A practical approach to the management of chronic hand eczema: expert insights

Abstract

Chronic hand eczema is a persistent inflammatory skin condition that significantly affects quality of life, especially in high-risk occupations. Often misdiagnosed as atopic dermatitis, chronic hand eczema has been historically managed inconsistently. Recent insights into its epidemiology, socioeconomic impact, and pathophysiology highlight the need for more targeted approaches. A panel of seven French dermatologists and allergologists independently convened over 6 months, to review current knowledge and develop a practical treatment algorithm for chronic hand eczema in France. Their goal was to align recent evidence with real-life clinical experience. The panel reaffirmed chronic hand eczema’s complex etiology, high occupational prevalence, and psychosocial burden. Updated diagnostic criteria were defined, stressing clinical evaluation, occupational history, and appropriate testing. Subtypes – including irritant, allergic, atopic, and protein contact dermatitis – were addressed, with emphasis on overlapping forms and diagnostic challenges. Treatment strategies were evaluated, distinguishing approved and off-label options available in France. The experts underscored the role of new targeted therapies in moderate-to-severe cases and emphasized prevention through patient education on irritant and allergen avoidance. The resulting algorithm provides a stepwise, pragmatic approach to chronic hand eczema management, tailored to disease severity, phenotype, and treatment response. This expert opinion promotes earlier recognition, multidisciplinary care, and improved management in everyday dermatological practice.