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

During the 2025 SDPA Annual Summer Dermatology Conference in Washington, DC, the HCPLive 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 chronic hand eczema (CHE) and strategies or interventions that he finds most effective in practice when patients do not respond to first-line options.

“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 latest conference coverage.

The quotes contained in this summary were edited for clarity.