Training module
Hand eczema severity index (HECSI) ranges from 0-360 points and incorporates both the extent and severity of hand eczema. According to the scale, the hands are divided into five regions: fingertips (corresponding to the distal phalanges), fingers (excl. fingertips), palm of hands, back of hands and wrists. The clinical signs considered are erythema, infiltration/papulation, vesicles, fissures, scaling and oedema.
How to assess hand eczema severity with HECSI
The first step is to assess the extent of eczema for a given region e.g. fingertips on both hands with an area score (Table 1). The second step is to assess the average severity (none, mild, moderate or severe) of the six clinical signs at each given region. To calculate the total HECSI, repeat the process for all five regions.
Area / extent
The five different area scores are given in Table 1. The area score is given collectively for both hands. For example, if only one palm of the hands is completely covered by eczema, the area score will be 50% (score of 2).
Severity of symptoms
For a visual scale of the severity of the six different signs, please go to the homepage.
If there are areas with mild and severe symptoms close to equal in size, a score of 2 (moderate) would be the most appropriate. If the majority of the involved areas correspond to a score 1 (mild), a score of 1 is more appropriate. Be careful not to score the highest severity in a region but the average one.
The severity of vesicles is not only based on the size of the vesicles but also the density. Thus, severe vesicles (score of 3) can comprise very large vesicles or a high density of several small vesicles in a region.
For assessment of oedema, please compare the area with eczema with the corresponding clear area. If for example all fingers are covered with eczema and there are no corresponding areas to compare with, please give an approximate score for the oedema.
Interpretation of the final HECSI score
According to the literature, a HECSI score of 1-16 corresponds to mild hand eczema, 17-37 to moderate, 38-116 to severe and >116 to very severe (1-2)
References
- Yüksel YT, Agner T, Ofenloch R. New evidence on the minimal important change (MIC) for the Hand Eczema Severity Index (HECSI). Contact Dermatitis. 2021; 85 (2): 164-70.
- Oosterhaven JAF, Schuttelaar MLA. Responsiveness and interpretability of the Hand Eczema Severity Index. Br J Dermatol. 2020;182(4):932-9.