CHECK-US Data Reveal Demographic Splits in How Patients Perceive CHE Causes

Patients with chronic hand eczema (CHE) attribute their disease to a complex mix of environmental, biological, and psychological factors, according to new data from the CHECK-US study presented at the American Academy of Dermatology (AAD) Annual Meeting in March 2026. The findings highlight just how heterogeneous patient-perceived disease drivers can be — and underscore the clinical value of incorporating the patient's own perspective when developing prevention and treatment strategies.¹

CHE is notoriously difficult to classify given the frequent overlap between etiological and clinical subtypes. While clinicians routinely assess occupational exposures and allergic histories, patients' own interpretations of what triggers their disease are often secondary to objective assessments.² The CHECK-US investigators set out to examine whether those perceptions differ meaningfully across demographic subgroups.

“CHE can be a challenging condition to manage, in part due to the diversity of triggering factors from the patient perspective,” study author Raj Chovatiya, MD, PhD, MSCI, clinical associate professor of dermatology at Northwestern University Feinberg School of Medicine, told Dermatology Times. “Findings from the CHECK-US study revealed that patients perceived a wide overlap of environmental, biological, psychological and lifestyle factors that were relevant to their CHE - which highlights the multifactorial nature of this disease state. An understanding of these factors is key for healthcare providers when it comes to tailoring individualized treatment strategies.

Study Design

The CHECK-US study (Chronic Hand Eczema epidemiology, Care, and Knowledge of real-life burden – United States) was a US-based online survey conducted from March to May 2025 among 10,636 adults recruited through general population panels. Of these, 982 participants who self-reported a physician diagnosis of CHE and completed the full questionnaire were included in the analysis. The cohort was predominantly urban (86.6%), employed (76.4%), and had a mean age of 37.1 years. Just over half (54.4%) were male. Participants selected perceived triggers from a pre-defined list across seven categories — environmental, biological, psychological, lifestyle and habits, physical, infections, and other — and then identified what they believed to be their single primary cause.

Key Findings

Environmental triggers were the most commonly endorsed category overall, cited by 69.4% of respondents. Within this category, general environmental factors (40.8%), frequent handwashing or water exposure (29.6%), contact allergen exposure (26.1%), and chemical irritant exposure (23.1%) were most frequently selected. Biological triggers followed at 47.4%, driven largely by genetic predisposition or family history (25.6%), overactive immune response (19.7%), and skin barrier dysfunction (19.2%). Psychological triggers — primarily stress or emotional factors — were identified by 34.1% of participants, and lifestyle or habit-related factors by 26.0%.

When participants were asked to identify a single primary cause, environmental factors topped the list at 14.2%, followed by genetic predisposition or family history (11.6%) and stress or emotional factors (10.4%).

Subgroup Differences

Demographic stratification revealed several statistically significant differences in trigger attribution. Female participants were significantly more likely than male participants to report environmental triggers (73.4% vs. 66.1%; p=0.02) and psychological triggers (47.5% vs. 22.8%; p<0.01). Males, in contrast, more commonly attributed CHE to lifestyle and habits (29.7% vs. 21.7%; p<0.01) and infections (19.1% vs. 10.9%; p<0.01).

Employment status also showed a meaningful association. Employed participants were more likely than unemployed participants to cite lifestyle and habits (28.0% vs. 19.7%; p<0.01) and physical triggers (21.4% vs. 14.8%; p=0.02) — a pattern that may reflect occupational exposures or work-related behavioral factors. Urban residents were significantly more likely than rural counterparts to report lifestyle and habits as a trigger (28.1% vs. 12.8%; p<0.01), while trigger profiles were otherwise broadly similar across residential settings. Among age groups, physical triggers were more commonly reported by younger participants aged 18 to 39 (22.0%) compared with those aged 40 to 69 (16.4%; p=0.04).

Clinical Implications

The authors concluded that patients with CHE commonly perceive their condition as multifactorial, with environmental, biological, psychological, and lifestyle influences often overlapping. The diversity of these perceptions, they note, reflects the inherent complexity of CHE as a disease — and points to the need for patient-centered care models that account for individual trigger profiles rather than a one-size-fits-all approach.

For practicing clinicians, these findings reinforce the value of systematically eliciting patients' own explanatory models during clinical encounters. Stress-related and lifestyle triggers, in particular, may be underemphasized during objective workups but remain prominent in how patients understand and experience their disease. Incorporating these perspectives more deliberately into shared decision-making may improve both patient engagement and therapeutic outcomes.

References

1. Simpson E, Balu S, Bin Sawad A, et al. Patient -perceived factors associated with Chronic Hand Eczema – results from the CHECK study in the United States. Poster presented at: 2026 American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver, CO.
2. Grant L, Seiding Larsen L, Burrows K, et al. Development of a conceptual model of Chronic Hand Eczema (CHE) based on qualitative interviews with patients and expert dermatologists. Adv Ther. 2020;37(2):692-706. doi:10.1007/s12325-019-01164-5