Patients with Severe Chronic Hand Eczema More Willing to Allocate Time for Treatment

Skin clearance is viewed as important among patients with chronic hand eczema (CHE), new findings suggest, with those reporting more severe disease expressing more commitment to a significant amount of time each day to treat their disease.¹

Alexandern Egeberg, MD, PhD, DMSc—Professor of Dermatology and Senior Consultant at the University of Copenhagen and Bispebjerg Hospital—led a team of investigators in authoring this analysis. Egeberg and coauthors had sought to explore the value of skin clearance and daily time trade-off (dTTO) among adults living with CHE.

The investigators highlighted that prior dermatological research had implemented time trade-off and concluded that individuals with psoriasis, alopecia areata, atopic dermatitis, hidradenitis suppurativa (HS), or rosacea who were also impacted by a high burden of disease were willing to allocate a substantial amount of daily treatment time and risk serious side effects if they could attain disease resolution.²

“However, the willingness to allocate daily time to treat the disease in return for complete disease resolution is unknown in patients with CHE,” Egeberg and colleagues wrote.¹ “We investigated the importance of skin clearance and TTO in adult patients with CHE.”

Trial Design Details

The investigative team’s analysis drew on patient-reported outcomes from the Danish Skin Cohort, a nationwide longitudinal study highlighting adults with dermatologist-confirmed skin diseases, including CHE. The cohort also served as representative sample of the general adult population in Denmark.

The study cohort, launched in 2018, was designed to explore the prevalence, clinical features, and broader consequences of different disorders impacting the skin. At the time of the study’s inception, Egeberg et al included individuals with dermatologist-verified plaque psoriasis or atopic dermatitis, in addition to a randomly selected group of skin-healthy controls who they drew from the general Danish population. Recruitment for this analysis was based on linkage to the Danish National Patient Registry, with the team using CPR numbers and ICD-10 diagnostic codes.

Those taking part in the study were given invitations via the national secure digital system. They were given 3 weeks to fill out the online questionnaire, with reminders sent each week during this period. Some of the items in the survey were required to be answered in order to submit the questionnaire, whereas others were labeled as optional. Data were gathered prospectively and then stored in an encrypted system.

Participants deemed eligible were identified as those who had received the validated diagnostic code DL308H for CHE from a dermatologist between January 2000 – December 2019. Patients who had an additional ICD-10 code for atopic dermatitis were not included, as they were recruited separately into the atopic dermatitis cohort. Those included as subjects also had to fulfill chronicity criteria—reporting hand eczema over the course of ≥3 months or appearing in ≥2 flare-ups within a 12-month timeframe—and confirmation of current CHE.

Egeberg and colleagues’ collection of demographic information took place through national registry linkage, while patients self-reported data on clinical features, age at the onset of CHE (≤5 years, 6–18 years, or ≥19 years), smoking status, atopic history, prior and ongoing therapies, trial subjects’ views of the importance of skin clearance, and the amount of time the subjects would be willing to devote daily to therapy for their disease in exchange for complete CHE clearance. Severity of CHE was graded by the investigative team using a modified 5-level scale adapted from a validated photographic tool.

The team defined flare-ups as notable worsening of CHE necessitating treatment escalation. Pruritus and pain were assessed with a numeric rating scale (NRS, 0–10) and participants’ perceived value of skin clearance was evaluated by asking respondents to rate the importance of attaining 50%, 75%, 90%, and 100% clearance on an NRS, with higher scores suggesting greater importance.

Time trade-off was assessed by Egeberg and coauthors as daily TTO (dTTO). Without specifying types of treatments, the study subjects were asked by the investigators how much time (<15 min, 15–30 min, 30–60 min, or >60 min each day) they would be willing to commit if it guaranteed complete disease clearance. A “low dTTO” was defined by the team as <30 minutes, while a “high dTTO” was >30 minutes each day.

Findings on Patients with CHE

Among the 372 participants reporting active CHE, Egeberg et al found that 58.1% described their condition as mild. They also noted that 26.3% of these individuals reported their CHE as moderate, 11.0% as being severe, and 4.6% as being very severe. In their evaluation of median NRS scores (interquartile ranges) for the importance of attaining 50%, 75%, 90%, and 100% clearance, the investigative team found these scores were 9 [5–10], 9 [7–10], 10 [8–10], and 10 [9–10], respectively.

Views on the importance of disease clearance among participants rose notably with increasing disease severity (P< .001). In another finding, the team concluded that 41.2% of the participants with severe or very severe CHE reported willingness to dedicate more than a single hour per day to treatment.

“Skin clearance was important among CHE patients, and patients with moderate to severe CHE were willing to dedicate a substantial amount of daily time to treat their CHE, especially if they also suffered from pain and itch,” the investigative team concluded.¹ “This emphasises the substantial disease burden of CHE and the urgent need for more effective and targeted treatment options.”

References

1. Christensen MO, Nymand LK, Egeberg A, et al. Treatment Willingness and Importance of Skin Clearance for Patients With Chronic Hand Eczema. Contact Dermatitis. 2025 Aug 30. doi: 10.1111/cod.70013. Epub ahead of print. PMID: 40884390.

2. YMF Andersen, C Zachariae, A Egeberg, et al. Estimating the Burden of Skin Diseases Using Patient-Reported Daily Time Trade-Off as a Measure of Disease Impact and Unmet Needs. JEADV Clinical Practice 3, no. 2 (2024): 755–763, https://doi.org/10.1002/jvc2.305.