Italian Expert Opinion on Chronic Hand Eczema: from Guidelines to Clinical Practice.

Introduction: Chronic hand eczema (CHE) is an inflammatory skin condition characterized by different pathomechanisms, clinical presentations, and prognoses. Treatment is often challenging because of limited approved drugs, and severe CHE is associated with reduced quality of life (QoL) and poor overall health measures in terms of psychological, functional, and occupational challenges. This study aims to describe the real-life management practices of Italian dermatologists who frequently treat patients with CHE, compare these practices with existing guidelines, and propose practical clinical recommendations for the management of these patients.
Methods: An 11-question survey was administered to 14 participating dermatologists to gather their insights on the diagnosis, treatment, and management of CHE. Moreover, a comprehensive literature search was conducted over the previous 10 years as a starting point for discussion among experts.
Results: CHE was the reason for 6.9% of dermatological consultations by the 14 experts. Median time to CHE diagnosis was 12 (range: 2-24) months. Fissuring and itching (85.7% for both) were the most frequently reported signs and symptoms of CHE. The survey highlighted the need for long-term treatment that is effective and well tolerated, with experts emphasizing the importance of improving disease awareness among physicians and patients. Practical clinical approaches were proposed, emphasizing the significance of a thorough medical history and identification of symptoms in the management of CHE. Experts advocated for specifically developed CHE treatment approaches, concentrating on alleviating symptoms and signs, minimizing adverse events/safety issues, enhancing the QoL of patients, and long-term disease control. Findings from this survey were further discussed and compared to recommendations of the available guidelines for the management of CHE.
Conclusions: Managing CHE requires a comprehensive approach that considers both objective clinical factors and subjective patient expectations. Experts emphasized the need for effective and well-tolerated long-term therapies, improved disease awareness, and communication among physicians and patients.
Competing Interests: Declarations. Conflict of Interest: The authors disclose the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Luca Stingeni has acted as Principal Investigator, speaker, and board member for AbbVie, Almirall, Amgen, Bristol Meyer Squibb, Eli Lilly, Janssen, Leo Pharma, Novartis and Sanofi. Maria Concetta Fargnoli has served on advisory boards, received honoraria for lectures and/or research grants from Amgen, Almirall, AbbVie, Boehringer-Ingelheim, BMS, Galderma, Kyowa Kyrin, Incyte, Leo Pharma, Pierre Fabre, UCB, Lilly, Pfizer, Janssen, MSD, Novartis, Sanofi, Regeneron and Sun Pharma. Fabrizio Guarneri has served as advisory board member for Leo Pharma. Anna Balato has served as advisory board member, consultant and/or has received fees, speakers’ honoraria or has participated in clinical trials for AbbVie, Almirall, Amgen, Boehringer-Ingelheim, BMS, LeoPharma, Eli Lilly, Incyte, Janssen, Novartis, Sanofi and UCB. Monica Corazza has acted as Principal Investigator, speaker, and board member for AbbVie, Almirall, Amgen, Janssen, Leo Pharma, Novartis and Sanofi. Anna Belloni Fortina has participated in advisory boards, acted as consultant and/or received fees from AbbVie, Amgen, Almirall, Sanofi Genzyme, Leo Pharma, Eli Lilly, Pfizer, Unifarco and Novartis. Piergiacomo Calzavara-Pinton served as advisory board member and consultant and has received fees and speakers’ honoraria or has participated in clinical trials for AbbVie, Almirall, Leo Pharma, Cantabria, Galderma, Incyte, Janssen, Novartis, Biogen, Sanofi Genzyme, La Roche Posay, Naos, Boehringer-Ingelheim and Sun Pharma. Antonio Castanzo has served as advisory board member and consultant and has received fees and speakers’ honoraria or has participated in clinical trials for AbbVie, Almirall, Amgen Leo Pharma, Lilly, Galderma, Incyte, Janssen, Novartis, Sanofi Genzyme, Boehringer-Ingelheim and UCB. Silvia Mariel Ferrucci has acted as Principal Investigator in clinical trials, Speaker and Member of Advisory board for: AbbVie, Amgen, Almirall, Bayer, Sanofi Genzyme, Leo Pharma, Eli Lilly, Pfizer, Unifarco and Novartis. Luigi Naldi has been consultant and speaker for AbbVie, Almirall, Boheringer Ingelheim, Bristol Myers Squibb, Janssen, Leo Pharma, Novartis and Sanofi. Giovanni Pellacani has served as advisory board member, consultant and investigator for: AbbVie, Allergan, Almirall, Amgen, Beiersdorf, Boheringer, Canfield, Difa-Cooper Ifc, Eli Lilly, Galderma, Janssen-Cilag, Krymi, Kyowa-Kirin, Leo Pharma, L’oreal, Mavig, Menarini, Pfizer, Pierre-Fabre, Sanofi, UCB and Viatris. Ketty Peris received grants from: AbbVie, Almirall, Lilly, Novartis and Sanofi; Advisory Board or consulting fees from: AbbVie, Almirall, Biogen, Galderma, Leo Pharma, Lilly, MSD, Pierre Fabre, Sun Pharma, Janssen and Sanofi. Francesca Prignano has served as advisory board member and consultant and has received fees and speaker's honoraria or has participated in clinical trials for AbbVie, Almirall, Leo Pharma, Lilly, Janssen, Novartis, Biogen, Sanofi Genzyme, UCB and Boehringer-Ingelheim. Giampiero Girolomoni has received personal fees from AbbVie, Almirall, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Leo Pharma, Merck Serono, Novartis, Pfizer, Pierre Fabre, Samsung Bioepis and Sanofi. Ethical Approval: This article is based on data derived from a survey conducted among dermatologists and previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
(© 2024. The Author(s).)