Showing papers on "Hand eczema published in 2005"

Fifteen-year follow-up of hand eczema: persistence and consequences.

Abstract: Summary Background Hand eczema is a skin disease often with a long-lasting and relapsing course. The long-term prognosis in the general population is unknown. Objectives The aims were to examine the extent to which hand eczema had persisted and the medicosocial consequences of the disease. Methods 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. Results 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. Conclusions 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.

Occupational skin disease in Sweden--a 12-year follow-up.

Abstract: 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.

Soak and smear: a standard technique revisited.

Abstract: Background Atopic dermatitis, nummular eczema, chronic hand dermatitis, palmar plantar psoriasis, and xerotic eczema are common inflammatory skin conditions. They may be refractory to conventional topical and even systemic treatment. Little evidence is available that demonstrates the benefits of aggressive topical treatment of patients with these disorders. Objective To describe a simple, inexpensive, effective topical treatment with an accompanying patient educational sheet. Design A retrospective study of 28 patients referred to a tertiary care center for refractory chronic pruritic eruptions. Intervention with a plain water 20-minute soak followed by smearing of midstrength to high-strength corticosteroid ointment led to clearing or dramatic improvement. Results Objective and symptomatic improvement was obtained from aggressive topical treatment. It was well accepted in this group of referral patients. Conclusions Hydration for 20 minutes before bedtime followed by ointment application to wet skin and alteration of cleansing habits is an effective method for caring for several common skin conditions. Prospective studies are needed to further validate these findings.

Prevalence of hand eczema in an adult Swedish population and the relationship to risk occupation and smoking.

Abstract: 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.

Influence of childhood atopic dermatitis on future worklife

Abstract: Results The proportions of cases and controls in jobs with a high risk of hand eczema were similar, as was the exposure to water, detergents, chemicals, and hand washing. The self-reported cumulative prevalence of hand eczema was 42% for the cases and 13% for the controls (P<0.001). The 1-year prevalence was 24% for the cases and 9% for the controls (P<0.001). Among the cases, 9% reported a change of job due to eczema compared with 2% of the controls (P<0.001). The corresponding proportions of sick leave were 10% and 2% (P<0.001). Conclusions In conclusion, a history of atopic dermatitis in childhood does not seem to influence the choice of job nor hazardous occupational skin exposure. It does, however, mean an increased risk for job changes, sick leave, and medical consultations, mainly due to the increased risk of hand eczema.

Allergic contact dermatitis from methyldibromo glutaronitrile--clinical cases from 2003.

Abstract: Of the 766 patients with eczematous skin disease patch tested in 2003 at the Department of Dermatology, University Clinic Gentofte, 38 (4.9%) showed a positive reaction to methyldibromo glutaronitrile (MDBGN), and in an additional 2 patients, a doubtful positive patch test reaction was found to be of relevance. Among these, 27 had hand eczema, with a relevant exposure predominantly from wash-off products, either liquid soaps or shampoos, in 24 patients. Following identification of the allergen by patch testing and subsequent avoidance of products containing MDBGN, the hand eczema either improved or cleared in 19 patients. Chemical analysis showed 11 p.p.m. to 473 p.p.m. MDBGN in products used by the patients. Based on the present clinical study and accumulated evidence in the literature, it is concluded that MDBGN is not suitable for use in any type of cosmetic product.

Hand dermatitis: a problem commonly affecting nurses.

Abstract: Hand dermatitis is regarded as one of the most often observed dermatological disorders among nurses. The factors that increase the risk of developing hand dermatitis are as follows: frequent washing hands, using disinfectants, wet-work conditions, exposure to medical substances, detergents and wearing rubber gloves. Most cases of occupational hand dermatitis is due to chronic exposure to irritants that cause the inflammation on the nonallergic pathway. Recurring contact to irritants disturbes the natural skin barrier and causes inflammation. There are reports showing the presence of skin barrier alterations among nurses working in operating room units. The most common contact allergens in the hospital environment include rubber, latex, medicaments and antiseptic products. In our study the incidence of self-reported hand dermatitis in hospital staff was very high. About 70% of respondents declared the presence of symptoms of hand eczema within the last 12 months and about 46% of the studied group had skin lesions at the moment of self-examination. Almost 75% of employees with hand dermatitis had observed the worsening of skin problems in relation to work and 79% reported improvement of skin changes during the leisure time. We also noted that a personal or family history of atopy increases the risk of developing hand dermatitis in nurses. We would also like to emphasize the psychological consequencies that affect nurses with hand dermatitis. According to our data 48% of hospital employees with hand eczema declare psychological distress caused by their skin lesions.

Therapie von handekzemen. Was können wir von publizierten klinischen Studien lernen

Abstract: Hand eczema is a very common skin disease, which can be induced by different causes. Although many interventions ranging from topical corticosteroids and UV therapy to oral cyclosporine and retinoids are available, the treatment of hand eczema can be very difficult and frustrating. The objective of our study was to assess the external evidence of different treatment modalities for hand eczema. Electronic databases (Cochrane, MEDLINE, Embase, Pascal, Jicst-Eplus, Amed) were systematically searched for clinical trials on therapy for hand eczema. Additionally, four general medical journals (BMJ, JAMA, Lancet, NEJM) and 17 specialists dermatological journals were hand searched from 1977 to August 2004. A total of 100 studies were found and 31 identified as randomised clinical trials (RCTs) dealing with different interventions. Due to the poor quality of most of these RCTs, they are inadequate as a guide to clinical practice. There is a need for high-quality RCTs on therapy for hand eczema regarding established as well as new treatment options taking different subgroups of hand eczema into consideration.

Getting to grips with hand eczema: measuring skin disease severity objectively.

Abstract: Measurements of skin disease severity play a central role in dermatological practice, both in routine clinical care and in clinical audit and research. It is therefore surprising that for many common skin diseases such as eczema the subject of severity scoring has been relatively neglected, and what we are actually measuring has all too often been given low priority, despite being central to clinical decision making. One reason may be because experienced clinicians think they know how to diagnose and assess severity of eczema without using objective, reproducible measures. Over recent years an increasing emphasis on evidence-based practice, clinical audit and demonstrable therapeutic outcomes has highlighted the need for a more standardized approach to skin disease measurement, and an understanding of the measurement tools available and their interpretation is becoming more and more relevant to all dermatology healthcare professionals. The articles by Coenraads et al. and Held et al. in this month’s edition of the journal describe two new scoring systems for objectively measuring hand eczema severity. Coenraads and colleagues have made use of the relatively small body area involved in hand eczema to produce a simple fivepoint photographic grading system not unlike that used in acne grading. In contrast, Held’s team has developed a more complex Hand Eczema Severity Index (HECSI) based on a traditional combination of clinical sign and disease extent measurements. Currently there is no widely accepted standardized scoring system for hand eczema, and although an unvalidated tool called the Hand Eczema Area and Severity Index has been used in two small studies, researchers have generally employed a variety of approaches to grading disease severity based on different combinations of visual parameters. The situation is akin to atopic eczema scoring, where there are almost as many scales as there are randomized controlled trials (RCTs). In a recent review of 93 atopic eczema RCTs, a total of 56 different objective clinical scales was identified, with almost 60% of trials using previously unpublished and unvalidated scoring systems. This lack of standardization in eczema assessment has significant implications, one of the most important being that the comparison of study results and production of systematic reviews becomes virtually impossible when investigators are using different measurements. Secondly, there is a real risk of bias if investigators invent scoring systems to suit their particular trial, and indeed it has already been demonstrated in other branches of medicine that trials are more likely to show treatment superiority over control when using unpublished scales. Thirdly, when untested scoring systems are employed the meaningful interpretation of results becomes extremely difficult, as data on how score changes reflect patient morbidity and on how much scores vary between observers are lacking. Unfortunately the validated scoring systems that have been developed for atopic eczema cannot easily be applied to hand eczema; first, because hand eczema is not always atopic but includes subtypes such as irritant, allergic and endogenous eczema, and secondly because these scoring systems incorporate an assessment of total body surface area involvement which cannot easily be separated out from the total score. The hand eczema photographic guide and the HECSI represent an important step towards improving standardization, although as with any new scale some fundamental principles need to be assessed before we can assume that the new scoring systems can indeed improve our clinical practice, as discussed below.

Atopic hand eczema and treatment strategies.

Abstract: Chronic hand eczema is frequent among atopic dermatitis (AD) patients. Due to the multifactorial causes of hand eczema, careful clinical and allergological examination is important for classification of the individual case, and hence for advice, treatment and preventive measures to be recommended. The importance of patient information and preventive strategies cannot be overemphasized.

Does long-lasting hand dermatosis have an influence on everyday living among teenagers?

Abstract: The purpose of this longitudinal study was to examine a cohort of secondary school pupils, aged 16-19 years (47 females and 18 males) with a 1-year prevalence of hand dermatosis. The study deals with the pupils' history of atopy, self-reported symptoms, exacerbating factors, protection habits, choice of education programme, self-rated health and impact on everyday life. The results showed that 61.5% of the pupils had a history of atopic dermatitis; 78% did not use protective gloves. Females reported use of corticosteroids more often than males. In all, 60% had not been given information at school about future occupational risks, when choosing education. The cohort changed education programme significantly more often than pupils reporting not having hand dermatosis. However, the cohort estimated their health as being as good as that of adolescents in the general population. The neglect of risks in choosing a future profession may cause not only suffering for the individual, but also costs for society.

Atopic Profiles, Familial Histories, and Coexisting Conditions Associated With Hand Eczema

Abstract: Background. Many of the eczema cases seen by dermatologists involve the hands. The discomfort and embarrassment of hand dermatitis in any of its forms may compromise a patient's quality of life, causing frustrated attempts to identify the cause of the disease and engendering disappointment with treatment failures. Methods. The authors assessed the severity scores for each patient, personal and familial histories of atopy, coexisting conditions, triggers of irritation, types of treatments, and their success rates. The authors administered a comprehensive survey to 50 consecutive patients presenting with eczematous dermatitis on the ventral aspect of the hands. The authors used a novel hand eczema severity index and a questionnaire that assessed personal and familial histories of atopy as well as coexisting conditions, triggers, and sources of irritation; types of treatments employed; and success rates. Patients were also encouraged to complete a composite quality of life assessment. Results. Results reveal a high frequency of personal and familial atopy, a 58% prevalence of contact allergy, a 67.4% history of hay fever, 25.6% cases of asthma, and a 44% incidence of fungal infection, which was one of the most common coexisting conditions. Conclusions. Both topical immunomodulators and topical corticosteroid therapy treatments demonstrated an impressive efficacy. An overlap should be considered when clinical symptoms and histological results vacillate between psoriasis and eczema.

Hand eczema: clinical efficacy of interventions, and burden of disease

Abstract: Hand eczema is considered a common disease. The exact prevalences however, are unknown. Studies estimate a point prevalence of 1 to 5% among adults in the general population, and a one-year prevalence of up to 10%, depending on whether the disease definition includes more pronounced or mild cases. Hand eczema tends to run a long lasting and chronic relapsing course, probably because of the multifactorial origin: atopy, irritant and allergic contact factors all may play a role, alone or in combination. In addition to the obvious itch, the social stigmata associated with a visible skin disease can be a great burden. The skin changes in hand eczema can prevent manual work, leading to significant disability and huge economic loss to both individuals and society. The above-mentioned characteristics of hand eczema make it an important disease to study from an individual and a societal perspective. The aim of this thesis, stimulated by our randomised controlled trial (RCT), is to clinically reflect on the evidence-base for the treatments of hand eczema. The work focuses on the comparative efficacy of interventions for hand eczema and on the burden of disease associated with it.