Transcript
Announcer:
This is DermConsult on ReachMD. On this episode, Dr. Christopher Bunick joins us to share what a comprehensive treatment plan for chronic hand eczema looks like. Dr. Bunick is an Associate Professor of Dermatology at Yale University School of Medicine in New Haven, Connecticut. Here he is now.
Dr. Bunick:
I think when it comes to a comprehensive treatment plan, the first thing is trying to identify, if possible, the subtypes that are involved. So really it comes down to identifying that they do have chronic hand eczema and then the subtypes that might be involved. It is really challenging. You don't always know just by looking, and even then testing may or may not actually reveal what a patient has if they have multiple subtypes.
One of the things that's very important when it comes to chronic hand eczema is knowing when to supplement topicals with other therapies. For example, when you have a component of hand atopic dermatitis, we now have available up to six FDA-approved advanced systemic therapies that could be used for the atopic dermatitis component. And that's why distinguishing that subtype can be very helpful.
One important part of chronic hand eczema treatment is not just the medical therapy we're talking about, but there are behavioral modifications that have to go with that. For example, in patients who have a compromised skin barrier, we need to know what they touch, the chemicals they come in contact with, the amount they wash their hands, whether they're using certain types of hand sanitizers, and whether they're over-washing their hands. All these types of things come together, and therefore, there is this component to managing someone long-term where you have to really get into the nitty-gritty of how they're using their hands, what they're doing, and what types of products they're using. I'm not saying that all of our personal hygiene products are bad, but we have a lot of chemicals in our personal hygiene products, and I really try to guide patients towards hypoallergenic products or products that have the least risk in terms of irritating or aggravating the skin or compromising that skin barrier.
And when I think about managing patients long term, my goal is to cut the inflammation down, heal their hands, heal their fissures, and focus on not just the skin, but make sure that I'm getting their quality of life better, and that means understanding the patient-reported outcomes like the itch and the pain. And so for me, the way I operate in clinic, I think chronic hand eczema is really a trifecta. I need skin clearance, I need itch relief, and I need pain relief. We often hear about treat-to-target goals. For atopic dermatitis and psoriasis in our specialty, we really have treat-to-target goals of clear or almost clear skin, and in the case of atopic dermatitis, little to no itch. And what I believe in chronic hand eczema is we need the skin clearance, no itch, and no pain. And that gives the trifecta that probably is going to give the patient the best quality of life and the best longevity when it comes to managing their hands.
Announcer:
That was Dr. Christopher Bunick discussing chronic hand eczema care. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
