<scp>CHEMIN</scp> —Results From the National Practice Survey in Chronic Hand Eczema Therapeutic Management

Chronic Hand Eczema (CHE) is the leading occupational disease causing disability [1] and affects 4.9% of the French population [2]. Due to the lack of standardised national guidelines, practitioners may rely on personal experience [3]. This practise survey aimed to assess current CHE management approaches in France and understand how European guidelines are applied in therapeutic strategies to address patient symptoms and challenges. Six French CHE experts developed an online questionnaire based on a literature review. The questionnaire, distributed via national professional networks to relevant specialists, included sections on moderate and severe CHE cases (Table 1) and treatment initiation practises. Description of the respondents can be found in the Figure 1 legend. The patient is a 35-year-old care assistant and mother of a one-year-old daughter. This patient has suffered for 2 years from red patches on her hands, itching and painful cracks. Her skin is dry and irritated, and she finds it difficult to perform certain daily tasks, such as grasping objects or looking after her daughter. She has a history of atopic dermatitis in childhood, which healed in adulthood. She is concerned about the impact of her eczema on her quality of life and professional abilities, and about the appearance of her hands, which can sometimes be embarrassing in public. An interview carried out 6 months ago revealed that she has an atopic condition, washes her hands 10 times a day with Marseille soap and washes dishes without gloves. In this context, therapeutic education on washing hands with a suitable soap and wearing gloves when exposed to irritants (washing up) was carried out. In addition, treatment with strong topical corticosteroids (1 application per day) was initiated, but symptoms persisted despite 1 month of treatment. The patient is a 50-year-old bricklayer who has worked in construction for over 20 years. He has no personal or family history of atopy. He has been exposed to various irritants throughout his career, including cement dust, solvents, glues, and paints. He developed hand eczema about 5 years ago, with red patches, itching and painful cracking of palms and fingers. The patient has consulted several dermatologists and tried various treatments, including strong and very strong topical corticosteroids and tacrolimus ointment. He has no other previous history. Although these treatments brought some temporary relief, symptoms tended to persist despite the avoidance of irritants and time off work. An extensive allergological workup revealed a contact allergy to chromium in cement. His workstation was adapted; he no longer handles cement but continues to suffer from hand lesions whilst working. The patient is concerned about the impact of his condition on his ability to work and earn a living, as well as on his overall quality of life. He is looking for an effective treatment that can provide lasting relief and enable him to continue practising his profession. Although corticosteroid treatments have provided some temporary relief, the symptoms persist even after avoiding cement exposure and periods of work absence. Eczema flares occur even outside the work context. After thorough discussion with the occupational health physician, workplace accommodations have been implemented for the patient, thereby avoiding direct handling of cement. However, despite this measure, lesions on the hands persist during his professional activities. The patient expresses significant concern about the impact of his condition on his ability to work, job retention, and overall quality of life. In seeking an effective and lasting solution, the patient actively seeks treatment that can significantly alleviate his symptoms, allowing him to continue working with peace of mind. Respondents reviewed two clinical cases: one with moderate CHE and another with severe CHE (Table 1). Despite prior topical corticosteroids (TCS) failure in both cases and differing disease severities, the proposed therapeutic approach for each patient mainly relied on topical treatments (Figure 1A), such as TCS, emollients, or moisturisers (Figure 1B). Therapeutic education was recommended for both patients, although the focus varied (Figure 1A). Biological treatments were considered for both patients, with a similar proportion for each (Figure 1A). For the severe patient, respondents favoured conventional systemic treatments (Figure 1A) including acitretin (74% moderate, 85% severe), methotrexate (15% moderate, 14% severe), and cyclosporine (15% moderate, 6% severe). Quality of life (QoL) was a key factor in treatment selection for most respondents, whilst lesion severity was specifically emphasised for severe CHE. Other factors, such as clinical signs and symptoms, or the frequency of flare-ups or persistence of lesions, were also reported (Figure 1C). This survey underscores the complexity of managing CHE in France, the challenges in adhering to European guidelines, and the variability in therapeutic approaches. Whilst most respondents favoured identifying and avoiding causative irritants and allergens in line with European guidelines [3], many chose to switch to another TCS after initial failure, with appropriate advice and associated local measures, contrary to recommendations for short-term use. This practise raises concerns about the long-term tolerability and side effects of TCS [4]. Inconsistencies in second-line treatment choices, including labelled and off labelled use, reflect the flexibility of European guidelines [3]. There was notable heterogeneity in physicians' approaches to control CHE lesions. Despite its importance, patient education may be underutilised, indicating a need for greater awareness and structured support. Respondents highlighted the importance of QoL in therapeutic choices, though its impact is inconsistently investigated. Effective CHE management requires a patient-centred approach, focusing on adherence and personalised care [5]. The survey highlights the need for new therapeutic alternatives and improved patient education, emphasising the necessity for alignment amongst healthcare professionals in managing CHE. C.B., M.N.C., B.H., C.L., S.L.C., M.T., A.S. participated in the survey design, data analysis, and manuscript writing. M.S. is a medical writer from Public Health Expertise who provided writing assistance. Confidentiality, GDPR compliance, and respondent anonymity were ensured by PHE, with no personal data shared with LEO Pharma French Affiliates or any third party. Regulatory statements were outlined on the first page of the questionnaire, and consent was obtained from respondents via a dedicated field before proceeding. Claire Bernier, Marie-Noëlle Crépy, Bruno Halioua, Camille Leleu, Marina Schverer, and Angèle Soria have disclosed conflicts of interest, including roles as consultants, speakers, advisory board members, or investigators for pharmaceutical companies such as Novartis, AbbVie, Lilly, LEO Pharma, Pfizer, and Sanofi. Additionally, Marie Tauber reported consulting or speaking for Medac and receiving congress invitations from Sanofi, AbbVie, and Lilly, whilst Angèle Soria disclosed similar invitations from Sanofi and Novartis. Marina Schverer and Solenn Le Clanche have declared no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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