Physician-Reported Treatment Patterns in Moderate to Severe Chronic Hand Eczema: the RWEAL Multinational Medical Chart Review
Bibliographic record
Abstract
INTRODUCTION: Evidence for moderate to severe chronic hand eczema (CHE) treatments in clinical practice is limited. The objective was to investigate treatment patterns in patients with moderate to severe CHE, and in those with an inadequate response to topical corticosteroids (TCS) or in whom TCS were contraindicated. METHODS: This was a multinational retrospective physician chart review. Physicians who routinely diagnosed and treated CHE were recruited in Canada, France, Germany, Italy, Spain, and the UK and provided data on adult patients with moderate to severe CHE treated with TCS over the past 12 months or for whom TCS were contraindicated. RESULTS: A total of 292 physicians provided data on 1939 patients. Worst severity of CHE in the 12-month study period was judged by the physician to be moderate in 56.8% and severe in 43.2% of patients. Overall, 6.7% of patients received topical calcineurin inhibitors, 3.9% phototherapy, 6.8% alitretinoin, 11.1% traditional orals (acitretin, azathioprine, oral corticosteroids, cyclosporine, methotrexate), 8.0% biologics, and 1.7% oral Janus kinase (JAK) inhibitors. An inadequate response or contraindication to TCS was reported in 39.9% of patients (27.4% progressed to phototherapy/systemics; 12.1% with adverse events or an inadequate response to high/ultra-high potency TCS, and 0.4% contraindicated). Among these patients, the highest line of treatment during the 12-month period was biologics in 29.2%, alitretinoin in 22.3%, oral JAK inhibitors in 5.1%, traditional orals in 33.3%, and phototherapy in 9.6% of patients. There were no significant differences in phototherapy/systemic treatments between patients with moderate and severe disease in this subgroup. CONCLUSIONS: Despite being a first-line treatment, 40% of patients with CHE were inadequately treated with or contraindicated to TCS. Over one-quarter of patients progressed to phototherapy or systemic therapy. These results suggest a lack of effective and well-tolerated topical treatment options in CHE. Graphical Abstract available for this article.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".