Burden and Etiopathogenesis of Chronic Hand Eczema: A Complex Interplay of Genes, Environment, and Exposures

Chronic hand eczema (CHE) is a relatively common skin disease that is associated with substantial personal and societal burden, including work disability and psychosocial impairment. The etiopathogenesis of CHE is heterogeneous and multifactorial, and although it is an area of active research, it remains incompletely understood. Methods to investigate the etiopathogenesis of CHE have largely been adopted from other skin diseases to examine gene expression, proteomics, and skin barrier integrity. Tape stripping has emerged as a practical and noninvasive method to study differences in transcriptomics that is less painful and more convenient than the gold standard, skin punch biopsy. Studies have suggested broad activation of immune pathways in CHE, including key Th1, Th2, Th17, and Th22 cytokines. In parallel, there are indications of broad skin barrier dysfunction in CHE including downregulation of barrier proteins. There is a dearth of high-quality evidence on etiopathological differences between CHE subtypes, and this remains an area of research need to identify new targets for treatment.