Consensus statement on the management of chronic hand eczema

Authors


  • Conflict of interest: JE has received lecture honoraria from Basilea. RA and BS have no conflicts of interest to declare. DJG is Chair of the Expert Advisory Group on Dermatology at the Commission on Human Medicines and has received funding for consultancy from Novartis. SK is Chair of the Primary Care Dermatology Society, which receives funding from pharmaceutical companies including Basilea, and has received funding for research and consultancy from Novartis. JMLW has received consultancy fees and lecture honoraria from Basilea. JW has received an honorarium from Basilea. This paper is based on a roundtable meeting supported through an unrestricted grant from Basilea. The participants retained full control of the discussion and the resulting content of this article.

Dr John English, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
E-mail: john.english@nuh.nhs.uk

Summary

The management of chronic hand eczema is often inadequate. There are currently no evidence-based guidelines specifically for the management of chronic hand eczema, and evidence for established treatments for hand eczema is not of sufficient quality to guide clinical practice. This consensus statement, based on a review of published data and clinical practice in both primary and secondary care, is intended to guide the management of chronic hand eczema. It describes the epidemiology and pathogenesis of hand eczema, its diagnosis and its effect on patients’ quality of life. Management strategies include a skin education programme, lifestyle changes, and the use of emollients, barriers and soap substitutes. Topical drug therapy includes topical steroids and calcineurin inhibitors. Treatment with psoralen ultraviolet A and systemic therapies may then be appropriate, although there is no strong evidence of efficacy. Alitretinoin has been shown to be effective in a randomized controlled trial, and is currently the only treatment specifically licensed for the treatment of hand eczema. Recommendations for management are summarized in a treatment algorithm.

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