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

At the 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.

“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 HCPLive. “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 latest conference coverage.

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