Q&A: Occupational Risk, Chronic Flares, and New Therapies in Chronic Hand Eczema

The CHECK observational study underscores the significant prevalence and long-term burden of chronic hand eczema (CHE), a condition that remains difficult to manage due to occupational exposures and historically limited treatment options. In an interview with Pharmacy Times®, Shannon Schneider, PhD, vice president of North America medical affairs at LEO Pharma, noted that patients frequently experience prolonged flares that interfere with daily activities, work productivity, and mental health. Reliance on potent topical corticosteroids has contributed to treatment challenges, as these agents are not appropriate for long-term use. Schneider added that pharmacists can help bridge care gaps by identifying at-risk patients, educating them on emerging therapies, and facilitating timely referral to dermatology.

Pharmacy Times: The CHECK study found that nearly 10% of U.S. adults report a physician diagnosis of chronic hand eczema. Why do you think CHE remains underrecognized or undertreated despite its high prevalence?

Shannon Schneider, PhD: Well, thank you for the question. I think that actually, when you talk to patients and clinicians, CHE isn’t underrecognized, but treating it effectively has been an issue. Chronic hand eczema is eczema that occurs for greater than three months or relapses two or more times per year. It’s highly heterogeneous in its presentation; there is currently no ICD-10 code for the condition, and up until recently there was no approved treatment for it. For these reasons, health care professionals have had to rely predominantly on potent topical corticosteroids for its treatment, which isn’t ideal because these medications should not be used long-term. Furthermore, there’s a strong occupational component to CHE, and people who suffer from workplace-induced chronic hand eczema struggle to avoid those offending irritants or allergens. It’s really more that it’s difficult to treat, not that it’s necessarily underrecognized.

Pharmacy Times: CHE prevalence was higher among younger adults, males, and employed individuals. What occupational or environmental exposures should pharmacists be most alert to when identifying at-risk patients?

Schneider: That’s correct. The CHECK study did find higher CHE prevalence among men, employed individuals, younger adults under 40, and residents of urban areas. CHE symptoms such as itch, pain, fissures, and scaling can be triggered or worsened by repeated exposures that disrupt the skin barrier. This can be particularly difficult for people who do wet work or have to frequently wash their hands, such as those in the health care industry. Other occupations, like manufacturing, where people are regularly exposed to irritants and allergens, can also be particularly problematic. Pharmacists who know their patients and understand their work life can be especially helpful in identifying chronic hand eczema.

Pharmacy Times: More than three-quarters of patients reported flares lasting three months or longer. How should this level of chronicity influence treatment planning and expectations for patients?

Schneider: Due to our reliance on our hands to perform everyday tasks like washing your hands, doing the dishes, taking care of children, and in some cases performing our jobs, it’s very difficult to treat chronic hand eczema because the hands are constantly being exposed. This is compounded by the fact that until recently there were no approved medications to treat chronic hand eczema, so clinicians had to predominantly rely on potent topical corticosteroids, which should not be used long term. For many patients, this has led to years of struggling to control their symptoms. In many cases, as shown in the CHECK study, patients have had to change jobs or modify their daily activities due to their hand eczema.

Pharmacy Times: Many patients reported moderate to severe disease and involvement of multiple hand areas. What does this suggest about the limitations of topical therapy alone for some patients?

Schneider: I don’t know if this suggests a limitation to topical therapy in general, but rather that potent topical corticosteroids aren’t supposed to be used long-term. There are some patients who may also have moderate to severe atopic dermatitis and need a biologic to treat other body regions, and in these cases some biologics have been shown to clear the hands. Now there’s a nonsteroidal topical that’s been shown to be safe and effective for long-term treatment of chronic hand eczema. Ultimately, it comes down to patient preference and symptoms to help guide the treatment regimen. Topical treatments, if they’re nonsteroidal, still definitely have a place in the treatment algorithm.

Pharmacy Times: Emotional and mental health conditions were among the most common comorbidities. How significant is the psychosocial burden of CHE, and how can pharmacists help address it?

Schneider: Talking to patients about their chronic hand eczema is really eye-opening. It’s been shown to cause psychological and functional burdens that significantly affect quality of life, and about 70% of individuals with severe chronic hand eczema report difficulty performing everyday activities like washing your hair, taking care of your children, washing dishes, and cleaning. This makes it very difficult for patients to live their lives. Patients in the CHECK study also reported notable impacts on work productivity and the need to change or modify job responsibilities, highlighting additional stress and economic burden. Pharmacists can play an important role by recognizing persistent or moderate to severe symptoms, understanding the broader burden on patients, and encouraging referral to a dermatologist for further evaluation and management.

Pharmacy Times: Based on these findings, where can pharmacists have the greatest impact in improving earlier recognition, referral, and long-term management of chronic hand eczema?

Schneider: Pharmacists know their patients and can help guide awareness of the disease, as well as proper use of steroids. More importantly, they can provide information on newer therapies developed specifically for chronic hand eczema. Patients may not know that new treatments are available. Pharmacists can play a big role in connecting patients to appropriate long-term care, because this is a chronic disease and topical corticosteroids are not appropriate for long-term management.