SHORT COMMUNICATION
Maria O. CHRISTENSEN1, Lea K. NYMAND1, Caroline OLESEN1, Silvia MARIEL FERRUCCI2, Marie LOUISE SCHUTTELAAR3, Jonathan I. SILVERBERG4, Claus ZACHARIAE5,6, Simon F. THOMSEN MD1,7, Jacob P. THYSSEN1,6 and ALEXANDER EGEBERG1,6
1Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark, 2Dermatology Section, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy, 3Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, 4George Washington University School of Medicine and Health Sciences, Washington, USA, 5Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, 6Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, and 7Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark. E-mail: maria.oberlaender.christensen@regionh.dk
Citation: Acta Derm Venereol 2025; 105: adv43634. DOI: https://doi.org/10.2340/actadv.v105.43634.
Copyright: © 2025 The Author(s). Published by MJS Publishing, on behalf of the Society for Publication of Acta Dermato-Venereologica. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
Submitted: Apr 15, 2025; Accepted after revision: Nov 6, 2025; Published: Dec 10, 2025.
Chronic hand eczema (CHE) is a prevalent inflammatory skin disease that causes itching, stinging, burning sensation, and pain (1). CHE has a high disease burden and a negative impact on patients’ quality of life (QoL) (2). Touch is the most fundamental aspect of human interaction that supports both verbal and tactile communication. Because of its important role in maintaining social bonds, touch avoidance, e.g., due to skin disease or disfiguration, may prevent people from benefiting fully from interaction with other people. Touch avoidance may impair psychosocial well-being and is associated with increased stress, loneliness, anxiety and depression (3, 4). The magnitude and impact of touch avoidance behaviour was not examined in patients with CHE.
We included patients with active CHE within the past 12 months from the Danish Skin Cohort, a nationwide population-based prospective cohort (4). Patients were sent digital surveys including questions on demographics, clinical characteristics, and perception of having CHE. A validated photographic guide was used to evaluate CHE severity (5, 6). Patients reported the extent to which they had avoided touching other people within the past 7 days (e.g., handshakes) using a numeric rating scale (NRS, 0 = no touch avoidance; 10 = most touch avoidance), their feelings towards having CHE, and whether CHE impacted their social life using the Hand Eczema Impact Scale (HEIS) (7) and the Dermatology Life Quality Index (DLQI) (8). Patients’ overall DLQI scores were grouped into no/small impairment (score: 0–5), moderate impairment (6–10), and severe impairment (11–30). The study was registered in the Capital Region’s Inventory (Videncenter for Dataanmeldelse, ref. P-2021-386).
A total of 879 CHE patients were eligible for this study and 514 patients answered the questionnaire (response rate: 58.5%). The 514 included patients (mean age: 55.3 [standard deviation 12.6]) were predominantly women (66.9%) and included 113 (22.0%) who reported not currently having CHE and 384 (74.7%) with current CHE. Among individuals with current CHE, 226 (44.0%), 100 (19.5%), 41 (8.0%), and 17 (3.3%) classified their CHE as almost clear, moderate, severe, or very severe, respectively; 279 (72.7%) reported CHE on both hands, 48 (12.5%) reported CHE only on their right hand, and 37 (9.6%) reported CHE only on their left hand. When asked about the specific location of their current CHE, 26.3% reported CHE on the dorsal hand(s), 38.5% on their palm(s), 49.2% on their finger(s), 38.3% between their fingers, and 7.6% on their wrist(s). Notably, 8.6% reported CHE on the entire hand. Of the 384 patients with current CHE, 356 (92.7%) answered the question on touch avoidance and 128 (36.0%) reported some level of touch avoidance (mean [SD]: 4.79 [3.1]); 77 (21.6%) reported touch avoidance scores between 1 and 5, and 51 (14.3%) reported touch avoidance scores between 6 and 10. When stratifying by CHE severity, 72 (50.4%) patients (median score [interquartile range]: 4 [0–7]) with moderate-to-very severe CHE reported some level of touch avoidance compared with 56 (26.3%) patients with almost clear CHE (0 [0–1]). In contrast, only 10 (9.9%) patients with no current CHE reported some level of touch avoidance (Table I). Overall, we observed a positive association between the level of touch avoidance and CHE severity and there was a significant difference in touch avoidance (p < 0.0001) between patients with almost clear CHE and patients with moderate-to-very severe CHE. Moreover, patients with CHE on both hands reported significantly higher touch avoidance scores (p < 0.05) compared with patients with CHE on only 1 hand. There was no difference in touch avoidance when stratifying by current CHE location, sex, age, or AD history.
| Item | Overall (n = 514) | Almost clear CHE (n = 226) | Moderate to very severe CHE (n = 158) |
| Sex, n (%) | |||
| Women | 344 (66.9) | 151 (66.8) | 106 (67.1) |
| Men | 170 (33.1) | 75 (33.2) | 52 (32.9) |
| Current age, mean (SD) | 55.3 (12.6) | 55.2 (12.6) | 54.8 (12.8) |
| Age at CHE onset, mean (SD) | |||
| ≤ 5 years | 32 (6.2) | 14 (6.2) | 8 (5.1) |
| 6–18 years | 78 (15.2) | 42 (18.6) | 19 (12.0) |
| ≥ 19 years | 399 (77.6) | 168 (74.3) | 130 (82.3) |
| History of atopic dermatitis, n (%) | 165 (32.1) | 75 (33.2) | 51 (32.3) |
| Smoking status, n (%) | |||
| Daily | 65 (12.6) | 26 (11.5) | 26 (16.5) |
| Occasional smoker | 21 (4.1) | 9 (4.0) | 5 (3.2) |
| Former smoker | 230 (44.7) | 98 (43.4) | 72 (45.6) |
| Never smoked | 193 (37.5) | 92 (40.7) | 53 (33.5) |
| Current CHE, n (%) | |||
| Yes | 384 (74.7) | 226 (100.0) | 158 (100.0) |
| No | 113 (22.0) | – | – |
| Unknown/missing | 17 (3.3) | – | – |
| CHE severity, n (%) | |||
| Clear | 113 (22.0) | – | – |
| Almost clear | 226 (44.0) | 226 (100.0) | – |
| Moderate | 100 (19.5) | – | 100 (63.3) |
| Severe | 41 (8.0) | – | 41 (25.9) |
| Very severe | 17 (3.3) | – | 17 (10.8) |
| Unknown/missing | 17 (3.3) | – | – |
| Location of current CHE, n (%)a | |||
| Only right hand | 48 (12.5) | 36 (15.9) | 12 (7.6) |
| Only left hand | 37 (9.6) | 28 (12.4) | 9 (5.7) |
| Both hands | 279 (72.7) | 150 (66.4) | 129 (81.6) |
| Anatomical location of current CHE, n (%)a | |||
| Dorsal | 101 (26.3) | 62 (27.4) | 39 (24.7) |
| Palmar | 148 (38.5) | 80 (35.4) | 68 (43.0) |
| Fingers | 189 (49.2) | 115 (50.9) | 74 (46.8) |
| Between fingers | 147 (38.3) | 92 (40.7) | 55 (34.8) |
| Wrist | 29 (7.6) | 14 (6.2) | 15 (9.5) |
| Entire hand(s) | 33 (8.6) | 9 (4.0) | 24 (15.2) |
| Touch avoidance | |||
| Touch avoidance, n (%) | 138 (30.1)b | 56 (26.3)C | 72 (50.4)d |
| No touch avoidance [score 0], n (%) | 320 (70.9)b | 157 (73.7)C | 71 (49.6)d |
| Touch avoidance [score 1–5], n (%) | 86 (18.8)b | 46 (21.6)C | 31 (21.7)d |
| Touch avoidance [score 6–10], n (%) | 52 (11.3)b | 10 (4.7)C | 41 (28.7)d |
| Touch avoidance, median (IQR) | 0 (0–1)b | 0 (0–1)c | 4 (0–7)d |
| DLQI, mean (SD) | 3.69 (3.6)e | 2.94 (2.4)f | 6.23 (4.4)g |
| No/small impairment (0–5) | 244 (47.5) | 136 (60.2) | 44 (27.8) |
| Moderate impairment (6–10) | 51 (9.9) | 16 (7.1) | 29 (18.4) |
| Severe impairment (11–30) | 23 (4.5) | 3 (1.3) | 18 (11.4) |
| DLQI, median (IQR) | 3 (1–5)e | 2 (1–4)f | 6 (3–8)g |
| aBased on 384 patients with current CHE. bBased on 458/514 patients with CHE who were given the questionnaire on touch avoidance and answered it. cBased on 213/226 patients with almost clear CHE who were given the questionnaire on touch avoidance and answered it. dBased on 143/158 patients with moderate to very severe CHE who were given the questionnaire on touch avoidance and answered it. eBased on 318/514 patients with CHE who were given the Dermatology Life Quality Index (DLQI) and answered the questionnaire. fBased on 155/226 patients with almost clear CHE who were given the Dermatology Life Quality Index (DLQI) and answered the questionnaire. gBased on 91/158 patients with moderate- to-very severe CHE who were given the Dermatology Life Quality Index (DLQI) and answered the questionnaire. CHE: chronic hand eczema; DLQI: Dermatology Life Quality Index; IQR: interquartile range; SD: standard deviation. |
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Finally, 46.5% of patients with severe-to-very severe CHE reported feeling very much or extremely embarrassed by their CHE, 51.7% reported that they very much or extremely disliked the appearance of their hands, and 53.5% expressed that their hands made them feel very much or extremely frustrated. In contrast, 3.1%, 5.3%, and 1.3% of patients with almost clear CHE and 13.0%, 22.0%, and 17.0% of patients with moderate CHE reported similar levels of embarrassment, dislike, and frustration, respectively. Patients with moderate- to-very severe CHE were significantly more embarrassed and frustrated (p < 0.0001) by their CHE and disliked their hands’ appearance significantly more (p < 0.0001) compared with patients with almost clear CHE. Overall, patients with moderate-to-severe CHE tended to have more severe QoL impairment compared with patients with almost clear CHE when assessed with DLQI (see Table I).
We found that touch avoidance is reported by one-third of patients with CHE in a severity-dependent manner. Patients with bilateral CHE were significantly more likely to avoid touch compared with patients with unilateral CHE. Patients suffering from touch avoidance may be face challenges with work, daily activities, intimate relationships, and social isolation. Altogether, this indicates that CHE patients may struggle with forming and maintaining manual contact and, thus, be at higher risk of social stigmatization. Interestingly, we found no significant differences in touch avoidance based on CHE location despite the majority of the general population being right-handed. However, patients were not asked if they were right- or left-handed, which could have provided further insight into functional and social aspects of touch avoidance. Similarly, data on occupation were not available, although work-related exposures and professional requirements likely influence both disease burden and social interaction. We found no difference in touch avoidance when stratifying by sex or age, despite the expectation that women and younger patients might be more self-conscious about the appearance of their hands, considering they devote more time for beauty procedures, such as manicures, and therefore would have a lower threshold of touch avoidance. Finally, CHE has been associated with depression and anxiety in multiple studies (9), which correlates positively with CHE severity (10). Patients experienced emotional distress because of their CHE and there was a noticeable impact of CHE severity on touch avoidance. This emphasizes the negative impact of CHE on patients’ emotional and social well-being.
Conflict of interest disclosures: MOC, with no relation to this manuscript, has been a sub-investigator for LEO Pharma, paid consultant for LEO Pharma, and paid speaker for Pierre Fabre. CMO with no relation to this study, is employed as an industrial postdoc at LEO Pharma and Bispebjerg Hospital. SMF, with no relation to this study, has been a speaker, advisory board members or Principal Investigator in clinical trials for: AbbVie, Almirall, Amgen, Incyte, Novartis, Pfizer, Leo Pharma, Sanofi, Elli Lilly, and Galderma. MLS has, with no relation to this study, received honoraria as a consultant and/or advisory board member for AbbVie, Amgen, Galderma, Incyte, Leo Pharma, and Sanofi-Genzyme; been a speaker for Leo Pharma and Sanofi-Genzyme; her institution has received grants from Pfizer, Sanofi-Genzyme. JS has, with no relation to this study, received honoraria as a consultant and/or advisory board member for AbbVie, Aldena, Amgen, AObiome, Apollo, Arcutis, Arena, Asana, Aslan, Attovia, Bodewell, Boehringer-Ingelheim, Bristol-Myers Squibb, Cara, Castle Biosciences, Celgene, Connect Biopharma, Corevitas, Dermavant, Eli Lilly, FIDE, Formation Bio, Galderma, GlaxoSmithKline, Incyte, Inmagene, Invea, Kiniksa, Leo Pharma, Merck, Nektar, Novartis, Optum, Pfizer, RAPT, Recludix, Regeneron, Sandoz, Sanofi-Genzyme, Shaperon, TARGET-RWE, Teva, Triveni, Union, and UpToDate; been a speaker for AbbVie, Arcutis, Dermavant, Eli Lilly, Galderma, Leo Pharma, Pfizer, Regeneron, and Sanofi-Genzyme; his institution has received grants from Galderma, Incyte, and Pfizer. CZ has, with no relation to the present manuscript, been a paid speaker for Eli Lilly, Novartis, CSL, UCB, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, Takeda, Amgen, and CSL. SFT has received research support from AbbVie, Almirall, Janssen, LEO Pharma, Novartis, Sanofi, and UCB, and has been a speaker/consultant for AbbVie, Almirall, Boehringer, CSL, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, Servier, Symphogen, UCB, and Union Therapeutics outside the submitted work. JPT is, with no relation to this study, an adviser for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron, and Sanofi-Genzyme; been a speaker for AbbVie, Almirall, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron, and Sanofi-Genzyme; and received research grants from Pfizer, Regeneron, and Sanofi-Genzyme. Dr Thyssen is a full time employee at Leo Pharma. AE has, unrelated to the present study, received research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, Boehringer Ingelheim, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, and honoraria as consultant and/or speaker from Amgen, AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis, Pfizer, Eli Lilly, Novartis, Union Therapeutics, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, McNeil Consumer Healthcare, Horizon Therapeutics, Boehringer Ingelheim, and Janssen Pharmaceuticals. He is currently employed by LEO Pharma. LKN has nothing to declare.