CHE Imposes Heavy Occupational, Quality-of-Life, and Economic Burden on US Patients

At the Revolutionizing Atopic Dermatitis (RAD) 2026 Conference, 4 studies document the substantial burden of chronic hand eczema (CHE) in the United States, spanning workers' compensation (WC) costs, health-related quality of life (HRQoL), patient-perceived triggers, and treatment preferences in patients with moderate-to-severe disease.1,2,3,4

The analyses draw from real-world WC claims, the CHECK-US cross-sectional survey, and a discrete choice experiment (DCE) among 300 US adults with moderate-to-severe CHE. Together, they paint a picture of a condition carrying major occupational, psychosocial, and functional consequences.

"Chronic hand eczema imposes substantial physical and psychosocial burden, especially among individuals with moderate to severe disease, despite treatment with topical corticosteroids," the CHECK-US investigators concluded. "These results highlight the need to optimize treatment strategies to alleviate the overall individual burden of CHE in the United States."

Workers' compensation claims and occupational burden of CHE

A retrospective analysis of the Workpartners Research Reference Database identified 226 employees with closed WC claims involving the hands, wrists, or fingers and ICD-coded diagnoses consistent with hand eczema. The overall incidence was 6.06 CHE-related WC claims per 100,000 eligible person-years.

The highest claim incidences were in manufacturing (11.20 per 100,000 person-years), retail trade (10.49), and health care and social assistance (8.70).

The mean WC claim cost was $10,197 (SD=$45,172), with median $477. In manufacturing, mean costs reached $29,587 per claim. Finger-location claims carried the highest mean cost at $37,792.1 Of the 11.5% of claims involving lost work time, the average absence was 277 days (median 121 days). Healthcare and social assistance claims averaged 1,443 days of work absence per claim.

HRQoL, triggers, and treatment preferences in CHE

In the CHECK-US survey, which contained data from 982 patients, those with moderate-to-severe CHE receiving topical corticosteroids (TCS) reported significantly lower HRQoL than those receiving systemics or phototherapy (DLQI 7.6 vs 15.9; P <.01), indicating the systemics-treated group carried greater disease burden requiring escalation.2 Among moderate-to-severe patients, 65.1% rated disease severity as moderate-to-severe by patient global assessment. Only 19.1% were currently untreated.

In the same CHECK-US cohort, 69.4% of participants identified environmental factors as a CHE trigger, most commonly frequent hand washing or water exposure, chemical irritant exposure, and contact allergen exposure.3 Biological triggers (47.4%), psychological triggers including stress (34.1%), and lifestyle factors (26.0%) were also frequently cited.

Females were significantly more likely to report environmental (73.4% vs 66.1%; P = .02) and psychological triggers (47.5% vs 22.8%; P <.01) than males.3

In the DCE study among 300 patients with moderate-to-severe CHE, itch improvement, skin appearance improvement, and risk of adverse events (cancer, serious infections, major cardiac events) were the most heavily weighted treatment attributes. Patients were willing to trade 28 percentage points of itch improvement to avoid a 1 percentage point increase in cancer risk.

The investigators noted the DCE findings could inform shared decision-making discussions with patients, including weighing treatment trade-offs likely to improve adherence and clinical outcomes.

References

1. Brook RA, Bin Sawad A, Beren IA, et al. Hand eczema workers' compensation claims: real-world data analysis in the United States. Presented at: Revolutionizing Atopic Dermatitis; Nashville, TN; June 17-19, 2026.

2. Chovatiya R, Balu S, Bin Sawad A, et al. Health-related quality of life in people with chronic hand eczema: results from the CHECK study in the United States. Presented at: Revolutionizing Atopic Dermatitis; Nashville, TN; June 17-19, 2026.

3. Simpson E, Balu S, Bin Sawad A, et al. Patient-perceived factors associated with chronic hand eczema: results from the CHECK study in the United States. Presented at: Revolutionizing Atopic Dermatitis; Nashville, TN; June 17-19, 2026.

4. Armstrong AW, Bin Sawad A, Hazra NC, et al. Patient preference study of medication attributes in moderate to severe chronic hand eczema using a discrete choice experiment. Presented at: Revolutionizing Atopic Dermatitis; Nashville, TN; June 17-19, 2026.