Improving Outcomes and Quality of Life for Patients With Hand and Foot Eczema: Randomized Study of a Patient-Centered Monitoring App
Authors: Bruch Aimee , Weigandt Wanja , Schardt Yannic , Herr Raphael , Benecke Johannes , Schmieder Astrid 
Published: September 2024

Background
Hand and foot eczema is a frequent chronic dermatological condition. The persistent itching, pain, and blistering can impair hand and foot function, leading to difficulties in performing tasks requiring fine motor skills. In addition, the impact on the quality of life for affected patients is significant, as the symptoms can be extremely uncomfortable and disruptive to daily activities. By incorporating digital health apps and educational programs into the management of hand and foot eczema, patients may receive ongoing support, optimize their clinical outcomes, and ultimately enhance their overall quality of life.

Objective
The purpose of this study was to evaluate the effect of a smartphone app combined with educational training on the clinical outcomes and mental health of patients with chronic hand and foot eczema during a 60-week study period.

Methods
Patients in the intervention group participated in an educational program focused on chronic hand and foot eczema at baseline and had in-person visits at weeks 0, 12, 24, 36, and 60, as well as access to our study smartphone app. The app allowed patients to upload pictures of their hands and feet and answer questions about pain severity, itching, mood, and quality of life. A chat function was also available for patients to contact their dermatologist. The control group received only the in-person study visits described above.

Results
A total of 87 patients were included in the study and randomized to the intervention (n=43) or control (n=44) groups. In total, 23 patients from the intervention group and 34 patients from the control group completed the study. Throughout the 60-week study period, a significant reduction in Hand Eczema Severity Index (HECSI) was consistently observed in all patients (week 60: linear regression coefficient [Coef]=–1.108; P≤.001). A trend toward a greater improvement of the HECSI in the intervention group compared to the control group was noticed (week 60: Coef=0.597; P=.05). Subgroup analysis revealed that patients who used the app with a usage frequency of less than 20% demonstrated a significant reduction in the HECSI from week 0 to week 60 (week 60: Coef=–1.275; P=.04) and a significant reduction in the Dermatology Life Quality Index (week 60: Coef=–1.246; P=.04) compared to the control group. We were able to demonstrate a significant correlation between the HECSI calculated based on pictures uploaded by patients through the app and the HECSI assessed during personal visits (ρ=0.885; P<.001), despite the potentially lower image quality of the pictures uploaded through the app.

Conclusions
This study provides further evidence that digital health apps can provide valuable support in improving patient clinical outcomes and management, especially as the app-based assessment of hand and feed images appears to be reliable.

Trial Registration
Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963