Treatment Patterns in Chronic Hand Eczema in the US ̶ Results from the RWEAL-US Medical Chart Review

Abstract

Introduction & Objectives Chronic Hand Eczema (CHE) is a difficult-to-treat, relapsing inflammatory skin disease that affects the hands and wrists and is characterized by pain and itch. Although CHE is common, understanding of CHE treatments used in routine clinical practice remains limited in the United States (US). The objective of this analysis was to investigate treatments used by patients with moderate to severe CHE who visited a health care professional (HCP) over a 12-month period. 

Material & Methods The RWEAL-US (Real-World trEatment & mAnagement of chronic hand eczema in cLinical practice) study was a large medical chart review of adults with moderate to severe CHE which involved US healthcare professionals (HCPs) specializing in dermatology. HCPs were recruited from specialized online panels. These panels comprise a large, well-established, and verified network of HCPs with nationwide geographic coverage of dermatologists in the US. Each HCP included up to six patients (aged ≥18 years with moderate to severe CHE at last visit) seen in the week or months following HCP’s enrollment (between June and September 2025). Data on treatments received in the 12 months prior to the last visit were collected and analyzed descriptively. Differences between moderate and severe CHE patients were assessed. For categorical variables, Pearson's chi-squared test was applied. 

Results In total, 68 HCPs participated in the study: 56 MD’s, 5 PA’s, 4 NP’s, and 3 DO’s. They completed case report forms for a total of 307 patients with moderate to severe CHE, of which 55.0% (N=169) were females. The mean (SD) time since diagnosis was 3.2 (4.1) years. In the past 12 months, HCP-assessed worst disease severity was moderate for 61.9% (N=190) and severe for 38.1% (N=117) of patients. 

Over the 12 months prior to the last visit, use of topical corticosteroids (TCS) was reported in 84.0% (N=258) of patients. Although all of these patients had active disease, HCPs reported an inadequate response - or a contraindication to TCS for 31.4% of them (N=81/258). 

The second most used treatment class for CHE was biologics, reported in 24.1% (N=74) of patients, with a significantly higher proportion among severe patients compared to moderate patients (30.8% vs. 20.0%, p=0.03). Use of advanced topicals (roflumilast, ruxolitinib and tapinarof) was reported in 13.4% (N=41) of patients; other topicals in 11.1% (N=34); conventional oral therapies in 3.9% (N=12); oral JAK inhibitors in 2.3% (N=7); and phototherapy in 1.6% (N=5). For one patient, no treatment was reported at all in the past 12 months. 

Conclusion Although patients in this study had moderate to severe CHE, the findings of this large observational study show that TCS are the most used treatment in US clinical practice. Biologic treatments come second with nearly one in four patients receiving them for moderate to severe CHE. Given the limited evidence on the effectiveness, value, and cost-effectiveness of biologics in CHE, the findings of this analysis underscore the need for safe and effective treatment options with demonstrated efficacy and value to benefit both patients and health care systems in managing this difficult-to-treat disease.