Hand eczema: from pathogenesis to novel treatments

Abstract

Hand eczema is a common condition that affects the hands and can have significant negative impacts on quality of life and socio-economic consequences. Unfortunately, treatment options are currently limited, with only alitretinoin approved for systemic treatment of severe chronic hand eczema. To identify new therapies, understanding the pathogenesis is crucial. Additionally, limited data is available on the prevalence and severity of chronic hand eczema in the general population. It was found that the lifetime prevalence of hand eczema in Dutch general population was 15.0%, with a one-year prevalence of 7.3%, and a majority of patients (56.9%) experiencing mild hand eczema. However, a significant portion of participants had severe to very severe hand eczema (1.9%). The majority of patients with hand eczema had chronic hand eczema, resulting in a one-year prevalence of 4.7%, and the severity of the condition was significantly higher in those with chronic complaints. A transcriptome (gene expression) and proteome (protein expression) analysis on vesicular hand eczema was conducted, in which it was found that the transcriptome of vesicular hand eczema overlaps largely with the transcriptome of eczema in patients with atopic dermatitis. Therefore, treatments for atopic dermatitis may also be effective in treating vesicular hand eczema. Finally, dupilumab, a biological treatment, showed promising results in hand eczema patients with atopic dermatitis in daily practice studies and in patients with severe hand eczema in a 16-week randomized, placebo-controlled clinical trial.