The Patient Journey: From Diagnosis to Therapeutic Management of Chronic Hand Eczema

Chronic hand eczema (CHE) is a frequent and heterogeneous condition associated with long-lasting symptoms, functional impairment, and high psychosocial and socioeconomic burden. Diagnostic evaluation relies on detailed history taking, physical examination, and patch testing, which remains the gold standard for identifying relevant sensitizations. Disease severity can be assessed with clinician-reported instruments, such as the Hand Eczema Severity Index, and patient-reported outcomes, particularly the Quality of Life in Hand Eczema Questionnaire (QOLHEQ). Management requires a structured, stepwise approach integrating preventive measures with pharmacological interventions. Topical corticosteroids remain the first-line treatment, whereas phototherapy and systemic options, including alitretinoin and immunosuppressants, are indicated in refractory cases. Recently, novel agents such as topical delgocitinib and biologics like dupilumab have expanded the therapeutic armamentarium, particularly for atopic CHE. Preventive strategies, implemented at primary, secondary, and tertiary levels, are crucial for reducing recurrences and improving long-term outcomes. Despite these advances, there is still a lack of standardized diagnostic tools, validated severity measures, and evidence-based treatment algorithms. Future efforts should focus on patient-centered, multidisciplinary care and further research to optimize disease control and quality of life in CHE.