A Practical Approach to Chronic Hand Eczema

Chronic hand eczema (CHE) is a multifactorial condition with significant physical, psychological, and socioeconomic burdens. Its complex pathogenesis often does not align with clinical presentation, leading to overlapping etiologic subtypes, including allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), and atopic hand eczema (AHE). While patch testing remains the gold standard for confirming ACD, its clinical utility can be limited owing to frequent subtype overlap, impracticality of allergen avoidance, and practical considerations relating to the process and availability of patch testing itself. This review provides a practical, clinician-oriented framework for managing CHE, emphasizing the importance of clinical judgment in deciding when patch testing is indicated versus when prompt treatment should take priority. We explore the role of patch testing in CHE within the context of real-world practice, incorporating global perspectives where they inform practical clinical decision-making. With the emergence of targeted therapies addressing CHE immunopathogenesis, balancing traditional diagnostic approaches with early, effective treatment is increasingly necessary. A streamlined, patient-centered strategy balancing diagnostic thoroughness with timely interventions may aid clinicians in optimizing outcomes in this complex disease.