Hand Eczema Severity Index (HECSI): A scoring system for clinical evaluation.

Hand eczema can occur both independently and within the context of generalised eczema. This inflammatory disease is characterised by flare-up periods where the skin on the hands becomes very red, swollen, painful and itchy, alternating with remission periods, where the hands are extremely dry. In the latter case, we refer to this as xerosis. Hand eczema is a fairly common form and affects approximately 15% of the European population. Both men and women are almost equally affected, with hand eczema being slightly more prevalent in women.

This form of eczema often resembles what is known ascontact eczema. This occurs when the skin is exposed to a specific allergen in the environment that it cannot tolerate. Feeling attacked, it responds by releasing chemical mediators of inflammation. Contact eczema is generally similar tooccupational eczema, which is caused by a substance present in the workplace. Among the most affected professions, we notably find construction jobs (cement, paint), healthcare professions (gloves, resin) and agricultural jobs (pesticides, fertilisers).

Hand eczema is characterised by inflammatory lesions accompanied by itching and a burning sensation. These can extend from the fingertips to the wrists and forearms. Depending on the location of the lesions, hand eczema can be classified into different categories.

• Irritative hand dermatitis : this form is characterised by the appearance of lesions on the back of the hands and fingers. Dry, scaly, cracked skin, as well as a glossy palmar erythema are observed. Often of occupational origin, it occurs following frictions and microtraumas and is likely to improve during rest periods. However, it only completely heals after the cessation of the causative occupational activities.

• The dyshidrotic form or vesicular : Dyshidrotic eczema of the hands is associated with itchy vesicles embedded in the skin. It appears on an erythematous background on the lateral sides of the fingers, the palmar surfaces, and the back of the last phalanges. It is associated with painful cracks.

• The hyperkeratotic form of the palms : it is characterised by the emergence of fissured lesions that affect the central part of the palms. Hyperkeratotic eczema is painful and can spread across the entire palm.

There are numerous clinical scores for assessing the severity of hand eczema, focusing on the physical and/or psychological consequences of this dermatosis. Among them, we can mention the HECSI (Hand ECzema Severity Index), the PGA (Physician’s Global Assessment), the mTLSS (modified Total Lesion Syndrome Score) and the OHSI (Osnabrück Hand Eczema Severity Index).

The HECSI is one of the most commonly used and relies on an objective assessment of the intensity and extent of eczematous lesions. The reliability of this assessment has been the subject of several studies which have concluded that it is a very good model. Indeed, the HECSI demonstrates excellent inter-observer reliability, meaning that for a case of hand eczema, if different people calculate a HECSI score, they will obtain almost identical results.

The HECSI score rating ranges from 0 to 360, with 0 indicating a complete absence of eczema while 360 corresponds to the maximum level of severity. The HECSI is based on the grading of the severity of six types of lesions, including erythema, fissures, vesicles, scaling, oedema, and papules. This grading ranges from 0 to 3 and is evaluated for five areas of the hands, namely the fingertips, the fingers, the palms, the back of the hands, and the wrists. A score between 0 and 4 is also given to each area to assess the intensity of the lesions. The HECSI score is then calculated as follows:

• AGNER T. & al. The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. The British Journal of Dermatology (2005).

• BORRADORI L. & al. Dermatologie et infections sexuellement transmissibles. Elsevier Masson (2017).