Canadian derms propose treat-to-target map for chronic hand eczema

Photo by James Heilman, MD via Wikimedia Commons

A group of Canadian dermatologists has proposed the first practical “treat-to-target” framework for chronic hand eczema, aiming to bring more structure and predictability to management of a condition that is both common and highly burdensome for patients. The recommendations, published as an open-access brief report in the Journal of the American Academy of Dermatology, come at a time when an expanding range of therapies for chronic hand eczema is reshaping clinical practice.

Treat-to-target strategies, already adopted in psoriasis and atopic dermatitis, rely on predefined goals, regular outcome monitoring, and timely treatment adaptation if those goals are not met. In Nov. 2025, a consensus committee of seven Canadian dermatologists with expertise in chronic hand eczema was convened to define such goals for this disease.

Using a targeted literature review, surveys, and a virtual consensus meeting, the panel agreed on two complementary targets: one for initial response and one for longer-term maintenance.

Both targets pair a clinician-rated measure with a patient-reported outcome. The Investigator’s Global Assessment for Chronic Hand Eczema (IGA-CHE) was selected as the preferred clinician scale because it is a single-item measure that can be readily integrated into routine practice; an improvement of at least one point was judged clinically meaningful. For patients, the preferred measure is the pruritus numerical rating scale (NRS), with a threshold of at least a three‑point improvement to define a relevant within-patient response. Pain NRS or the Dermatology Life Quality Index are considered acceptable alternatives when itch is not the predominant symptom.

Initial targets should be assessed eight to 16 weeks after treatment initiation and focus on degree of improvement, while maintenance targets, assessed 16 to 32 weeks after initial goals are achieved, represent absolute states such as IGA-CHE scores of 0 or 1 and pruritus scores of 0 or 1. The authors acknowledge limitations, including the subjective nature of outcome measures and the lack of real-world validation, but argue that the framework offers a pragmatic, patient-centred approach to guiding escalation or modification of therapy when goals are not met.