The Irregular Border: Non-pharmacologic and Lifestyle-based Approaches to Managing Chronic Hand Eczema: A Narrative Review

By Sawyeh Maher, BS, and Peter A. Lio, MD

Introduction

Chronic hand eczema (CHE) is a typical and debilitating situation characterised by eczematous lesions on the fingers and wrists that persist for longer than three months or recur not less than twice per yr (Figure 1). CHE is usually related to ache and itch and sometimes carries a social and financial burden.^1,2,3,4 Lifetime prevalence is estimated to be about 15%, with the next incidence in ladies and younger adults.⁵ CHE is advanced and multifactorial, encompassing a number of overlapping subtypes together with atopic dermatitis (AD)/atopic hand eczema (AHE), irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), and protein contact dermatitis/contact urticaria (PCD/CU). The situation is pushed by genetic, immunologic, environmental, and occupational components that always complicate analysis and administration.⁶

Current CHE therapies vary from supportive to systemic interventions. First-line administration emphasizes supportive measures corresponding to pores and skin safety, moisturizers, and avoidance of allergens and irritants.7,8 Topical corticosteroids (TCS) and calcineurin inhibitors (TCIs) are widespread second-line choices, although each are restricted by unwanted side effects, adherence challenges, and decreased efficacy in extreme illness.^9,10,7,11,12 For refractory illness, systemic brokers corresponding to alitretinoin, cyclosporine, or methotrexate could also be thought of, although they carry the danger of potential toxicity and lack of US approval in some circumstances.^13,14,15 More just lately, therapies have emerged that extra immediately goal the pathogenesis of CHE, together with biologics and Janus kinase (JAK) inhibitors. Delgocitinib (Anzupgo, LEO Pharma), a pan-JAK inhibitor that was just lately authorised for CHE, is notable for its results on the pathways related to CHE. Its broad mechanism makes it notably appropriate for CHE with combined subtypes and allergic triggers, since in such circumstances there could also be a number of immune pathways which can be dysregulated.¹⁶ While it doesn’t carry a proper boxed warning like different JAK inhibitors, opposed results corresponding to application-site ache, paresthesia, and bacterial pores and skin infections have been reported.^17,18

Despite these advances, no single remedy has totally addressed the multifactorial drivers of CHE. For this purpose, non-pharmacologic and lifestyle-based approaches could supply viable adjunctive methods for CHE.

In this narrative evaluation, we spotlight non-pharmacologic and lifestyle-based interventions accessible for CHE with the strongest proof, security, and practicality for scientific use. Priority was given to randomized managed trials (RCTs), systematic evaluations, and enormous observational research. Study high quality was appraised utilizing established instruments, together with the Jadad scale for randomized trials, with complementary reference to Risk of Bias 2.0 (RoB 2), Newcastle–Ottawa, Joanna Briggs Institute (JBI), and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2), the place acceptable. All adjunct therapies reviewed additionally introduced little to no unwanted side effects for members. Outcomes of curiosity included Hand Eczema Severity Index (HECSI) and HECSI-R, Investigator’s Global Assessment for CHE (IGA-CHE), itch/ache, high quality of life, flare frequency, work-related affect, and opposed occasions (Table).

Barrier Protection and Moisturizer Therapy

Barrier safety and moisturizer use are foundational elements of CHE administration, as most subtypes contain pores and skin barrier dysfunction and elevated transepidermal water loss.^19,20 Regular use of moisturizers can restore barrier integrity, scale back water loss, and alleviate signs corresponding to dryness and pruritus.²¹ Avoidance of widespread irritants corresponding to harsh and/or scented soaps, detergents, and work hazards is equally very important for barrier safety.²² Glove use must also be carried out throughout wet-work and exposures to occupational hazards, with a give attention to limiting occlusion and irritation.²³ Barrier protectants corresponding to dimethicone-based lotions can scale back irritant-induced flares, notably when mixed with use of gloves and moisturizers.^24,25

The proof helps the significance of barrier energy in managing CHE. In a randomized, open-label research of 53 sufferers with resolved hand eczema, use of a 5% urea-containing barrier-strengthening moisturizer considerably delayed illness relapse in comparison with no remedy, with median relapse-free intervals of 20 days vs. 2 days (P = 0.04).²⁶ Another RCT of 102 CHE sufferers discovered {that a} ceramide-containing cream considerably improved HECSI scores at three months in contrast with standard care (odds ratio 2.6; 95% CI 1.3–5.2).²⁷

Beyond product use, affected person schooling about barrier safety improves adherence and outcomes. A potential research of 71 sufferers discovered that integrating therapeutic affected person schooling into routine CHE care considerably improved barrier-protective behaviors—together with moisturizing, glove use, and adherence to avoidance methods—and was related to enhancements in scientific severity (the modified Total Lesion Symptom Score, or mTLSS), high quality of life (The Dermatology Life Quality Index, or DLQI), and work productiveness (the Work Productivity and Activity Impairment, or WPAI) at three months.²⁸ No severe opposed occasions had been reported throughout any of those research.

These findings align with a Cochrane Database Systematic Review of 77 trials and observational research, which demonstrated that common moisturizer and barrier-supportive cream use prolongs time to flare, reduces flare frequency, and lowers corticosteroid necessities.²⁹

Paraffin Bath

Paraffin wax baths have been explored as an adjunct remedy for CHE. Paraffin, a petroleum-derived hydrocarbon, is usually used as an emollient in skincare merchandise and cosmetics. Its low melting level permits for submersion that gives superficial warmth, improves blood circulate, enhances the pores and skin barrier, and reduces discomfort.^30,31 In an RCT of 60 sufferers with moderate-tosevere CHE, twice-daily paraŸn baths for 12 weeks decreased SCORing Atopic Dermatitis (SCORAD) scores by 28.6% in comparison with 0.41% in controls. Reported signs, together with itch and sleep high quality, improved by 47% vs. 5.5% in controls, whereas DLQI improved by 60% vs. 3.8% in controls. No opposed occasions had been reported.³² A smaller potential research of 13 sufferers with CHE equally discovered excessive affected person satisfaction and symptomatic enchancment with out opposed results.³¹

Digital Self-monitoring and Education through Smartphone App

Digital well being instruments in dermatology have emerged as a strong avenue for sufferers to attach with their suppliers and optimize remedy outcomes. In CHE, smartphone purposes present real-time monitoring and schooling, which can enhance adherence, outcomes, and affected person–supplier communication.³³

An RCT of 87 sufferers with persistent hand and foot eczema in contrast frequent in-person visits plus entry to an academic app with in-person visits alone. The app allowed the power to add pictures, observe signs, and ship messages to the dermatologist. Patients within the intervention group displayed vital discount in HECSI scores over 60 weeks (coecient of −1.108, P ≤ 0.001). Benefits had been dose-dependent, with high-frequency customers with ≥20% app engagement exhibiting extra enhancements in high quality of life (DLQI) and symptom management. The app additionally reliably assessed illness severity, with patient-submitted pictures strongly correlating with physician-scored HECSI (P = 0.885, P < 0.001). No opposed occasions had been reported.³⁴

Phototherapy

Phototherapy has been a continuously employed remedy for refractory eczema. Various modalities exist—together with psoralen plus ultraviolet A (PUVA), UVA1, broadband UVB, and narrowband UVB (NB–UVB)—with NB–UVB rising as essentially the most used as a result of its favorable stability of efficacy, security, and practicality.³⁵

In a randomized pilot research, CHE sufferers had been assigned to obtain both NB–UVB or PUVA twice weekly for 12 weeks. At Week 12, 23% of NB–UVB sufferers achieved a “Clear” or “Almost Clear” Physician’s Global Assessment response, with comparable enhancements within the mTLSS and DLQI. Adverse occasions had been minimal.³⁶

A Cochrane systematic evaluation additional helps NB–UVB to be used in atopic-driven eczema, and located that sufferers present vital symptomatic enchancment after 12 weeks.³⁷ The American Academy of Allergy, Asthma, and Immunology additionally highlights NB–UVB as efficient for atopic eczema, with enhancements displayed in each severity and itch. No opposed results or elevated threat of pores and skin most cancers had been found.³⁸

Conclusion

CHE stays a difficult and sometimes refractory situation, with extensively used standard therapies restricted by unwanted side effects, adherence challenges, and variable efficacy throughout subtypes. While conventional pharmacologic choices are increasing, non-pharmacologic and lifestyle-based methods—together with barrier optimization, paraffin baths, digital self-monitoring instruments, and phototherapy—stay secure, low-risk, and sensible adjunct therapies that may improve outcomes and affected person high quality of life. While the information is promising, additional investigation is warranted to raised outline the position of those strategies as adjunctive or stand-alone therapies for CHE.

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ABOUT THE AUTHORS
Sawyeh Maher, BS is a third-year medical pupil at Rosalind Franklin University of Medicine and Science in Chicago, IL.

Peter A. Lio, MD, is a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a accomplice at Medical Dermatology Associates of Chicago in Chicago, IL.