Raj Chovatiya, MD, PhD: Pathophysiology, Diagnosis of Chronic Hand Eczema

Chronic hand eczema (CHE) is a condition which can heavily impact a patient’s life, especially given the centrality of one’s hands to daily activities and general quality of life as a result. At the 44th Annual Fall Clinical Dermatology conference in Las Vegas, a presentation on updates and facts important to understand about CHE was given.

The talk, titled ‘Chronic Hand Eczema: Pathophysiology, Diagnosis, and Disease Management’ was an expert therapeutic update session which was also sponsored by LEO Pharma. It was given by Raj Chovatiya, MD, PhD, clinical associate professor of medicine for Rosalind Franklin University Chicago School of Medicine.

“When we say the word eczema, we oftentimes think about eczema, atopic dermatitis, as one of the same but we're actually not talking about atopic dermatitis per se,” Chovatiya explained. “So CHE is actually going to be distinct from atopic dermatitis and there's actually a number of different subtypes of epidemiology that compose this entity of chronic hand eczema.”

An important point Chovatiya noted in his talk which he hopes attendees remember is that CHE, though it has limited involvement, is often debilitating due to both itch and pain. He added that it involves a high psychological, functional, and occupational burden while it only impacts the hands and the wrists.

“Chronic hand eczema is defined as hand eczema that lasts for more than 3 months or relapses twice or more per year,” Chovatiya said. “So just pausing on that definition for a moment, you might think about your own patients and your clinic, your own hands maybe, and realize that there's actually probably a lot of people that fit into that definition. So keep that in mind the next time you're seeing that patient.”

Chovatiya also highlighted the significant economic and daily-life burdens impacting individuals with hand eczema. In fact, he pointed to the fact that approximately 80% of patients in 1 study reported a moderate to extremely large impact on their quality of life. He also noted the multifactorial nature of CHE.

“When I say intrinsic (risk factors) it’s some of the stuff that you're probably familiar with atopic dermatitis and we’ve been talking about over the past few years,” Chovatiya said. “Everything from childhood eczema, a filaggrin gene mutation, or a prior history of atopic dermatitis, which can be one of the more important associated risk factors. However, there are a number of extrinsic risk factors, and that's really what's unique about chronic hand eczema, because these are so extremely diverse.”

Chovatiya noted that these are important to the overall disease state itself, highlighting that some extrinsic factors include the weather, use of substances like tobacco, education, and occupations involving wet conditions. He explained that occupational exposure is 1 of the most important aspects of the disease state. Some of the professions associated with the condition include:

• Hairdressers
• Healthcare workers
• Cleaners

Chovatiya also highlighted several facts about the subsets of CHE, including information about irritant contact dermatitis, allergic contact dermatitis, hyperkeratotic hand eczema, pulpitis, and acute recurrent vesicular hand eczema.

“The bottom line is that more than half of patients have one or more additional diagnosis subtypes, and this changes over time,” Chovatiya said. “So the idea of really trying to narrow somebody into a singular category is practically quite difficult, and practically isn't really necessary.”

He discussed several useful notes on these conditions, for example pointing to irritant contact dermatitis and that irritancy on the hands is likely a driver of almost everything. Chovatiya added that there’s usually no contact allergen and that it can involve all different parts of the hand.

Prolonged repeated irritant exposure, such as detergent, can be one clear precipitant of this particular phenotype, he explained.

“Aside from etiology, what about morphology?” Chovatiya said. “Because we often tend to define our hand eczema based on morphology itself. So in the case of hyperkeratotic hand eczema, perhaps unsurprisingly, you see a lot of hyperkeratosis, usually for palms…There is actually a fairly strong demonstrated risk with tobacco smoke in the literature.”

Chovatiya also highlighted facts on conditions such as nummular hand eczema, which he notes has an association that has been identified with allergic contact dermatitis. After discussing some of the exogenous factors and endogenous factors, as well as a discussion about the unmet needs and challenges to treatment, Chovatiya summarized the major takeaways.

“The disease state itself is incredibly burdensome, not only to the patients but actually to the entire infrastructure of society as a whole,” Chovatiya said. “It's actually really common. You saw some of the recent data suggesting maybe around 5%, and it's really impossible to avoid for people that work in wet conditions…There's no FDA-approved treatment for moderate to severe chronic hand eczema that gives the 2 things we want, short term control and long term control to really eliminate the flares.”

For additional information on our latest coverage of this conference, view our most recent articles here.

The quotes contained in this summary of the talk were edited for the purposes of clarity.