The Multifactorial and Heterogenous Nature of Chronic Hand Eczema Seen in Clinical Practice in the United States ̶ Results from the RWEAL-US Study

Abstract

Introduction & Objectives Chronic Hand Eczema (CHE) is a heterogeneous, multifactorial disease that can significantly impair quality of life, resulting in functional limitations for patients. Diagnosis and management of CHE remain challenging, especially in the United States (US), where substantial gaps exist in real-world data describing clinical features, presentation, and assessment. This large study characterizes the clinical features of CHE in routine clinical practice in the US. 

Materials & Methods The RWEAL-US study (Real-World trEatment & mAnagement of chronic hand eczema in cLinical practice) was a survey-based medical chart review. The survey was distributed by specialized online panels. These panels comprise a large, well-established, and verified network of dermatology HCPs (MDs, DOs, NPs, and PAs) with nationwide geographic coverage in the US. Each HCP was asked to complete case report forms for up to six adult patients (≥18 years) who had moderate to severe CHE at their last visit, seen in the weeks/months following HCP’s enrollment in the study. 

Results A total of 307 adult patients with moderate to severe CHE were included by 68 participating HCPs (86.8% MD/DO’s). Disease severity was assessed in various ways: formal hand eczema scoring systems were used in only 9.1% of patients, while clinical judgement was used for 81.8% (N=251) of patients. In addition, HCPs considered CHE treatment history (42.3% [130], psychosocial burden or impact on quality of life for (32.6% [100]), and impact on ability to work (24.4% [75]) when assessing CHE severity. 

Across patients, the worst assessed CHE severity within the past 12 months was moderate in 61.9% (N=190) of patients and severe in 38.1% (N=117) of patients. 

During the last visit, the most frequently observed clinical signs included scaling (66.1%, N=203), erythema (64.8%, N=199), fissures (51.1%, N=157), lichenification (35.8%, N=110), hyperkeratosis (26.7%, N=82), vesicles (20.5%, N=63) and edema (17.9%, 55). Common symptoms included pruritus (73.9%, N=227) and pain (32.6%, N=100). Most patients (76.9%, N=236) exhibited three or more signs and symptoms. 

CHE was most commonly localized on the palms (56.0%, N=172) and fingertips (52.1%, N=160), followed by back of hands (41.4%, N=127) and interdigital spaces and wrists (27.4% for both, N=84). Single localization was reported in 37.8% (N=116) of patients, two areas in 33.2% (N=102), and three areas or more in 28.7% (N=88). 

Conclusion This large observational study provides valuable real-world insights into the clinical assessment and presentation of CHE in the US. Findings demonstrate that formal scoring systems of CHE are rarely used in clinical practice, with severity most commonly assessed by general clinical evaluation and treatment history. Patients with moderate to severe CHE frequently present with multiple signs and symptoms. Improved management strategies are needed to address the multifaceted nature of CHE and better meet patients’ clinical needs.