Molecular Diagnostics in Hand Dermatoses: Clinical Findings and Health-Related Quality of Life in a 3-Year Follow-Up Cohort Study

Hand eczema and psoriasis present overlapping clinical features, complicating diagnosis and treatment selection. Traditional diagnostic methods rely on clinical assessment, patient history, allergy testing, and histopathology. However, recent advancements in molecular diagnostics offer promising alternatives. Accurate diagnosis is crucial for optimal therapy selection, particularly in occupational dermatology, where hand eczema is a common occupational disease.This study aims to assess the effectiveness of molecular diagnostics in distinguishing hand eczema from psoriasis, analyze disease severity and chronicity, and evaluate therapeutic changes and health-related quality of life (HrQoL) over a 2-year period. A long-term cohort study was initiated in November 2020, enrolling 287 patients with suspected occupational skin disease. Molecular classification based on gene expression ( CCL27 and NOS2 ) was performed on skin biopsies. Data collection included physician global assessment (PGA), Quality of Life in Hand Eczema Questionnaire (QOLHEQ), and Dermatology Life Quality Index (DLQI). Statistical analyses employed Cohen’s kappa, χ 2 tests, Wilcoxon signed-rank tests, and 95% confidence intervals. Of 272 patients assessed via molecular diagnostics, 38.9% had clinically unclear diagnoses, with over 95% of these clarified through molecular classification. Dermatological and molecular diagnoses showed low agreement. Disease severity and chronicity significantly decreased over 2 years. Use of systemic therapies increased, while overall corticosteroid usage declined. HrQoL improved significantly, with DLQI scores decreasing by 50%. Molecular diagnostics significantly enhance diagnostic accuracy for hand dermatoses, leading to targeted treatment adjustments. The observed therapy shift correlated with improved disease outcomes and HrQoL. As specialized systemic treatments emerge, precise diagnostic tools will be essential for optimizing patient care and reducing the burden of occupational skin diseases.