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Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: Results from Italy
Abstract
Backgrounddata on epidemiological impact and clinical characteristics of chronic hand eczema in Southern Europe are lacking.Objectivesto estimate prevalence of chronic hand eczema and its different stages of severity and refractoriness to standard therapy among patients accessing Italian dermatological reference centers, and to evaluate socio-demographic and clinical factors associated with each different stage.MethodsA cross-sectional multicenter study was conducted. Adult hand eczema patients, consecutively accessing 14 centers through a 6-month period, were enrolled. Patients were classified according to disease duration, severity and response to standard therapy with potent topical corticosteroids. Logistic regression analyses were performed to investigate relationship between socio-demographic and clinical data with different stages of eczema.Results981 patients participated. Hand eczema was chronic in 83.5% of patients. Among them, 21.3% were severe, 62% of these patients being refractory to standard therapy. Food processing and related works, health professions, craft and related trades works (builders, plumbers, electricians), hairdressers/beauticians and handicraft works were the jobs most frequently associated with having chronic hand eczema. Severe chronic hand eczema was more likely to be among men, older patients and those with lower education. Severe and refractory hand eczema was also more likely among unemployed and patients with allergic rhinitis and/or atopic dermatitis.Conclusions
Chronic hand eczema is frequent among hand eczema patients accessing dermatology centers. Many patients were severe and refractory to standard therapy. The appropriate identification of hand eczema is a first step necessary to implement effective and efficient treatments.This article is protected by copyright. All rights reserved.
... Atopic dermatitis is one of the risk factors for HE, while asthma and allergic rhinitis do not have a significant association with HE. [8] A meta-analysis on HE showed that atopic dermatitis was identified in 34.4% of adult patients with HE. [30] A previous study reported that among patients with HE, 17.8% had allergic rhinitis, 10.8% had atopic dermatitis, and 8.4% had asthma. [31] Patients with a history of atopy present skin barrier disruption and hyperreactivity toward irritants from the environment, leading to a greater tendency to develop HE. [8,31] In the current study, the lack of a significant difference in atopic stigmata between the groups may be due to the lower prevalence of atopy in developing countries. Hence, there might not have been enough atopic findings to analyze the significance. ...
... Atopic dermatitis is one of the risk factors for HE, while asthma and allergic rhinitis do not have a significant association with HE. [8] A meta-analysis on HE showed that atopic dermatitis was identified in 34.4% of adult patients with HE. [30] A previous study reported that among patients with HE, 17.8% had allergic rhinitis, 10.8% had atopic dermatitis, and 8.4% had asthma. [31] Patients with a history of atopy present skin barrier disruption and hyperreactivity toward irritants from the environment, leading to a greater tendency to develop HE. [8,31] In the current study, the lack of a significant difference in atopic stigmata between the groups may be due to the lower prevalence of atopy in developing countries. Hence, there might not have been enough atopic findings to analyze the significance. ...
Background
An increased frequency of hand sanitizer use and washing hands with soap seems to increase the incidence of hand eczema (HE).
Objectives
The aim was to analyze HE in nonmedical personnel, its severity, and the effect of hand sanitizer use on transepidermal water loss (TEWL) and skin capacitance.
Methods
This observational cross-sectional study was conducted from July to September 2022. Subjects were recruited based on the study criteria with cluster random sampling method. Each subject’s identity, data related to hand sanitizer use and handwashing, atopic stigmata, and duration of HE were documented. The severity of HE was assessed with the HE Severity Index (HECSI). TEWL and skin capacitance were measured with the Tewameter ® TM 300 and Corneometer ® CM 825 instruments.
Results
Out of 240 subjects who were selected randomly, 24 normal subjects and 24 subjects with HE were recruited. The incidence of HE in nonmedical personnel using hand sanitizer was 10%, with a median disease duration of 22 weeks and a mean HECSI score of 9.25 ± 6.33. There was no significant difference in TEWL and skin capacitance between the groups ( P > 0.05). There was no significant correlation between TEWL and skin capacitance with the HECSI score ( P > 0.05). Subjects with HE washed their hands more frequently than subjects without HE (6 vs. 4.5 times per day; P 0.005).
Conclusion
Most nonmedical personnel with HE had a mild form of the condition. There were no significant barrier function and skin hydration differences between the groups.
... An Italian study found that 83.5% of patients with hand eczema had chronic eczema, 21.3% had severe eczema, and 62.0% had eczema refractory to standard therapy. 12 In the CARPE registry of German patients with chronic hand eczema, 23.4% of patients had very severe eczema, 47.0% had severe eczema, 20.1% had moderate eczema, and 9.6% had mild or very mild eczema. 13 In the Swedish study of adolescents with hand eczema, 27.0% of patients had moderate to severe disease. ...
... Workers most at risk are workers in the food processing industry and those frequently exposed to water, such as healthcare professionals and hairdressers. 12 Healthcare workers have been identified as high-risk groups in Canada, 30 Korea, 18 the Netherlands, 31 Denmark, 19,28,32 Norway, 8 and Germany, 15 with prevalence rates ranging from 21.0% to 47.0%. In a Danish study, 53% of healthcare workers with hand eczema had positive patch test reactions, mostly to nickel, thiomersal, fragrances, rubber chemicals, and colophonium. ...
Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients.
These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.
... Von den Personen, die angaben, in den letzten 12 Monaten an HE erkrankt zu sein, hatten sich in Dänemark 67% allgemeinmedizinisch und 44% hautfachärztlich vorgestellt[46]. In Schweden betrug die durchschnittliche Dauer der Arbeitsunfähigkeit (AU) bei den Betroffenen, die eine AU angaben, HE im beruflichen Umfeld war am häufigsten mit CHE assoziiert[48].Ein systematischer Review zum Vergleich der Krankheitskosten von HE zeigte, dass die mittleren jährlichen Gesamtkosten pro Patient*in zwischen 1.311 € und 9.792 € variierten. Dabei verursachten vor allem schwerere HE und berufsbedingte HE höhere Kosten [49]. ...
... В свою очередь, хроническая экзема кистей, симптомы которой могут сохраняться на протяжении 10-15 лет, составляет от 9 до 35% всех профессиональных заболеваний [7]. Хроническое течение заболевания развивается приблизительно у 80% больных экземой [4], у 60% пациентов процесс приобретает торпидный характер с формированием резистентности к стандартной терапии [8]. Процесс считается хроническим в случае продолжительности его течения более 3 мес. ...
Hand eczema is a common multi-etiological disease manifested by evolutionary polymorphism of rashes. Hand eczema develops against the background of altered reactivity and genetic predisposition under the adverse effects of endogenous and exogenous factors. Hand eczema has a chronic course and is characterized by a wide range of clinical manifestations. The prevalence of eczematous lesions of the hands among the adult population is 1–2%, and among all skin diseases – 30–40%. The disease has an extremely negative impact on the quality of life, ability to work, career prospects and the social status of a person. The long course of eczematous lesions of the hands can be complicated by a secondary infection: bacterial and mycotic flora. Therefore, choosing the right and effective treatment for hand eczema is a particularly difficult task for a dermatologist. In recent years, a multicomponent drug based on gentamicin sulfate, dexpanthenol, mometasone furoate and econazole nitrate has been widely used for the treatment of hand eczema due to its high efficacy, tolerability, and safety. The use of this multicomponent drug in monotherapy for hand eczema is effective, leads to clinical remission and restoration of the quality of life of patients and is not accompanied by side effects and complications. This review focuses on the epidemiology, clinical features, and treatment options for hand eczema. Clinical experience with the use of a multicomponent drug in patients with hand eczema complicated by infection is also given.
... Besides occupational-related factors, the possible association between HE and socioeconomic status (SES) has been reported. [15][16][17][18][19] For instance, educational attainment, income, or a combination of these socioeconomic factors have been studied in the association with HE. [15][16][17]19 Since data on SES are limited, further research on the association between HE and different socioeconomic measures is needed. ...
Background:
Hand eczema (HE) is the most frequent occupational skin disease. However, studies on non-occupational wet exposure, occupations not considered as high-risk, and socioeconomic factors are scarce.
Objectives:
To investigate the association between HE and occupational and non-occupational wet exposure and work-related factors in the Dutch general population.
Methods:
Within the Lifelines Cohort Study, participants with HE were identified by a digital add-on questionnaire, including questions regarding exposure. Data on work-related and socioeconomic factors were collected from baseline.
Results:
Overall, 57 046 participants (42.0%) were included. Occupational and non-occupational wet exposure were positive associated with HE in the past year (Odds Ratios (OR) 1.35 95% confidence interval (CI) [1.22-1.49] and OR 1.34 95% CI [1.17-1.53], respectively). Positive associations for high-risk occupations (OR 1.20 95% CI [1.06-1.36] for personal care workers in health services and OR 1.25 95% CI [1.06-1.48] for nursing and midwifery professionals), occupations not considered as high-risk (OR 1.19 95% CI [1.03-1.39 for legal, social and religious associate professionals) and higher levels of education were found (OR 1.17 95% CI [1.04-1.32] and OR 1.18 95% CI [1.04-1.34] for middle and high level, respectively).
Conclusion:
Preventive strategies for HE should focus on avoidance of all exposure to wet, regardless of origin. In addition, job tasks instead of job title should be taken into account. As previous results on the association between HE and socioeconomic factors differ, future research should focus on a uniform definition. This article is protected by copyright. All rights reserved.
... HE in occupational settings was most frequently associated with CHE. 50 A systematic review, comparing cost-of-illness of HE showed that the mean total yearly costs per patient varied between €1,311 and €9,792. Particularly more severe HE and OHE resulted in higher costs. ...
Background:
Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients.
Objectives:
To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema.
Method:
The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month.
Results:
Consensus was achieved for several statements and management strategies.
Conclusion:
The updated guideline should improve management of hand eczema.
... En cuanto a la gravedad de la enfermedad, un estudio de la población italiana con EM reveló que el EM era crónico en el 83,5% de los pacientes; el 21,3% tenían eccema grave, y el 62,0% eran refractarios al tratamiento estándar 12 . Del registro CARPE de pacientes alemanes con ECM, el ECM fue muy grave en el 23,4%, grave en el 47,0%, moderado en el 20,1% y leve o muy leve en el 9,6% de los pacientes 13 . ...
Resumen
El eccema de manos es una patología frecuente con un fuerte impacto en la calidad de vida de los pacientes y un alto coste social y laboral. Su manejo por los médicos de atención primaria y de medicina del trabajo es complejo debido a la variedad de etiologías, la evolución difícilmente predecible de la enfermedad y la respuesta al tratamiento. El diagnóstico precoz y las medidas protectoras adecuadas son esenciales para evitar la cronificación, que es mucho más difícil de tratar. Una correcta derivación a un especialista y la valoración de una baja laboral en el momento adecuado resultan cruciales para un buen manejo de estos pacientes.
En esta guía sobre el eccema crónico de manos analizamos el proceso diagnóstico, las medidas preventivas y los tratamientos, con especial énfasis en el papel del médico de atención primaria y de medicina del trabajo en los estados iniciales de su manejo.
... antihistamines and disodium cromoglycate have not been reported to influence the allergic patch test reaction, 106 and the same is true for NSaids. Concerning retinoids (alitretinoin), which are used in the treatment of hand dermatitis, 107 there are no data in the literature. ongoing topical treatment with corticosteroids is not believed to influence patch testing unless treatment is applied to the site of application of the tests. ...
Patch testing is the standard procedure used to diagnose allergic contact dermatitis. It is an in-vivo test, which reproduces the reaction to a contact allergen. This in-vivo test aims to reproduce the elicitation phase of allergic contact dermatitis and is performed applying allergens under occlusion on the skin under standardized conditions. These guidelines for the best practice in performing patch test have been developed by an Italian group of experts taking in account the Italian legislation and local pharmacological governance. Guidelines are adapted from the original article under the guidance of the European Society of Contact Dermatitis (ESCD) and on the basis of the SIDAPA guidelines.
... Additionally, occupational rhinitis can be associated with occupational asthma and upper airway symptoms may precede those of the lower respiratory tract. Taken together, occupational rhinitis is an important disease for study given its medical as well as socioeconomic implications (5)(6)(7). Diagnosis is usually based on a medical history in combination with a skin prick test or blood tests for allergen-specific IgE antibodies. In Western countries, about 20% of people are affected in a given year (8,9). ...
The underlying mechanism of allergic rhinitis involves IgE antibodies attaching to the allergen and causing the release of inflammatory chemicals such as histamine from mast cells. Cytokines are very important in this process. Many data suggest a systemic shift to more intensely type 1-dominated immune responses in non-allergic individuals and, conversely, to more type 2-dominated responses in allergic individuals upon natural re-exposure to grass pollen. However other studies have found that chemokine (C-X-C motif) ligand (CXCL)10/ interferon (IFN)-γ-induced protein 10 (IP-10) and CXCL9/monokine induced by IFN-γ (MIG) concentrations are elevated in nasal lavages from allergic patients suggesting that these chemokines may play a role in chronic allergic inflammation. Several studies have also evaluated the effect of different immune-modulating drugs in allergic rhinitis showing local and peripheral increase of IFN-γ and IP-10, associated with a reduction of symptoms. Further studies are needed to clarify the role of T helper (Th)1 chemokines in the pathogenesis of allergic rhinitis, and to evaluate their role as biomarkers of disease and of response to treatments.
... clinical features and histology are often unsatisfactory in differentiating CHE from a very common skin disease like psoriasis. [6][7][8][9][10][11][12] Hence, the possibility to have a molecular diagnostic aid in CHE diagnosis would be very desirable. ...
Background:
Chronic hand eczema (CHE) is not a homogenous disease, necessitating complex differential diagnostics. Interleukin (IL)-1 family members are significantly up-regulated in ACD and psoriasis patients skin.
Methods:
The present study aims to deepen the knowledge about clinical assessment and characterization of patients affected by chronic hand dermatitis (CHD) as well as to investigate the role of possible biomarkers which may help in the diagnostic process. An observational case- control study was performed enrolling 30 CHD patients and 20 healthy controls. Each patient underwent detailed medical history, clinical examination, epicutaneous patch test, and lesional skin biopsies for histological and immunohistochemical analysis.
Results:
Patient history, clinical examination and patch testing led us to a final CHD characterization in only 8/30 subjects (26.7%). In the remaining subjects, clinical and histological features suggested a diagnosis of psoriasis in 9/22 (30%) and idiopathic chronic hand eczema (CHE) in 13/22 (43.3%). Trying to find a possible marker for the latter dermatosis, we analysed IL-1 family in all the recruited subjects. IL-1 members were increased in all conditions, but IL- 36α was the only analyzed cytokine able to characterize patients who end up with a diagnosis of idiopathic CHE.
Conclusions:
In conclusion, we can assess that medical history and patch testing remain essential investigations in CHD patients even if not always sufficient to perform a final diagnosis. Moreover, IL-1 members are probably involved in CHE skin inflammation, with IL-36α being a possible future biomarker which might help in the complex diagnostic process of CHE.
... Most patients searching for dermatological help for hand dermatitis have a chronic condition [8]. ...
Hand dermatitis is a socially significant health problem. This review provides a discussion on the clinical features and patterns as well as the differential diagnosis of hand dermatitis, because these are essential for proper diagnosis in clinical practice. The morphology, however, is poorly related to the etiology in chronic cases. In all cases of chronic hand dermatitis, a full diagnostic examination should be undertaken and the etiology should be clarified and addressed in the treatment concept, instead of just moving directly from a morphological diagnosis to therapy. Preventive measures should be included in the treatment concept according to etiology. A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others.
Allergic contact dermatitis (ACD) is a common inflammatory skin disease that, especially when the condition becomes chronic, has a high impact on the quality of life and represents a significant disease burden. ACD represents a type IV delayed-type hypersensitivity reaction that is triggered by contact with an allergen in previously sensitized individuals through the activation of allergen-specific T cells. In the acute phase, it is characterized by eczematous dermatitis, which presents with erythema, edema, vesicles, scaling, and intense itch. Non-eczematous clinical forms are also described (lichenoid, bullous, and lymphomatosis). Lichenification is the most common clinical picture in the chronic phase if the culprit allergen is not found or eliminated. ACD can be associated with both occupational and non-occupational exposure to allergens, representing approximately 90% of occupational skin disorders along with irritant contact dermatitis. Patch testing with suspected allergens is required for a diagnosis. Metals, especially nickel, fragrance mix, isothiazolinones, and para-phenylenediamine, are the most commonly positive allergens in patients patch tested for suspected ACD. The treatment goal is to avoid contact with the culprit agent and use topical and/or systemic corticosteroid therapy.
Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.
The course of contact dermatitis is variable: the condition may resolve, or recur in the same site, or else spread and become unpredictably chronic. Although rarely, it can be complicated by erythroderma, which is often irreversible, has a poor prognosis and can even be fatal. With the exception of the last complication, the prognosis of contact dermatitis in its various clinical expressions is favorable. The course of the disease can be stopped only if contact with the agent or agents responsible is avoided. Topical or systemic treatments are useful only to reduce the duration of the clinical episode. Topical treatment and in part, systemic treatment are largerly similar in the two different forms of irritant and allergic contact dermatitits. Local treatment relies on Galenic products (solutions or antiseptic tinctures, emulsions and soothing lotions, powders, pastes and creams), that must be used considering the clinical phase of the disease (acute, subacute, chronic) and the relative manifestations. Apart from these very useful products, topical corticosteroids can be used with some important criteria, such as time and modality of use. Systemic antihistamines can be used for short or long periods to calm the pruritus. Systemic corticosteroids are used only in forms that are highly refractory to other treatments, and in diffuse and erythrodermic forms. Various other physical (ultraviolet light, Grenz rays) and chemical (antimetabolites, such as methotrexate, azathioprine, mycophenolate mofetil; IFN-γ antagonists, such as cyclosporin, apremilast; TNF-α antagonists, such as infliximab, etanercept; IL-4 receptor-α antagonists, such as dupilumab; calcineurin inhibitors, such as tacrolimus and pimecrolimus) substances can be used as attempts of immunotolerance. Many attempts have been also provided to induce specific oral tolerance to nickel in nickel-allergic subjects.
Hand dermatitis is a common condition with a lifetime prevalence of 20%. Glove allergic contact dermatitis (ACD) is a very important dermatitis affecting health care workers, hairdressers, cleaning personnel, kitchen workers, craftsmen, construction workers, laboratory workers, and homemakers. Occupationally related cases may be severe and can result in significant disability. Glove ACD is most commonly due to exposure to rubber accelerators, which are compounds that are added to rubber during production to increase strength and durability. Given the known allergic potential of these compounds, glove manufacturing companies have reformulated gloves leading to the introduction of new rubber allergens. In this review, we will discuss risk factors for glove ACD, both common and uncommon allergens in gloves, common contact allergens that permeate gloves, and patch testing to help uncover the inciting allergen(s).
Contact dermatitis is a broad term that encompasses both non-immunologic irritant contact dermatitis (ICD) and immunologically mediated allergic contact dermatitis (ACD). Both ICD and ACD can negatively affect a patient's quality of life and are a source of exorbitant medical and societal costs. Avoidance of inciting irritants and/or allergens and liberal use of emollients or humectants are the cornerstone of therapy. When an allergic cause is suspected, patch testing is highly encouraged. In this contribution, we highlight both the commonalities and differences of acral contact dermatitis as it relates to specific regions of the body. In addition, a review of the predisposing conditions, risk factors, and treatment options in the literature is presented to help with the care of these challenging patients.
Background:
Dental workers are considered to have a high risk of developing occupational hand eczema.
Objectives:
To estimate the prevalence of work-related hand eczema and associated risk factors in dental workers in Japan.
Methods:
A self-administered questionnaire was sent by mail to all dental clinics of Kumamoto City, Japan. In addition, patch testing with 24 dentistry-related allergens was offered.
Results:
In total, 46.4% of dental workers (n = 528: response 31.4%, based on 97 clinics) reported a lifetime history of chronic hand eczema. The 1-year prevalence was 36.2%. According to logistic regression analysis, the most important risk factors for the 1-year prevalence were a personal history of atopic dermatitis [odds ratio (OR) 4.7, 95% confidence interval (CI): 2.2-8.8], asthma and/or allergic rhinitis (OR 2.0, 95%CI: 1.3-3.0), dry skin (OR 1.7, 95%CI: 1.1-2.7), shorter duration of work (OR 2.0, 95%CI: 1.2-3.5 for up to 10 years versus >20 years), and washing hands >10 times per day (OR 1.6, 95%CI: 1.0-2.5). Fifty-four workers were patch tested. Rubber chemicals and acrylates were the most frequent occupationally relevant contact allergens.
Conclusions:
Dental workers in Japan have a high prevalence of hand eczema. Health education to prevent hand eczema and more frequent patch testing are needed.
Background:
Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea.
Objective:
To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers.
Methods:
To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects.
Results:
The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively.
Conclusion:
Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.
Background
Cobalt is a strong skin sensitizer and a prevalent contact allergen. Recent studies have recognized exposure to leather articles as a potential cause of cobalt allergy.Objectives
To examine the association between contact allergy to cobalt and a history of dermatitis resulting from exposure to leather.MethodsA questionnaire case–control study was performed: the case group consisted of 183 dermatitis patients with a positive patch test reaction to cobalt chloride and a negative patch test reaction to potassium dichromate; the control group consisted of 621 dermatitis patients who did not react to either cobalt or chromium in patch testing. Comparisons were made by use of a χ2-test, Fisher's exact, and the Mann–Whitney test. Logistic regression analyses were used to test for associations while taking confounding factors into consideration.ResultsLeather was observed as the most frequent exposure source causing dermatitis in the case group. Although the case group significantly more often reported non-occupational dermatitis caused by leather exposure (p < 0.001), no association was found between cobalt allergy and dermatitis caused by work-related exposure to leather.Conclusions
Our study suggests a positive association between cobalt allergy and a history of dermatitis caused by non-occupational exposure to leather articles.
The aim of the CARPE registry is to investigate characteristics and medical care in patients affected by chronic hand eczema. Patients are assessed by dermatological examination and patient questionnaire. Socio-economic and clinical data are collected, and quality of life is measured using the Dermatology Life Quality Index (DLQI). A total of 1,163 patients with chronic hand eczema were eligible for analysis (mean age 47.0 years; 54.6% female; mean disease duration 7.6 years). At inclusion, chronic hand eczema was very severe in 23.4%, severe in 47.0%, moderate in 20.1%, and clear or almost clear in 9.6% of patients. Median DLQI was 8.0. In all, 93.8% of patients reported use of topical corticosteroids, 25.6% systemic antihistamines, 28.3% topical calcineurin-inhibitors, 38.0% ultraviolet phototherapy, and 35.3% systemic treatment (19.7% alitretinoin) prior to inclusion in the registry. A significant proportion of patients may not receive adequate treatment according to the guideline on management of hand eczema.
Hand eczema is common and has an adverse impact on the lives of patients. There is a need for population-based surveys on the pharmacoepidemiological aspects, quality of life and impact of socioeconomic factors in hand eczema. The aim of this cross-sectional study was to investigate these factors. A questionnaire-based nationwide survey of health was performed, including questions on hand eczema, use of pharmaceuticals and socioeconomic factors. Quality of life was estimated with the generic instrument Short Form 36 (SF-36). The questionnaire was sent to 7,985 persons (age range 18-84 years), response rate 61.1% (n = 4,875). The 1-year prevalence of hand eczema in the study population was 7.5%. In this group, quality of life was lower. All dimensions of SF-36 were affected, most markedly general health and those dimensions reporting on mental health. In the group with self-reported hand eczema, 51% reported using topical pharmaceuticals. Hand eczema was more common among women (9.1%, n = 2,630) than among men (5.6%, n = 2,245) and in the age group below 65 years (8.5%, n = 3,274) compared with those aged 65 years and over (4.3%, n = 1,151). This survey clearly demonstrates the impact of hand eczema on several dimensions of life and also highlights age, gender and socioeconomic differences.
Little is known about the prevalence of atopic eczema outside Northern Europe.
We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world.
A cross-sectional questionnaire survey was conducted on random samples of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world. Those children with a positive response to being questioned about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema. Children whose atopic eczema symptoms resulted in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema.
Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers. The prevalence range for symptoms of atopic eczema was from less than 2% in Iran to over 16% in Japan and Sweden in the 6 to 7 year age range and less than 1% in Albania to over 17% in Nigeria for the 13 to 14 year age range. Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe, and lower prevalences were reported in Eastern and Central Europe and Asia. Similar patterns were seen for symptoms of severe atopic eczema.
Atopic eczema is a common health problem for children and adolescents throughout the world. Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups, suggesting that environmental factors may be critical in determining disease expression. Studies that include objective skin examinations are required to confirm these findings.
Little is known about the socio-economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids.
To estimate the socio-economic burden of severe chronic hand eczema refractory to potent topical corticosteroids, and to establish an algorithm for the estimation of the health-related quality of life EuroQol five-dimensional (EQ-5D) utility index from the Dermatology Life Quality Index (DLQI) summary score.
A multicentre cost of illness study was conducted, adopting the societal perspective. Adult patients with severe and refractory chronic hand eczema were enrolled. Direct (e.g. drug treatment and travel) and indirect (i.e. loss of productivity) mean costs/patient-month were estimated. Health-related quality of life was assessed with the EQ-5D and DLQI questionnaires. An ordinary least square regression model was used to investigate relationships between health-related quality of life scores.
One hundred and four valid patients (mean age 44.5 years, 39.4% male) participated. Overall mean costs were €418.3/patient-month: loss of productivity contributed 43.7%, followed by hospitalization (16.1%) and travel (10.3%). Health-related quality of life scores were, on average, 0.50 (EQ-5D utility) and 11.3 (DLQI). Utility and DLQI summary were significantly related to each other.
Wellbeing and loss of productivity are the most important consequences in these patients. Appropriate treatment is necessary to improve patient health and productivity, which will contribute to reducing societal costs.
Eczema Lichenification Prurigo Erythroderma References
It is broadly assumed that costs caused by chronic hand eczema (CHE) are significant. However, there is a lack of cost-of-illness studies on CHE.
To determine the direct and indirect costs of CHE under routine conditions in Germany from the societal perspective.
A cross-sectional survey was conducted in 24 outpatient practices and clinics across Germany. Patients with CHE refractory to potent topical steroids and insured by statutory health insurance were eligible. Clinical and cost data were collected using standardized questionnaires. Severity classes were defined according to a photographic guide and physician global assessment (PGA). Four treatment stages were defined based on the German CHE guidelines: topical treatments only (stage I), additionally ultraviolet (UV) radiation therapy (II), systemic therapy (III) and inpatient treatment (IV). Bivariate associations between costs and severity as well as treatment stage were assessed.
Two hundred and twenty-three patients with CHE (mean age 45·7years, 56% women) enrolled in the study, of whom 63·2% were treated only with topical treatments, 15·7% additionally with UV radiation and 11·7% with systemic treatments. Of all patients, 9·4% had been admitted to hospital. Total costs per year and patient were €2128, including €1742 direct costs and €386 indirect costs. The total costs increased with treatment stages I-IV (P<0·001): €1044, €2307, €2697 and €8407, respectively. Accordingly, costs also correlated with clinical severity.
Patients with CHE refractory to topical steroids incur marked costs to society. The costs increase disproportionately with escalating treatment stages, especially in patients admitted to hospital. Hence, new treatments may help to reduce the societal costs of CHE.
Long-term follow-up studies on the prognosis and consequences of occupational hand eczema (OHE) and the prognostic risk factors for persistent OHE are sparse.
To determine the medical and occupational outcome after a follow-up of 7-14 years in 605 patients diagnosed with OHE and to identify the prognostic risk factors for the continuation of hand eczema.
Patients examined at the Finnish Institute of Occupational Health in 1994-2001 completed a follow-up questionnaire 7-14 years after diagnosis.
The hand eczema had healed (no eczema during the last year) in 40% of patients with OHE. The duration of hand eczema before diagnosis was strongly associated with the continuation of eczema. Age, sex and diagnosis (allergic or irritant contact dermatitis) were not associated with the prognosis, but skin atopy, and especially respiratory atopy, were correlated with the continuation of hand eczema. Contact allergies in general were not risk factors for persistent OHE, but the presence of a work-related chromate allergy was associated with poor healing. A total of 34% of patients had changed their occupation due to OHE, and their long-term prognosis was better than those who had not. The hand eczema of patients originally in food-related occupations continued on an unfavourable course.
In the logistic model, risk factors for the continuation of OHE were a long duration of hand eczema before diagnosis, respiratory atopy, skin atopy, and continuation in the same occupation. Those who ended up changing occupation due to their OHE had a better medical and economic prognosis.
Ever since its inception a couple of centuries ago, hand dermatitis/eczema has been in the reckoning. Idiosyncrasies continued to loom large thereafter, till it acquired its appropriate position. Dermatitis/eczema are synonymous, often used to indicate a polymorphic pattern of the inflammation of the skin, characterized by pruritus, erythema and vesiculation. A spectrum delineated into acute sub-acute and chronic dermatitis of the hands. Pompholyx, recurrent focal palmer peeling, ring, wear and tear and fingertip eczema, apron, discoid eczema, chronic acral dermatitis, gut and patchy papulosquamous eczema are its clinical variants. Occupational dermatitis/eczema may be contributory. Etiological definitions are clinched by detailed history of exogenous and endogenous factors. However, scientific confirmation of the entity is through patch testing by using available antigens.
Numerous studies have investigated the prevalence and risk factors of hand eczema in the general population. These studies are of high value as they tend to be less biased than studies using clinical populations and as they are important for healthcare decision makers when they allocate resources. This study aimed to review the epidemiology of hand eczema in the general population.
Literature was examined using Pubmed-Medline, Biosis, Science Citation Index, and dermatology text books. On the basis of studies performed between 1964 and 2007, the point prevalence of hand eczema was around 4%, the 1-year prevalence nearly 10%, whereas the lifetime prevalence reached 15%. Based on seven studies, the median incidence rate of hand eczema was 5.5 cases/1000 person-years (women = 9.6 and men = 4.0). A high incidence rate was associated with female sex, contact allergy, atopic dermatitis, and wet work. Atopic dermatitis was the single most important risk factor for hand eczema. Hand eczema resulted in medical consultations in 70%, sick leave (> 7 days) in about 20%, and job change in about 10%. Mean sick time was longer among those with allergic hand eczema than those with atopic and irritant hand eczema. Moderate to severe extension of hand eczema was the strongest risk factor for persistence of hand eczema. Other risk factors included early onset of hand eczema and childhood eczema. The aetiology of hand eczema is multifactorial and includes environmental as well as genetic factors. Future studies should focus on unresolved areas of hand eczema, for example, genetic predisposition.
This article reviews the prognosis of contact dermatitis, particularly of occupational contact dermatitis. Most studies document a poor prognosis for occupational and nonoccupational contact dermatitis. The prognoses of occupational and nonoccupational contact dermatitis, irritant contact dermatitis, and allergic contact dermatitis are similar. Only a minority of studies on the prognosis of occupational contact dermatitis have found that a job change by the affected worker leads to clearing of the dermatitis. Dermatologic and nondermatologic factors associated with a poor prognosis are discussed.
To elucidate the importance of hand eczema in the population of Gothenburg, a questionnaire was sent to 20,000 individuals aged 20-65 years, randomly selected from the population register of the city. After two reminders, a response rate of 83% was obtained. Those individuals considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination including patch testing. 1385 persons (71%) participated. Analysis of drop-outs was performed by interview by telephone and post. The 1-year period prevalence of hand eczema was estimated to be about 11% and the point prevalence 5.4%. Hand eczema was twice as common among females as among males. The most common type of hand eczema was irritant contact dermatitis (35%), followed by atopic hand eczema (22%) and allergic contact dermatitis (19%). The most common contact allergies were to nickel, cobalt, fragrance-mix, balsam of Peru and colophony. Comparing these results with a 20-year earlier study on hand eczema, an increased prevalence, especially of atopic hand eczema, was found. The only occupational group that reported a significantly higher period prevalence of hand eczema was service workers. Of all occupations, cleaners had the highest period prevalence, 21.3%. Hand eczema was more common among people reporting some kind of occupational exposure. The most harmful exposure turned out to be to unspecified chemicals, water and detergents and dust and dry dirt. The only contact allergen that was statistically related to an occupational group was colophony among female office workers. Change of work, where the hand eczema was the main reason, was reported by 8% and was most common in service work. Hairdressers had the highest frequency of change. Hand eczema was shown to be a long-lasting disease with a relapsing course. 69% of the patients had consulted a doctor and 21% had been on sick-leave at least once because of their hand eczema. The mean total sick-leave time was 18.9 weeks, median 8 weeks. Treatment with topical steroids was reported by 51%, emollients by 85%. Frequent itching was reported by 54% of the patients. 81% experienced some kind of disturbance of their daily life considered to be caused by the hand eczema. A multiple logistic regression analysis revealed that the most important predictive factor for hand eczema was a history of childhood eczema. Number two was female sex, followed by occupational exposure, a history of asthma and/or hayfever and a service occupation.(ABSTRACT TRUNCATED AT 400 WORDS)
In a sample of about 3000 adults the hands and arms were examined for the presence of skin disorders. The most important diagnostic category was eczema; prevalence among males was 4.6% and among females it was 8%. In the majority of patients with eczema irritant factors were found to play a role. Among males occupation was a major factor associated with prevalence of eczema. After correction for occupation there remained no association with age.
Occupational contact dermatitis (OCD) ranks first of all occupational diseases in many countries. The incidence rate is believed to be around 0.5–1.9 cases per 1000 full-time workers per year. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. In this review article the lack of truly epidemiologic data on OCD and the difficulties of those studies are illustrated. The following issues are highlighted: case ascertainment and bias, the distribution of allergic and irritant contact dermatitis in the working population, the interrelationship between exogenous (allergens, irritants) and endogenous factors, the prognosis, the social and economic impact, and the need for intervention studies.
The prevalence of hand dermatitis in different occupational groups was estimated using a standardized questionnaire in a series of surveys among workers of a chemical company, a municipal electricity company, municipal public works, nurses and surgical assistants. A survey in a sample of the general population was performed to obtain a reference estimate of the prevalence. The prevalence of hand dermatitis in the general population was 5.2% in men and 10.6% in women. The prevalence of hand dermatitis among the occupational groups ranged from 2.9% in office workers to approximately 30% in nurses. The age-adjusted prevalence ratio (PR) of hand dermatitis in office workers was not significantly elevated compared with the general population. In nurses, the age-adjusted PR was 9.3 among men (95% confidence interval [CI]: 3.6-23.9) and 2.2 among women (95% CI: 1.5-3.5). The PR in surgical assistants was not significantly elevated (PR = 1.4, 95% CI: 0.7-2.6). This suggests that exposure in nurses (frequent washing of the hands), is more harmful to the skin than the less frequent but more intensive exposure in surgical assistants. The age-adjusted PR were also significantly elevated in male manual workers of the chemical company, the electricity company and public works and varied from 2.4 to 2.8. Occasional or regular occupational exposure to a variety of irritants in combination with mechanical stress (as occurs frequently in manual work) may be responsible for this observation.(ABSTRACT TRUNCATED AT 250 WORDS)
Occupational contact dermatitis (OCD) ranks first of all occupational diseases in many countries. The incidence rate is believed to be around 0.5-1.9 cases per 1000 full-time workers per year. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. In this review article the lack of truly epidemiologic data on OCD and the difficulties of those studies are illustrated. The following issues are highlighted: case ascertainment and bias, the distribution of allergic and irritant contact dermatitis in the working population, the interrelationship between exogenous (allergens, irritants) and endogenous factors, the prognosis, the social and economic impact, and the need for intervention studies.
Atopic diseases are common in children and adolescents. However, epidemiological knowledge is sparse for hand eczema and allergic contact dermatitis in this age group. Furthermore, no population-based studies have evaluated the prevalence of atopic diseases and hand and contact dermatitis in the same group of adolescents.
To assess prevalence measures of atopic dermatitis (AD), asthma, allergic rhinitis and hand and contact dermatitis in adolescents in Odense municipality, Denmark.
The study was carried out as a cross-sectional study among 1501 eighth grade school children (age 12-16 years) and included questionnaire, interview, clinical examination and patch testing.
The lifetime prevalence of AD was 21.3% (girls 25.7% vs. boys 17.0%, P < 0.001) using predefined questionnaire criteria. The 1-year period prevalence of AD was 6.7% and the point prevalence 3.6% (Hanifin and Rajka criteria). In the interview the lifetime prevalence of inhalant allergy was estimated as 17.7% (6.9% allergic asthma, 15.7% allergic rhinitis). The lifetime prevalence of hand eczema based on the questionnaire was 9.2%, the 1-year period prevalence was 7.3% and the point prevalence 3.2%, with a significant predominance in girls. A significant association was found both between AD and inhalant allergy, and between AD and hand eczema using lifetime prevalence measures. The point prevalence of contact allergy was 15.2% (girls 19.4% vs. boys 10.3%, P < 0.001), and present or past allergic contact dermatitis was found in 7.2% (girls 11.3% vs. boys 2.5%). Contact allergy was most common to nickel (8.6%) and fragrance mix (1.8%).
High prevalence figures were found for atopic diseases, hand eczema and allergic contact dermatitis, and the diseases were closely associated. A considerable number of adolescents still suffers from AD, and a considerable sex difference was noted for hand eczema and allergic contact dermatitis. Nickel allergy and perfume allergy were the major contact allergies. In the future this cohort of eighth grade school children will be followed up with regard to the course and development of atopic diseases, hand eczema and contact dermatitis.
Hand eczema is the most frequent occupational skin disease. Our aim was to study changes in its prevalence in Swedish adults. Cross-sectional studies were performed in 1983 and 1996. Random samples from the population of Gothenburg, Sweden, aged 20-65 y, were drawn from the population register. Data were collected with a postal questionnaire, which was identical in the two studies. The response rate was 83.5% (16,708 out of 20,000) in 1983 and 73.9% (2218 out of 3000) in 1996. The reported 1 y prevalence of hand eczema decreased from 11.8% in 1983 to 9.7% in 1996 (p < 0.01), a large difference being found in the youngest age group. Reported childhood eczema increased from 10.4% to 12.4%, however (p < 0.01). Of those with childhood eczema 27.9% and 25.2% reported hand eczema, compared to 10.0% and 7.5% among those without childhood eczema. In total 76.8% were gainfully employed in 1983 and 68.3% in 1996 (p < 0.001). In 1983 23.0% were employed in "high-risk" occupations for hand eczema compared to 19.4% in 1996 (p < 0.001). Even though the increase in childhood eczema was largest in the youngest group, there was a large decrease in the prevalence of hand eczema in that age group among both sexes. The study indicates that the prevalence of hand eczema in Swedish adults had decreased between 1983 and 1996 despite an increasing prevalence of childhood eczema. Secular changes in reporting hand eczema and childhood eczema may explain some of the changes, but a decreased occupational exposure to skin irritants is a probable cause, implying that occupational factors may be important predictors of hand eczema.
Occupational skin disease (OSD) is a significant public health concern. To keep OSDs under surveillance, a register of OSDs (BKH-S) was implemented in 1999 in the Saarland, FRG. We conducted a population-based register study to analyse all initial reports of OSDs reported to the BKH-S. 336 cases were prospectively assessed from July 1999 to June 2001. In 78% (n = 263) of the cases an occupational cause for the skin disease was stated, 91% (n = 240) of which fell within 16 occupational groups. This is equivalent to 6.8 cases per 10,000 workers per year within these occupational groups. Notably, young age groups (median age 35 years) were affected with a female predominance. The most frequent final diagnosis was irritant contact dermatitis (75%) followed by allergic contact dermatitis (34%) and atopic dermatitis (19%). The overall prevalence of occupationally relevant delayed-type reactors was 21% and of immediate-type reactors 17%. Work-related delayed-type sensitizations to potassium dichromate (n = 8) and immediate-type sensitizations to natural rubber latex (n = 11) were the most frequently observed. Questionnaire results showed frequent occupational skin contact with wet work (59%), detergents (48%), and disinfectants (38%). The second valid surveillance scheme for OSD in the FRG has been introduced and can be made available for further analysis.
When etiological relationship is of interest, the incidence rate is a preferred measure. The aim of the present retrospective study was to estimate the incidence rate of self-reported hand eczema in a sample from the general population and to study the relation of this to age, sex, and atopy. A questionnaire was mailed to 3000 individuals aged 20-65 y, randomly selected from the population register of Göteborg, Sweden. This gave a response rate of 73.9%. Questions were asked about ever having had hand eczema, time of onset of the disease, history of childhood eczema, and history of asthma/hay fever. The crude incidence rate of self-reported hand eczema was 5.5 cases per 1000 person-years (females 7.1 and males 4.0). There was no difference, however, in incidence rate between women and men above 30 y of age. In a Poisson regression analysis, female sex, childhood eczema, and asthma/hay fever were all significantly associated with hand eczema, but only at ages below 30 y. A moderate influence of recall bias and a probable tendency to underreport imply that the incidence rates presented are to be considered as minimum rates.
Previous studies on prevalence of skin diseases in the population have been based on clinical examination of a sample of the population. A questionnaire on self-reported skin complaints has recently been developed and validated for use in population surveys, but has not been used until now.
To quantify the skin morbidity in an adult urban population assessed by a newly developed self-measurement instrument, and to explore the associations between skin morbidity and sociodemographic factors in the community.
The study was a population-based cross-sectional study carried out in the city of Oslo. Adult participants (n = 18 770) aged 30-76 years answered a questionnaire giving information on self-reported skin complaints, and which included demographic, psychosocial and general health variables.
Itch was the dominating skin complaint in all age groups. Adjusted odds ratios for itch, self-reported hand eczema and self-reported acne showed significant associations with female gender and reporting households of middle income. There was no association with employment categories.
This study shows that skin complaints referring to the most common chronic skin diseases varied with age, gender and marital status, and worsened with middle-income household. It provides evidence that household income is associated with skin morbidity, bringing dermatological aspects to studies on health inequalities.
There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE).
To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.
Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient.
ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment. ICC for intraobserver agreement was 0.90.
Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.
A standardized instrument is needed to rate the overall severity of chronic hand dermatitis (CHD), in particular during clinical trials.
To design and validate a photographic guide.
Initially, five experts were asked to grade 50 photographs of CHD, first individually, then as a consensus-building group, in order to select the photographs included in the guide. Then, a validation session with 11 different dermatologists evaluating 28 patients was conducted to assess the interrater reliability and test-retest reproducibility of the assessment of disease severity, relying on the photographic guide, on two consecutive days. Patient order was randomized, and only diseased hands were visible to prevent any bias in evaluation.
The experts reached a consensus for development of a photographic guide composed of five severity levels and four photographs per severity level. Results of the validation session showed a high level of interrater reliability and test-retest reproducibility.
The photographic guide is a reliable tool for assessing the morphological severity of hand dermatitis, and can be used as part of a comprehensive evaluation of disease in international multicentre clinical trials.
Hand eczema is a skin disease often with a long-lasting and relapsing course. The long-term prognosis in the general population is unknown.
The aims were to examine the extent to which hand eczema had persisted and the medicosocial consequences of the disease.
In a 15-year follow-up of hand eczema, patients diagnosed in a previous population-based study were sent a questionnaire with 20 questions concerning the persistence and course of the disease, and its occupational and medicosocial consequences.
Addresses were available for 1115 persons, of whom 868 answered the questionnaire. Sixty-six per cent of the respondents reported periods of hand eczema and 44% reported symptoms during the previous year, with no sex difference. Twelve per cent reported continuous eczema. However, 74% of those reporting symptoms considered that their hand eczema had improved; of these more were women than men (78% vs. 66%, P < 0.01). Twenty people, 3% of those who were gainfully employed in 1983, reported a change to another occupation because of their hand eczema, 15 of these reporting improvement after the job change. A considerable need for medical consultation was reported, as was the influence on psychosocial functions among those who had eczema the previous year, e.g. sleep disturbances (36%) and hampered leisure activities (72%). Job changes related to hand eczema and psychosocial impairment were also reported by individuals who had not sought medical help for their hand eczema.
This study demonstrates a variable and poor long-term prognosis for hand eczema in the general population. One-third sought medical care during follow-up, while the vast majority with ongoing hand eczema experienced negative psychosocial consequences. For about 5%, the hand eczema gave far-reaching consequences including long sick-leave periods, sick pension and changes of occupation.
Using a postal questionnaire the prevalence of hand eczema was determined in a general population of 11,798 individuals aged 20-77 years who were randomly drawn from the population records. The response rate was 78.1%. One-year prevalence of hand eczema among women varied between 1.9% and 10.8%, with the highest figure among those aged 30-39 years. The corresponding figures for men were 2.3% and 5.6%, with the highest figure among those aged 20-29 years. Lifetime prevalence varied between 5.7% and 16.7% among women and between 5.2% and 9.5% among men. Using multiple logistic regression analysis female sex (OR=1.91, 95% CI 1.47-2.47) and smoking (OR=1.35, 95% CI 1.04-1.75) were independent risk factors for reporting 1-year prevalence of hand eczema, whereas age (OR=0.99, 95% CI 0.97-0.99) was inversely related to the 1-year prevalence of hand eczema. Aggregated risk occupation or categorized occupation such as medical and nursing work, production or service were not significantly associated with 1-year prevalence of hand eczema.
The aim of this project was to study the long-term prognosis of occupational skin diseases in Sweden. In 1999, a questionnaire was sent to 623/655 individuals who in 1987 reported occupational skin disease to the Social Insurance Office. 394 answered the questionnaire, and 123 non-responders were interviewed by telephone, giving 517 participants (83%), 323 females and 194 males. 85% reported skin symptoms after 1987, 70% during the previous year. 28% considered themselves recovered, of those with nickel allergy only 12%. In a logistic regression model, skin atopy was the strongest unfavourable factor for the prognosis followed by contact allergy and female sex. 66% had consulted a doctor after 1987 and the majority, 82%, had performed occupational changes - most common was change of jobs, 44%. Those who had changed jobs reported less sick leave. The conclusion is that occupational skin diseases have a clear tendency to end up as chronic conditions with a majority reporting symptoms at a 12-year follow-up. The skin disease had influenced the occupational situation for the majority (82%) and for 15% resulted in exclusion from the labour market through unemployment or disability pension.
The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.
Population-based studies on the incidence of hand eczema are sparse.
The aim of this prospective follow-up study was to determine the incidence rate of hand eczema in a population-based twin cohort. Secondly, the role of genetic factors and other potential risk factors for hand eczema was investigated.
A questionnaire on self-reported hand eczema was answered by 5610 and 4128 twin individuals in 1996 and 2005, respectively. Data were analysed in a Poisson regression analysis.
The crude incidence rate was 8.8 cases per 1000 person-years (95% confidence interval, [CI] 7.7-9.9). Incidence rate ratios (IRRs) dependent on the co-twin's hand eczema status revealed a significant, doubled risk for monozygotic twin individuals with a co-twin affected by hand eczema, compared with dizygotic twin individuals with a co-twin affected by hand eczema (IRR 2.4, 95% CI 1.4-4.1). Also, significantly increased IRRs were found for positive patch test, atopic dermatitis, and wet work.
Hand eczema is still a frequent disease and genetic factors are confirmed important risk factors. Positive patch test, atopic dermatitis and wet work were associated with an increased risk, whereas no association with age, sex, smoking or alcohol was found.
Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the 'management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidence-based approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity.
Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations.
To describe the self-rated severity of hand eczema in a general population and the relationship to seeking medical attention.
A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe.
Five hundred and sixty-four individuals (75%) returned the second questionnaire. The 1-year period prevalence of hand eczema was estimated to be 14% in the population. Twenty-three per cent rated their hand eczema as moderate to very severe. In total, 67% had consulted their general practitioner and 44% had consulted a dermatologist because of hand eczema. Multivariate analysis showed a positive association (P < 0.05) between severity of hand eczema and medical consultations. Of those individuals (n = 102) who had not consulted a dermatologist 26% had experienced moderate to very severe hand eczema within the previous 12 months.
A considerable proportion of individuals with moderate to very severe hand eczema in the general population miss out on the potential benefit of a dermatological examination, patch testing and a thorough-going exploration of environmental factors.
Patients with severe chronic hand eczema (CHE) refractory to topical corticosteroids currently have limited treatment options suited for chronic use, and few controlled clinical studies have investigated new therapies in this setting.
To assess the efficacy and safety of oral alitretinoin (9-cis retinoic acid) taken at 10 mg or 30 mg once daily for up to 24 weeks, compared with placebo control, in the treatment of severe CHE refractory to topical corticosteroids.
A randomized, double-blind, placebo-controlled, prospective, multicentre trial was conducted in 111 dermatology outpatient clinics in Europe and Canada. A total of 1032 patients with severe refractory CHE were randomized in a 1 : 2 : 2 ratio to placebo, or 10 mg or 30 mg of oral alitretinoin once daily for up to 24 weeks. Safety was assessed for all patients during a follow-up period of 4 weeks, and responders were observed for relapse for 24 weeks after the end of therapy. The primary efficacy parameter was Physician Global Assessment of overall CHE severity, with response defined as clear or almost clear hands.
Responses, defined as clear or almost clear hands, were achieved in up to 48% of patients treated with alitretinoin, compared with 17% for placebo (P < 0.001), with up to 75% median reduction in disease signs and symptoms. Treatment was well tolerated, with dose-dependent adverse effects comprising headache, mucocutaneous events, hyperlipidaemia, and decreased free thyroxine and thyroid-stimulating hormone. The median time to relapse, defined as recurrence of 75% of initial signs and symptoms, was 5.5-6.2 months in the absence of anti-eczema medication.
Alitretinoin given at well-tolerated doses induced clearing of CHE in a substantial proportion of patients with severe disease refractory to standard therapy.
Few population-based clinical follow-up studies on hand eczema are reported. Objectives: The aim of this study was to characterize clinical symptoms and to examine occupational and medical consequences as well as persistence of hand eczema in a population-based twin cohort.
A total of 274 individuals with and without hand eczema were examined, patch tested, and interviewed in 1997-1998 and 2005-2006. Data on 188 individuals with hand eczema in 2005-2006 were analysed.
Erythema and scaling were the most frequent symptoms, and fingers and palms were most often affected. Mean hand eczema severity index score in individuals with clinical symptoms was 12.0. Sick leave was reported by 12.4%; job change by 8.5%. Being in the lowest socio-economic group and atopic dermatitis were risk factors for sick leave [odds ratio (OR) = 5.6; 95% confidence interval (95% CI) 1.5-22.9 and OR = 2.9; 95% CI 1.0-8.1]. The majority (63.4%) had seen a doctor at least once, and atopic dermatitis was a risk factor for more than 1 visit (OR = 3.0; 95% CI 1.4-6.4). Duration of >10 years was a risk factor for persistence of symptoms, which was reported by 67.7%.
The clinical picture and consequences of hand eczema vary; however, the majority experience chronic symptoms.
Only a few epidemiological studies on hand eczema (HE) in the metalworking industry have been conducted, and no study has attempted a long-term follow-up.
In the Prospective Audi Cohort (PACO) II follow-up study, we aimed to estimate burden and prognosis of HE in a car industry setting (follow-up > 10 years).
Eligible participants were individuals who had been examined in the original PACO study (1990-1998) and had been followed through until the end of their apprenticeship (n = 1909). Participants were interviewed and underwent dermatological examination. An exposure assessment was carried out according to a pre-defined algorithm.
The follow-up rate was 78.3% (1494/1909). Mean follow-up time was 13.3 [standard deviation 1.3] years. The period prevalence of HE in the follow-up period was 21.0% [95% confidence interval (CI) 19.0-23.1%], yielding a cumulative incidence of 29.3% (95% CI 26.9-31.6%) in the entire study period. HE persisted after the end of apprenticeship in 40.0% (95% CI 33.3-46.7%) of subjects who had had HE during apprenticeship (n = 205). 18.0% (95% CI 15.9-20.1%) developed HE in the follow-up period (n = 1289).
Around 30% of subjects were affected by HE at least once during the study period. HE persisted in 40% of the participants affected during apprenticeship.
WMA) Declaration of Helsinki Adopted by the 18th WMA General Assembly, held in Helsinki Available at URL http
World Medical Association (WMA) Declaration of Helsinki. Adopted by the 18th WMA
General Assembly, held in Helsinki in June 1964. Available at URL
http://www.wma.net/en/30publications/10policies/b3/index.html (last accessed 31 October
2012)
Hand dermatitis. The perennial scourge
- Londow
Londow K. Hand dermatitis. The perennial scourge. Postgrad Med 1998; 8: 151-2.
Adopted by the 18th WMA General Assembly
World Medical Association (WMA) Declaration of Helsinki. Adopted by the 18th WMA
General Assembly, held in Helsinki in June 1964. Available at URL
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