P015 Clinical characteristics of patients and treatment of moderate-to-severe chronic hand eczema in the UK: the RWEAL study

Abstract The aim of this study was to describe physician-recorded disease characteristics, aetiological subtypes and treatment patterns in patients with moderate-to-severe chronic hand eczema (CHE) in real-world clinical practice in the UK. RWEAL was a multinational, retrospective physician chart review study, with data for the UK reported here. Dermatologists and general practitioners with a special focus on dermatology were eligible if they had ≥ 3 years of clinical experience and routinely diagnosed and treated CHE (≥ 15 patients in the last 12 months). Physicians completed a case report form for up to 10 patients treated with topical corticosteroids (TCS) over the past 12 months or for whom TCS were contraindicated. Information about the clinical characteristics and treatment of CHE was extracted from medical charts. In total 55 physicians were included and completed forms for 365 patients. Half of patients were female and the worst severity of CHE in the previous 12 months was moderate in 58% and severe in 42% of patients. Clinical judgement was the most frequent method for determining CHE severity (79% of patients), with 24% assessed using a scoring system. Erythema (64% of patients), pruritus (62%) and scaling (51%) were the most frequently reported clinical signs at the last visit. Palms were the most frequently affected area (59% of patients), followed by backs of hands (48%), wrists (45%), fingertips (44%) and interdigital spaces (34%). The most frequently reported aetiological CHE subtypes were irritant contact dermatitis (41%) and atopic dermatitis (40%); mixed aetiologies were frequent and only 28% of patients had atopic dermatitis aetiology alone. Among 183 patients treated by dermatologists, 11% received alitretinoin, 10% phototherapy, 10% methotrexate, 8% ciclosporin and 7% dupilumab during the past 12-month period. Overall, TCS were considered to have an inadequate response (or were medically inadvisable) in 43% of patients. Among these patients, 41% continued on TCS without escalation to other treatments. In conclusion, patients with CHE presented with a combination of different signs and symptoms and aetiological subtypes. Treatment with TCS was considered to have an inadequate response or was contraindicated in > 40% of patients, many of whom continued to receive TCS without treatment escalation. This indicates a need for new treatment options that address the heterogeneous and multifactorial nature of CHE. The absence of clear lines of treatment after TCS suggests a need for UK-specific guidelines for CHE.