HECSI Calculator

Hand Eczema Severity Index — Held, Skoet, Johansen & Agner, 2005 · severity strata: Oosterhaven & Schuttelaar, 2020

Purpose
Physician-rated severity of hand eczema combining the intensity of six clinical signs and the extent of involvement in five areas of both hands; the most widely used outcome measure in hand eczema trials (HECSI-75, HECSI-90).
Population
Adults and adolescents with hand eczema of any subtype (irritant, allergic, atopic, hyperkeratotic, vesicular). Assesses hands and wrists only.
Formula
HECSI = Σ over 5 areas [ (erythema + infiltration/papulation + vesicles + fissures + scaling + oedema) × extent ] · signs 0–3 · extent 0–4 · Range 0–360
Severity thresholds
Oosterhaven 2020: clear 0 · almost clear 1–16 · moderate 17–37 · severe 38–116 · very severe ≥ 117
📖 How to score

For each of the five areas, grade the intensity of the six signs (0 = none · 1 = mild · 2 = moderate · 3 = severe) and the extent of involvement of that area counting both hands together. The area score is (sum of the six signs) × extent; HECSI is the sum of the five areas.

Extent: 0 0 % 1 1–25 % 2 26–50 % 3 51–75 % 4 76–100 %
ℹ️ Trial response endpoints are relative: HECSI-75 and HECSI-90 = ≥ 75 % / ≥ 90 % reduction from baseline. HECSI scores signs only; pair it with a patient-reported measure (itch/pain NRS, DLQI or HEIS) as recommended by the original authors.
📚 References
  1. Held E, Skoet R, Johansen JD, Agner T. The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. Br J Dermatol. 2005;152(2):302–7. doi:10.1111/j.1365-2133.2004.06305.x
  2. Oosterhaven JAF, Schuttelaar MLA. Responsiveness and interpretability of the Hand Eczema Severity Index. Br J Dermatol. 2020;182(4):932–9. doi:10.1111/bjd.18295
  3. Thyssen JP, Schuttelaar MLA, Alfonso JH, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermatitis. 2022;86(5):357–78. doi:10.1111/cod.14035
  4. Agner T, Elsner P. Hand eczema: epidemiology, prognosis and prevention. J Eur Acad Dermatol Venereol. 2020;34(Suppl 1):4–12. doi:10.1111/jdv.16061
Clinical decision support only. This tool is intended to assist clinical assessment and does not replace professional judgment. Always interpret results in the context of the individual patient.