In vitro bactericidal and fungicidal activities of commercially available low-irritant hand sanitizers.

Dyshidrotic eczema (DE), also termed acute and recurrent vesicular dermatitis, is a vesicular clinical pattern of hand eczema (HE) with heterogeneous aetiologies. To characterise the clinical-allergological profile of patients with DE and to compare it with non-DE HE subtypes. A multicentre, retrospective, observational study was conducted using data from the Spanish Contact Dermatitis Registry (2019-2024). Of 4378 patients with HE, 559 were diagnosed with DE. A longer median disease duration (24 vs. 14 months) and more frequent palmoplantar involvement (16% vs. 7%) were observed in DE compared with non-DE HE. At least one positive patch test was identified in 43% of DE versus 52% in non-DE HE. Although overall sensitisation patterns were largely comparable, DE showed lower sensitisation rates to 2-HEMA, carba mix and thiuram mix. Occupational factors were less frequently implicated in DE (9% vs. 29%) compared with non-DE HE. Despite a high overall frequency of contact allergen sensitisation, the pattern of findings suggests that the dyshidrotic phenotype may follow a clinical course less dependent on external or occupational triggers, pointing towards a relatively greater contribution of endogenous factors compared with other HE subtypes.

Chronic hand eczema (CHE) is a common dermatitis with morphological and aetiological heterogeneity. Allergic contact dermatitis (ACD) is a major aetiology, and patch testing (PT) is essential to characterize CHE and guide its treatment and prevention. Determine the prevalence of ACD in CHE patients, describe relevant allergens, and identify differences in atopic and occupational settings. We conducted a multicentric retrospective observational study, based on PT results of CHE patients evaluated between 2021 and 2023, in Portuguese dermatology departments, comparing atopic dermatitis and non-atopic and occupational and non-occupational groups. Among 1267 patients (391 males/876 females) with CHE, representing 43% of all patients tested, 57% had at least one positive PT reaction, 41% of which were currently relevant. The most common allergens included metals, preservatives, fragrances, rubber constituents and 2-hydroxyethyl methacrylate. The occupational group revealed higher relevance rates for metals and benzisothiazolinone, whereas in the atopic dermatitis group, methylisothiazolinone and Myroxylon pereirae were considered more frequently relevant. CHE patients present a high sensitization rate and ACD is a main aetiology. Methylisothiazolinone and 2-hydroxyethyl methacrylate are confirmed as emergent allergens. The higher relevance rate of metals and benzisothiazolinone in the occupational group reinforces the importance of PT in the occupational setting.

Delgocitinib cream is a topical pan-Janus kinase inhibitor approved for adults with moderate to severe Chronic Hand Eczema (CHE) in the USA, Canada, European Union, and multiple other countries. Here, we assessed the systemic exposure of twice-daily topical application of delgocitinib cream 20 mg/g in adults with moderate to severe CHE treated under normal or maximal use conditions in the DELTA 2 trial and compared with the systemic exposure in adults with moderate to severe atopic dermatitis (AD) from a delgocitinib cream phase 1 AD trial. Blood sampling was performed 2-6h after delgocitinib cream application at weeks 1, 4, and 16 in DELTA 2. In the delgocitinib cream phase 1 trial, blood sampling was performed prior to application and at six timepoints (0-12h) post-application on day 1 and day 8. Geometric mean delgocitinib plasma concentrations were calculated in DELTA 2 and peak delgocitinib plasma concentrations (geometric mean Cmax) were calculated in the phase 1 trial. In DELTA 2, patients treated with delgocitinib cream under normal (n = 294; body surface area [BSA], 1.48%; application, 7.3g/week) or maximal use conditions (n = 19; BSA, 2.17%; application, 13.7g/week) showed geometric mean delgocitinib plasma concentrations at week 1 of 0.19ng/mL (n = 268) and 0.58ng/mL, respectively. In the phase 1 trial, patients (n = 14; BSA, 33.6%; application, 72.3g/week) showed a geometric mean Cmax of 1.20ng/mL (n = 13) on day 8. Delgocitinib cream 20mg/g resulted in minimal systemic exposure among adults with moderate to severe CHE, including those treated under maximal use conditions. Low systemic exposure was also observed in adults with moderate to severe AD, despite substantially greater BSA involvement and higher delgocitinib cream usage, highlighting the properties of delgocitinib cream's novel formulation. NCT03826901 (phase 1, delgocitinib cream); study start date: 20 February 2019; primary completion date: 29 October 2021; study completion date: 29 October 2021. NCT04872101 (DELTA 2); study start date: 25 May 2021; primary completion date: 27 December 2022; study completion date: 6 January 2023.

Hand eczema is one of the most common inflammatory skin conditions and is of great significance both clinically and in terms of health economics. With alifetime prevalence of up to 15%, it affects asignificant portion of the population, particularly in occupational settings, where it is the most common work-related skin condition. The condition leads to asignificant reduction in quality of life as well as considerable economic burdens. Diagnosis is complex due to its multifactorial etiology and variable clinical presentation. Astructured literature search was conducted for publications on the diagnosis of hand eczema within the last 5years. A total of 32publications were classified as relevant in terms of content: 7guidelines or expert recommendations, 13on biomarkers, 6publications on dermoscopy and histological analyses, and 7general descriptions of the current state of knowledge. Current research shows significant progress: Molecular and immunological analyses enable more precise differentiation between subtypes and differential diagnoses such as psoriasis. Biomarkers, transcriptome analyses, and noninvasive methods such as tape stripping open up new diagnostic possibilities. Additionally, data-based approaches show potential for improved histological classification. Overall, there is agrowing trend toward precision medicine diagnostics that go beyond purely clinical and morphological approaches. In the long term, these developments could enable more personalized treatment and better disease management.

Occupational skin diseases, particularly hand eczema and contact dermatitis (of the hands), are among the most common occupational diseases and can be associated with substantial psychosocial burden. They can impair quality of life, work ability, and mental health. To present the current state of knowledge on mental health in patients with occupational dermatoses, including relevant psychosocial stressors, comorbidities, and perspectives for care. Review of the literature on psychological comorbidities, quality of life, stress, and interventions in occupational skin diseases, as well as rehabilitation programs such as tertiary individual prevention (TIP). Symptoms of anxiety and depression are common in patients with occupational skin diseases. In one study of occupational hand eczema, 20% of patients reported anxiety symptoms and 14% depressive symptoms. Overall, approximately 7.5-24% of dermatoses are associated with obsessive-compulsive symptoms. Psychological comorbidities are linked to reduced quality of life, poorer disease outcomes, and impaired work ability. Stress acts both as arisk factor and aconsequence of the disease and is associated with delayed healing and reduced work performance. Psychological factors play an important role in occupational skin diseases and should be considered in diagnosis and treatment. Interdisciplinary and psychoeducational interventions may improve mental health, disease coping, and occupational participation.

A practical framework for treating-to-target in chronic hand eczema.

Many adult patients with hand eczema report having noticed the first signs of their skin condition at ayoung age. The pathogenesis of hand eczema is multifactorial. In children or teenagers, atopic predisposition as well as skin irritation or contact sensitization play amajor role in hand eczema development. To provide effective counseling to adolescents with hand eczema who are about to choose acareer, it is helpful to know the current state of knowledge regarding hand eczema in this special group of patients. Overview on the factors that are important for hand eczema in teenage patients, as well as possible approaches to career counseling. Evaluation of the current literature on hand eczema in childhood and adolescence and the recommendations for career counseling. The average age of onset for hand eczema is about 12years. The 1‑year and lifetime prevalence in childhood are described as 5.2-10% and 6.5-13.3%, respectively, and 12.1% and 18.3% in adolescents and young adults. Trigger factors differ within the young patient groups: while among children they are often found in the context of leisure activities and hobbies, in adolescents they sometimes relate to an occupational context. The choice of profession does not necessarily have to be restricted even in the context of aprevious history of eczema or an atopic preposition. It is crucial to counsel the young patients in detail, educating them about the special needs of their skin as well as on consistent moisturizing and skin protection. Early identification of trigger factors as well as good counseling and treatment optimization are essential for adolescent hand eczema patients in order to keep the influence of hand eczema on their development, thriving, and career choices as low as possible.

Although Chronic Hand Eczema (CHE) is associated with substantial humanistic burden, treatment patterns and economic impact are poorly understood in the USA. Therefore, this study characterized real-world treatment patterns and economic burden among patients with moderatetosevere CHE in the USA. US claims data (01/2016-04/2024) were used to identify adults with moderatetosevere CHE. Treatments were assessed post-diagnosis, with patients stratified into non-mutually exclusive cohorts on the basis of eczema/dermatitis-related treatment received. Eczema/dermatitis-related healthcare resource utilization and costs were descriptively reported while on treatment. In total, 6295 patients with moderatetosevere CHE were included (mean age: 48.2years; 63.8% female; 76.6% commercially insured). Topical and systemic corticosteroid therapies were used by 81.3% and 86.2% of patients, respectively. Treatment patterns were heterogeneous; patients frequently transitioned between systemic, topical, and no treatment. Total eczema/dermatitis-related costs per-person-per-year increased with treatment intensity, to $21,682 among patients receiving monoclonal antibodies/oral Janus kinase inhibitors. Substantial disease heterogeneity, extensive corticosteroid reliance, and steep increases in healthcare costs with treatment escalation were observed, underscoring an urgent need for CHE-specific therapies capable of providing durable control and reducing inappropriate resource use.

Successful treatment of chronic hand eczema with delgocitinib after systemic therapy failure.

Heterogeneity in outcome reporting and inconsistent use of outcome measurement instruments in allergy and clinical immunology research affects the comparability, synthesis, and clinical applicability of study findings. Harmonisation efforts, particularly Core Outcome Set (COS) development, aim to address these challenges by establishing standardised, evidence-based and consensus-driven outcome recommendations. This systematic review aims to map available COS and other harmonisation processes (HP) in allergy and clinical immunology, evaluate their methodological approaches, and assess their alignment with established development standards. We systematically searched MEDLINE, EMBASE, and the COMET Initiative database until June 7, 2024 to identify COS and HP. We included studies if they provided recommendations on 'core' outcomes and/or outcome measurement instruments. Data extraction included disease focus, methodological approach, stakeholder involvement, and adherence to the Core Outcome Set-STAndards for Development criteria. We synthesised the data at the initiative (process) level rather than the publication level because harmonisation initiatives are frequently iterative and reported across multiple papers (e.g., protocol, Delphi rounds, consensus statement, and subsequent instrument-selection outputs). A total of 15,612 records were identified, with 44 studies (representing 22 initiatives both finished and in development) meeting inclusion criteria. The majority of initiatives focused on asthma (n = 9), followed by eczema (atopic dermatitis n = 2; hand eczema = 1; eczema = 1), urticaria (n = 2), allergic rhinitis (n = 2), chronic rhinosinusitis (n = 1), celiac disease (n = 1), Immunoglobulin E (IgE)-mediated food allergy (n = 1), eosinophilic esophagitis (n = 1), and hereditary angioedema (n = 1). No COS or HP addressed drug allergy, anaphylaxis, or other immune-mediated allergic conditions. 'Quality of life' was consistently included in all COS with 'signs and symptoms', 'exacerbations' and 'disease control' frequently selected as well. Methodological approaches to COS development varied widely, with most employing Delphi surveys, consensus meetings, and stakeholder involvement, though levels of engagement differed. COS developers inconsistently adhered to Core Outcome Set-STAndards for Development criteria, with some initiatives demonstrating rigorous methodology while others lacked transparency in key developmental steps. This review highlights growing efforts to harmonise outcome assessment in allergy and clinical immunology. Major gaps remain in coverage and methodological rigour. Quality of life and patient-reported symptoms are frequently recommended outcomes, yet definitions and measurement tools are inconsistent. Strengthening methodological consistency and expanding COS development to neglected areas are critical next steps to improve outcome reliability and comparability in the field.

This report describes the treatment of a patient with subacute hand eczema. The patient presented with widespread eczema, especially severe on the palms, with thickened skin and intense pruritus. A combination therapy of fire-needle cluster shallow needling and cupping was administered once every two days, twice per week. After the first treatment, the patient reported significant relief of itching in the affected areas. After 12 treatments, the itching on the hands had resolved, the skin had become smooth, and the widespread eczema had also improved. At 3-month follow-up, the skin had returned to normal, with only temporary pigmentation.

This virtual roundtable covers the diagnosis of chronic hand eczema, the patient burden and emerging treatment pathways

Chronic hand eczema (CHE) is a frequent, often persistent inflammatory condition characterized by erythema, scaling, fissures and substantial discomfort of the hands. This condition occurs in both occupational and non-occupational settings and commonly follows a long, relapsing course that interferes with daily tasks, work performance, and impacts quality of life. The causes for CHE develop through a combination of genetic susceptibility, barrier disruption, immune activation, environmental irritants or allergens, and psychosocial stress.1 Despite the prevalence of chronic hand eczema and the availability of advanced treatments, many patients still experience inadequate disease control and persistent symptoms. Balato and colleagues, from the European Academy of Dermatology & Venereology Contact Dermatitis Task Force, published a comprehensive manuscript addressing frequent clinical questions and discussing topics such as the etiopathogenetic and epidemiologic background, clinical features, differential diagnosis, diagnostic workup, disease course, prognosis and scoring, the impact on quality of life and psychosocial and economic status, preventive strategies, and both established and emerging treatments for CHE. Among the newer pharmacological options are crisaborole, roflumilast, apremilast, AFX5931, dupilumab, tralokinumab, and lebrikizumab. The authors highlight that some of these agents are approved for other conditions but have demonstrated efficacy when used off-label in chronic hand eczema, while others have recently received approval or are expected to receive approval soon, specifically for this indication.2 Growing evidence shows that CHE cannot be adequately understood or treated through a purely dermatologic lens. Multiple studies now document that CHE carries a substantial psychiatric and psychosocial burden, with patients experiencing significantly elevated rates of anxiety, depression, social anxiety and avoidance behaviours3 A recent meta-analysis strengthens this conclusion, demonstrating that individuals with hand eczema consistently exhibit moderate-to-severe quality-of-life impairment and higher anxiety scores compared with healthy controls4 Psychosocial distress can be out of proportion to clinical severity. When taken together, these data show that CHE is not merely a localized skin inflammatory disorder but a biopsychosocial condition in which psychological state, stress biology, immune activation and skin barrier integrity continually interact. This perspective supports reshaping CHE management to routinely include psychosocial screening tools, stress-reduction strategies, referral to cognitive-behavioural interventions and evaluation of how comorbid anxiety or depression may influence the response to advanced systemic therapies such as JAK inhibitors or biologics. Dermatologists have the unique opportunity to provide early mental health referral and psychoeducation for these patients.5 Grammar and spelling were checked using Grammarly. No AI tools were used to generate or modify the scientific content of the manuscript. Katlein França receives book royalties from Springer, Wiley Blackwell and Nova Science Publisher, and is a medical board reviewer for the Health.com website. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Chronic hand eczema (CHE) remains difficult to treat, particularly in patients unresponsive or intolerant to topical corticosteroids. Although topical delgocitinib, the first topical JAK inhibitor approved for CHE, provides a steroid-free alternative, comparative real-world data versus localized cream psoralen-ultravioletA (PUVA) are missing. This retrospective real-world study compared the short-term effectiveness and patient-reported outcomes of topical delgocitinib and localized cream PUVA in patients with CHE under routine-care conditions. This retrospective cohort study analyzed anonymized routine-care data of patients with moderate-to-severe CHE treated between 2024 and 2025 at a tertiary center. Patients received topical delgocitinib twice daily or localized cream PUVA with as-needed topical corticosteroids (TCS). Twenty-two patients per group completed 12weeks of delgocitinib or 20-25 PUVA sessions plus TCS (per-protocol). Disease severity (Physician's Global Assessment, PGA), quality of life (Dermatology Life Quality Index, DLQI), and symptom numerical rating scales (pruritus, pain, sleep disturbance) were assessed at baseline and treatment end. Both therapies significantly improved all endpoints (p < 0.001). Median DLQI improvement was 10 with delgocitinib versus 7.5 with PUVA (p = 0.15). PGA0/1 responses were 82% vs 73% (p = 0.72). DLQI improvement ≥ 4 points occurred in 91% vs 77% (p = 0.41). Relapses were more frequent after PUVA. Two delgocitinib non-responders improved with alitretinoin. Most delgocitinib responders continued proactive low-frequency use to maintain remission; one remained clear 3months after stopping treatment. Delgocitinib and PUVA provided comparable short-term clinical efficacy in CHE, with a numerically greater DLQI reduction for delgocitinib. Proactive delgocitinib maintenance may help sustain disease control. Subtype-adapted treatment strategies could further optimize outcomes.

Chronic hand eczema (CHE) is a common inflammatory skin disease with considerable heterogeneity with respect to etiology and morphology. Medical history, physical examination, assessment of risk factors such as occupation, irritant and/or allergen exposures, and atopic comorbidities, are important steps in the diagnosis of CHE. An evaluation of the impact of CHE on quality of life and functioning is also important to appreciate the personal impact of this chronic and potentially debilitating disease. Skin biopsy and microbiological testing are generally not useful, and limited access to patch testing in Canada requires that clinicians prioritize and triage patients for patch testing to confirm a diagnosis of allergic contact CHE. Lack of a universally accepted classification system and standardized outcome measures for CHE poses challenges with respect to the interpretation of clinical trials for different CHE treatments. Several clinician- and patient-reported assessment scales have been validated for use in CHE, but only a few were specifically developed for hand eczema. Either the Investigator's Global Assessment-CHE or the Physician's Global Assessment and the pruritus or pain Numerical Rating Scale is a reasonable approach to the clinical implementation of CHE assessment tools, which can be used to monitor symptoms over time.

The chronic hand eczema (CHE) management landscape is rapidly evolving with emerging evidence supporting the efficacy and safety of new treatments, some of which are not included in current guidelines. Preventive measures remain a cornerstone in the management of CHE across all etiological and morphological subtypes. The array of topical therapies for CHE is expanding with mounting evidence for newer agents that directly target the underlying pathophysiology of CHE compared to older agents that are more broadly anti-inflammatory. Phototherapy remains an effective option for CHE, but access and inconvenience remain barriers in many regions. Several advances in targeted systemic therapies for CHE have been made, with some agents approved for the treatment of moderate-to-severe atopic dermatitis exhibiting efficacy in hand and foot eczema, while other agents have evidence specifically for efficacy in CHE. With this evolving treatment landscape, an updated algorithm for the management of CHE is proposed.

Chronic hand eczema (CHE) is a relatively common skin disease that is associated with substantial personal and societal burden, including work disability and psychosocial impairment. The etiopathogenesis of CHE is heterogeneous and multifactorial, and although it is an area of active research, it remains incompletely understood. Methods to investigate the etiopathogenesis of CHE have largely been adopted from other skin diseases to examine gene expression, proteomics, and skin barrier integrity. Tape stripping has emerged as a practical and noninvasive method to study differences in transcriptomics that is less painful and more convenient than the gold standard, skin punch biopsy. Studies have suggested broad activation of immune pathways in CHE, including key Th1, Th2, Th17, and Th22 cytokines. In parallel, there are indications of broad skin barrier dysfunction in CHE including downregulation of barrier proteins. There is a dearth of high-quality evidence on etiopathological differences between CHE subtypes, and this remains an area of research need to identify new targets for treatment.

The AWMF S1 guideline 013/056 "Occupational Skin Products: Protective Creams, Skin Cleansers and Skin Care Products" from 2014 has been revised and upgraded to S2K level. The aim was to develop a decision aid for the optimal use of occupational skin products for the prevention of hand eczema in the workplace. The multidisciplinary expert commission included representatives from dermatology, occupational medicine and dermopharmaceutical societies, as well as from German Social Accident Insurance. The update was conducted through a non-systematic review of current (inter)national scientific literature, focusing on randomized controlled clinical trials. The revised guideline integrates: (1) epidemiological studies demonstrating the effectiveness of skin protection and care, (2) results from the Cochrane Review on the primary prevention of occupational hand eczema, (3) skin physiological multicenter studies on the application and benefits of skin protectioncreams and the tolerability of skin cleansing products, (4) specific investigations on wet work, and (5) current positions on aluminum chlorohydrate and contact allergens based on opinions of the Scientific Committee on Consumer Safety (SCCS) and data from the Information Network of Departments of Dermatology (IVDK). The recommendations and key statements were agreed upon in a structured consensus conference using a nominal group process under professional moderation. The S2K guideline aims to improve the prevention of occupational hand eczema and promote the health of employees.

Background: Hand Eczema (HE) is a common chronic skin disease and is considered as one of the most common occupational skin disorders. Yet, differences in demographic factors, clinical manifestation and treatment between patients with and without occupational hand eczema remain insufficiently characterized. Objective: To assess one-year data on frequency, occupational exposure, clinical subtypes and the treatment modalities of patients diagnosed with hand eczema seen in a tertiary care center. Methods: The data analysis was performed from clinical records using a standardized data collection form. Patients (age ≥ 18 years) with the diagnosis of hand eczema were included. Results: 2023 193 patients were identified. The average age was 47 years with a higher proportion of female patients (55%). 50 of 193 patients had occupational hand eczema. 14% of the cohort presented through the emergency department (n=27), of these 2 were hospitalized. The overall annual hospitalization rate of the HE cohort reached 9% (n=18). Patients received a topical anti-inflammatory treatment with corticosteroid-ointments (100%), but &gt; 25% required a systemic treatment. Non-specified hand eczema was coded most frequently with 38% of all non-occupational hand eczema cases. Irritant hand eczema was most frequently diagnosed in occupational hand eczema (42%). Conclusion: HE patients are seen in a tertiary specialized university medical center, including emergency presentation and hospitalization. Most cases were classified as non-specified hand eczema indicating the need of an accurate coding system for HE. Only by standardized documentation the quality and interpretability of research on hand eczema can be facilitated.