective long-term management strategies.

Diagnosis of CHE is anchored in a detailed patient history and careful physical examination. Clinicians are encouraged to obtain structured information on the following:

• Disease onset
• Disease course
• Occupational exposures
• Hobby-related exposures
• Prior treatments
• Comorbid atopic dermatitis
• Psychosocial impact

Physical examination should document lesion morphology, distribution, severity, and chronicity, as CHE may involve erythema, vesicles, scaling, hyperkeratosis, fissures, or lichenification. Importantly, morphology alone cannot reliably identify disease etiology, as clinical subtypes frequently overlap and evolve over time.

Diagnostic Testing and Severity Assessments

Severity assessment should incorporate both clinician-reported and patient-reported outcome measures. Tools such as the Investigator Global Assessment for CHE and the Hand Eczema Severity Index (HECSI) are reviewed, with acknowledgment that although HECSI is widely used in clinical trials, its complexity limits routine use. The authors strongly recommend incorporating patient-reported measures, including itch and pain numeric rating scales and dermatology-specific QOL instruments, to capture the full burden of disease and guide shared decision-making.

Diagnostic testing should be individualized. Patch testing remains the gold standard for identifying allergic contact dermatitis and is particularly valuable in patients with refractory disease or high-risk occupational exposures, though access and feasibility vary across US practice settings. Nonetheless, testing should not delay treatment initiation. Skin prick testing is reserved for suspected protein contact dermatitis, whereas biopsies and microbiologic studies are recommended only in select cases to exclude alternative diagnoses or infection.

Treatment Advances and Special Considerations

The paper outlines a pragmatic, stepwise treatment approach tailored to disease severity, chronicity, morphology, comorbidities, and patient preferences. Supportive and preventive care form the foundation of management, including education on irritant and allergen avoidance, appropriate glove use, optimized hand hygiene, and regular use of bland, fragrance-free emollients to prevent exacerbated disease or contact allergy.

Topical therapies remain the first-line treatment. Topical corticosteroids are commonly used for acute flares but should be limited in duration due to risks of skin atrophy, barrier disruption, and steroid withdrawal. Silverberg et al stressed early recognition of treatment failure and avoidance of prolonged steroid dependence. Topical delgocitinib, a pan–Janus kinase (JAK) inhibitor, is the only FDA-approved therapy for CHE in the US for patients whose disease is inadequately controlled with or who are unable to use topical corticosteroids. Other topical agents used off-label, including calcineurin inhibitors, aryl hydrocarbon receptor agonists, PDE4 inhibitors, and topical JAK inhibitors, were reviewed.

For patients with refractory disease, systemic therapies and phototherapy may be considered, though regional options remain limited. Oral alitretinoin, widely used internationally, is not approved in the US. Systemic corticosteroids are discouraged except for short-term rescue due to safety concerns. Emerging systemic and biologic therapies show promise but require further study in CHE-specific populations. Special considerations were addressed for pediatric and adolescent CHE, where data are sparse and treatment options are constrained, underscoring the need for age-appropriate outcome measures and further research.

Improving the Therapeutic Landscape

“As more treatments for this condition are investigated, it is hoped that the therapeutic landscape will shift to provide better clinical and patient-reported outcomes,” the authors concluded. “Research and clinical assessments need to consistently make use of available clinician and patient-reported outcomes to help improve the availability of reliable and comparable outcome data for adult, adolescent, and pediatric patients with CHE.”

Overall, this expert review underscores CHE as a common, debilitating condition requiring early recognition, structured assessment, and individualized, multimodal management. By emphasizing practical diagnostic strategies, consistent use of outcome measures, and a rational treatment algorithm, US clinicians can improve disease control, reduce long-term morbidity, and enhance patient QOL.

References

1. Silverberg JI, Cohen D, Guttman-Yassky E, et al. Expert recommendations for the diagnosis and management of chronic hand eczema in the United States. Am J Clin Dermatol. Published online February 8, 2026. doi:10.1007/s40257-026-01008-3

2. Dibenedetti D, Baranowski E, Zelt S, Reynolds M, Sherrill B. Assessing United States patient and dermatologist experiences with severe chronic hand eczema. J Clin Aesthet Dermatol. 2015;8(11):19-27.