Adam Friedman, MD, FAAD

2025 SDPA Annual Summer Dermatology Conference

 editorial team spoke with Adam Friedman, MD, about some of the biggest takeaways from his talk at the conference, titled ‘Can't HANDle it?: Tips to Optimize the Diagnosis & Management of Chronic Hand Eczema.’

Friedman—who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the dermatology department at The George Washington University School of Medicine & Health—was asked about 

 and strategies or interventions that he finds most effective in practice when patients do not respond to first-line options.

More Tips to Optimize Management of Chronic Hand Eczema, with Adam Friedman, MD

“It's interesting when we talk about who responds to first-line options for chronic hand eczema and what those are, because none are technically approved for this,” Friedman said. “We know steroids have the label of anything that's responsive to a steroid, but I think it is important when someone says, ‘I've tried a couple things that don't work,’ and really get into the weeds in terms of how one used it. Did you use that class 1 steroid twice a day for 2 to 3 weeks and then transition to something less potent? Or maybe it's maintenance therapy of twice a week, or maybe it's a calcineurin inhibitor, or maybe it's an off-label, topical JAK or even roflumilast or an aryl hydrocarbon receptor agonist.”

Friedman noted that once a healthcare provider understands how a patient has used their treatment, the next step may be a simple as making some small tweaks. Nevertheless, he urged that the condition often requires significant attention to ensure it is managed properly.

“In my own practice over the years, I have found intramuscular analogue to be a nice band-aid on the problem,” Friedman said. “I find CHE responds very nicely to intramuscular analogue, but of course, that comes with limitations in terms of ongoing use. But what I like about it is that it buys you time. It lasts usually for 2 to 3 months while you may be getting your biologic onboard, because they can take a little little longer than a intramuscular, systemic, or topical steroid to work. Along those lines, I'm very quick to reach the systemic options. I used to use a lot of acitretin in my practice, but truthfully, I am leaning more now on the biologics and even off-label JAK inhibitors.”

Friedman noted that given CHE’s chronicity, going through the same approaches again and again is not the most optimal strategy.

“In terms of treatment escalation, you've got to knock it out and then you have to buy yourself time to keep it away,” Friedman explained. “I often say to patients, just like we don't use a one-off for diabetes or high blood pressure as these are chronic diseases, this hand dermatitis, this hand rash, is chronic, so it's going to require ongoing therapy. It's going to require their adherence and their investment to keep them clear over the years. So that's why I will step in very early to throw in some systemic options. Maybe we can get them off of them at some point, but I want 6 months of clearance before even considering to do considering to do so.”

For more information about Friedman’s insights into managing CHE, view his full interview segment posted above. To find out more information about CHE and related topics highlighted at SDPA, view our 

The quotes contained in this summary were edited for clarity.

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This interview segment at the 2025 SDPA Conference highlights additional insights by Friedman on the management and diagnosis of chronic hand eczema, or CHE.

SDPA Annual Summer Dermatology Conference

 in Washington, DC, Adam Friedman, MD, presented a session during the meeting titled ‘Can't HANDle it?: Tips to Optimize the Diagnosis & Management of Chronic Hand Eczema.’

Friedman is known for his work as professor and chair of dermatology and as Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the dermatology department at The George Washington University School of Medicine & Health Sciences. Friedman spoke in this interview about CHE and key clinical cues differentiating CHE from other forms of dermatitis.

Tips to Optimize Diagnosis, Management of Chronic Hand Eczema with Adam Friedman, MD

“I think chronic hand eczema is a spectrum, which is one of the reasons why I think it's so complicated when it comes to even making the right diagnosis,” Friedman explained in an interview with 

. “I think first and foremost, consider what could be in the differential diagnosis of CHE. This includes things like psoriasis, which I think is the hardest one to distinguish…But you have to think about secondary syphilis, pagetoid reticulosis, lichen planus, and there are many others.”

Friedman highlighted the value of asking the right questions to patients with potential CHE, specifically about recurrence rates, whether associations are temporal, and whether the CHE is related to one’s occupation.

“By definition, chronic hand eczema should last for more than 3 months with recurrences,” Friedman said. “It's really going to be based on the history, first and foremost. Now, in terms of looking at the hands and thinking about some of the things I mentioned, when we think about palmoplantar psoriasis, first off, look for other diseases. There can be independent palmoplantar psoriasis. You can have psoriasis elsewhere, so look for other unique sites, like the scalp, the ears, maybe the groin….I find that unique subtypes of psoriasis kind of run together.”

Friedman highlighted that, from a purely plaque-to-plaque comparison, palmoplantar psoriasis tends to be more demarcated. He added that the condition can have a preference for the more pressure-dependent areas.

“Whether it be ICD, ACD, or atopic dermatitis of the hands, it's usually more confluent,” Friedman said. “It has a predilection for the pulse, for the distal portions of the fingertips, and usually it's not that well demarcated, as compared to psoriasiform things. I think that could be a helpful tip, not to mention that the chronicity should also lend itself to having some lichenification and increased skin markings.”

To find out more about Friedman’s tips related to CHE, view his full interview segment posted above this summary. For any additional information on CHE and related topics highlighted at SDPA, view the 

The quotes used in this interview summary were edited for the purposes of clarity.

In an interview conducted at the 2025 SDPA Conference, Friedman provided several insights into management and diagnosis of chronic hand eczema, or CHE.

Adam Friedman, MD, FAAD

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