High topical corticosteroid utilization among employed patients with Chronic Hand Eczema: A survey of patients in a large integrated healthcare system in the United States

Introduction Chronic Hand Eczema (CHE) is an inflammatory skin disease of the hands associated with recurring flares. Sustained disease control is difficult due to ongoing environmental exposure and friction. Topical corticosteroids (TCS) are a mainstay first-line treatment; however, safety concerns limit long-term continuous use and may influence patient adherence. This survey aimed to describe patient and treatment-related characteristics among employed patients with CHE in a large integrated US healthcare system. Methods Between March and May 2026, an online cross-sectional survey was administered to employed adults receiving care within the Duke University Health System (DUHS). Patients with eczema/dermatitis were identified from electronic medical records using ICD-10-CM codes (L20, L23, L24, L25, and L30). Patients were invited to participate through Epic MyChart. The survey sample included patients with CHE, defined as hand/wrist eczema that persisted for ≥3 months or recurred ≥2 times within the past 12 months, who provided informed consent and completed the survey. Sociodemographic and clinical characteristics were collected. Patients assessed their CHE severity using an electronic photographic guide. Treatment history was collected, and patients were asked multiple-choice questions concerning their experiences with TCS. Data were summarized using descriptive statistics. Results Among 301 patients, 78.4% were female, mean (standard deviation) age was 38.5 (12.3) years; 62.8% were White, and 25.2% were Black. Most had a college degree (65.8%) and were employed full-time (77.1%). In addition, 41.5% worked in healthcare, and 50.5% reported a household income of ≥$75,000/year. The most common comorbidities were obesity (25.6%), hypertension (17.9%), diseases of the immune system (13.3%), chronic lung disease (8.0%), and diabetes (7.6%). Mean age was 20.2 (14.0) years at CHE symptom onset and 22.3 (14.3) years at diagnosis. The most common CHE subtypes were irritant contact hand eczema (54.5%), atopic hand eczema (51.5%), allergic contact dermatitis (35.2%), and vesicular/dyshidrotic dermatitis (27.9%). Current CHE severity was rated as moderate by 36.2%, severe by 8.7%, or very severe by 2.0% of patients. Nearly all patients reported prior/current topical treatment use (99.0%) and TCS (95.7%). Other previous therapies included systemics (58.5%, comprising oral corticosteroids [29.9%], injectables [18.3%], and oral non-steroid advanced treatments [10.3%]), and phototherapy (7.3%). Of 288 current TCS users, 65.3% had used 2‑5 TCS types and 8.3% had used ≥6 types. Among 112 current users, 28.6% had been using TCS for 6-10 weeks, including 25.0% who reported using TCS for approximately 10 weeks. Of 176 patients who reported reasons for discontinuing TCS, 7.4% cited side effects and 16.5% cited concerns about side effects. Among 216 participants who had previously used TCS alone, 15.3% reported that their eczema did not improve with TCS only. Conclusion Employed patients with CHE who received care at DUHS reported high TCS utilization, characterized by the use of multiple TCS, extended treatment durations, and treatment discontinuation due to side effects or ineffectiveness, with frequent escalation to systemic therapies. Despite near-universal use of TCS, a high percentage of patients still reported burdensome symptoms. These findings suggest an unmet treatment need and support the role of advanced non-steroidal topical options.