Showing papers on "Hand eczema published in 2016"

A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion

Abstract: Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.

Systematic review of cost-of-illness studies in hand eczema.

Abstract: The individual burden of disease in hand eczema patients is considerable. However, little is known about the socio-economic impact of this disease. The aims of this review were to evaluate the literature on cost-of-illness in hand eczema, and to compose a checklist for future use. The literature was retrieved from the MEDLINE and EMBASE databases up to October 2015. Quality evaluation was based on seven relevant items in cost-of-illness studies. Cost data (direct and indirect) were extracted and converted into euros (2014 price level) by use of the Dutch Consumer Price Index. Six articles were included. The mean annual total cost per patient ranged from €1311 [corrected] to €9792 (direct cost per patient, €521 to €3722; [corrected] and indirect cost per patient, €100 to €6846). Occupational hand eczema patients showed indirect costs up to 70% of total costs, mainly because of absenteeism. A large diversity in hand eczema severity was found between studies. The socio-economic burden of hand eczema is considerable, especially for more severe and/or occupational hand eczema. Absenteeism from paid work leads to a high total cost-of-illness, although disregard of presenteeism often leads to underestimation of indirect costs. Differences in included cost components, the occupational status of patients and hand eczema severity make international comparison difficult. A checklist was added to standardize the approach to cost-of-illness studies in hand eczema.

Prevalence of delayed-type and immediate-type hypersensitivity in healthcare workers with hand eczema

Abstract: Summary Background Occupational contact dermatitis is common in healthcare workers. Although irritant contact dermatitis resulting from wet work is the most frequently reported cause, healthcare workers also constitute high-risk group for the development of allergic contact dermatitis and contact urticaria. Objectives To evaluate the prevalence of delayed-type and immediate-type hypersensitivity in 120 healthcare workers with hand eczema. Methods One hundred and twenty healthcare workers from three major hospitals in Denmark with self-reported hand eczema within the last year participated in the study. Patch tests included baseline series plus selected allergens, and prick tests included standard inhalational allergens plus natural rubber latex and chlorhexidine. Levels of IgE specific for latex, chlorhexidine and ethylene oxide were measured. Results Of the participants, 53% had positive patch test reactions. The most frequent positive patch test reactions were to nickel, thiomersal, fragrances, rubber chemicals, and colophonium. The prevalence of natural rubber latex allergy as diagnosed by prick testing was 2.5%, and chlorhexidine allergy (both contact allergy and IgE-mediated allergy) was found in <1%. Ethylene oxide allergy was not identified in any of the participants. Conclusions Our results confirm previous reports on contact allergy patterns in healthcare workers. Testing for natural rubber latex allergy is still important, but increased risks of chlorhexidine and ethylene oxide allergy could not be confirmed.

Predictive factors of self-reported hand eczema in adult Danes: a population-based cohort study with 5-year follow-up.

Abstract: BACKGROUND Information about predictive factors of hand eczema is crucial for primary prevention. OBJECTIVES To investigate predictive factors of hand eczema in adult Danes from the general population. METHODS Participants from a cross-sectional 5-year follow-up study in the general population, aged 18-72 years (n = 2270), completed questionnaires about skin health and were grouped into four hand eczema groups: 'never', 'incident', 'nonpersistent' and 'persistent'. Multiple logistic regression models adjusted for age group and sex were used to evaluate associations with baseline variables. The participation rate for the follow-up study was 66·5% (29·7% of the participants originally invited to the baseline study). RESULTS A history of atopic dermatitis (AD) was associated with both persistent and incident hand eczema [odds ratio (OR) 9·0, 95% confidence interval (95% CI) 5·6-14·4 and OR 3·0, 95% CI 1·7-5·2, respectively]. Thus, even in adulthood, a history of AD should be considered as a predictor of incident hand eczema. While filaggrin gene (FLG) null mutations were not associated with incident hand eczema, a statistically significant association was observed with persistent hand eczema (OR 3·1, 95% CI 1·8-5·2). Finally, contact sensitization (23 allergens without nickel) was also associated with persistent hand eczema (OR 2·5, 95% CI 1·2-5·0), independently of a history of AD. CONCLUSIONS This study confirms a history of AD as the strongest predictor of persistent hand eczema. We additionally found that a history of AD was associated with incident hand eczema in adults, in contrast to FLG mutations, which were associated only with persistent hand eczema in individuals with a history of AD, and not with incident hand eczema. Our study adds new knowledge to the interplay between AD, FLG mutations and hand eczema in the adult general population.

Staphylococcus aureus colonization related to severity of hand eczema.

Abstract: Knowledge on Staphylococcus aureus colonization rates and epidemiology in hand eczema is limited. The aim of this study was to clarify some of these issues. Samples were collected by the "glove juice" method from the hands of 59 patients with chronic hand eczema and 24 healthy individuals. Swab samples were taken from anterior nares and throat from 43 of the 59 patients and all healthy individuals. S. aureus were spa typed and analysed by DNA-microarray-based genotyping. The extent of the eczema was evaluated by the hand eczema extent score (HEES). The colonization rate was higher on the hands of hand eczema patients (69 %) compared to healthy individuals (21 %, p < 0.001). This was also seen for bacterial density (p = 0.002). Patients with severe hand eczema (HEES ≥ 13) had a significantly higher S. aureus density on their hands compared to those with milder eczema (HEES = 1 to 12, p = 0.004). There was no difference between patients and healthy individuals regarding colonization rates in anterior nares or throat. spa typing and DNA-microarray-based genotyping indicated certain types more prone to colonize eczematous skin. Simultaneous colonization, in one individual, with S. aureus of different types, was identified in 60-85 % of the study subjects. The colonization rate and density indicate a need for effective treatment of eczema and may have an impact on infection control in healthcare.

Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study.

Abstract: BACKGROUND Hand eczema (HE) is a common skin disease with major medical psychological and socio-economic implications. Onset and prognosis of HE are determined by individual as well as environmental factors. So far, most epidemiological data on HE have been reported from Scandinavian and recently German studies. OBJECTIVE To investigate the characteristics and medical care of patients with chronic HE (CHE) in Switzerland, and identify risk factors. METHODS In this cross-sectional study, data from patients with chronic HE were obtained by means of medical history, dermatological examination and patient questionnaires. Multiple logistic regression analysis was applied to identify risk factors for high severity and dermatology life quality index (DLQI). RESULTS In seven dermatology departments, 199 patients (mean age 40.4 years, 50.8% female) with CHE (mean duration 6.6 years) were enrolled. Moderate to severe HE was reported by 70.9% of patients, and was associated with age 50 years, localization of lesions and pruritus. Because of the CHE, 37.3% of patients were on sick leave over the past 12 months, 14.8% had changed or lost their job. Practically all patients applied topical therapy, 21% were treated with alitretinoin, and 21% with psoralen plus UVA light (PUVA). The effects on the health-related quality of life was moderate to large in 33.7% and 39.4% of CHE patients, respectively. Factors associated with a high impact on DLQI (mean 9.7 ± 5.8) were female sex, lesions on back of the hands and pruritus as well as mechanical skin irritation and wearing gloves. CONCLUSION In agreement with recent studies, the Swiss data demonstrate the high impact of CHE on medical well-being, patient quality of life and work ability. As it is associated with an intense use of health care services, high rate of sick leave, job loss and change, CHE may cause a high socio-economic burden.

Oral alitretinoin treatment in patients with palmoplantar pustulosis inadequately responding to standard topical treatment: a randomized phase II study

Abstract: Background Palmoplantar pustulosis (PPP) is an inflammatory, debilitating skin disease. Topical drugs and systemic immunosuppressive agents are often ineffective. Previous uncontrolled studies have suggested that alitretinoin could be a meaningful treatment option for PPP. Objectives The primary objective was to determine response to alitretinoin for the treatment of PPP based on the Palmoplantar Pustulosis Area and Severity Index (PPPASI) after 24 weeks of treatment. Methods A phase II, randomized, double-blind, placebo-controlled, multicentre study. Adult patients with PPP (with or without psoriasis) refractory to topical therapy and standard skin care were randomized 2:1 to alitretinoin 30 mg once daily or placebo for up to 24 weeks. The primary end point was PPPASI at week 24 (or the last visit in case of early withdrawal). Secondary end points included: percentage change from baseline in the modified Psoriasis Area and Severity Index (mPASI); percentage of patients with ≥ 50% or 75% improvement in PPPASI or mPASI scores from baseline; change in pustule count on the palms and soles; change in the Nail Psoriasis Severity Index and safety and tolerability assessments. Results Thirty-three patients were randomized: 24 patients to alitretinoin 30 mg and nine to placebo. Overall, there were no significant differences between alitretinoin 30 mg and placebo for any end point. The safety profile was consistent with that seen in patients with chronic severe hand eczema refractory to potent topical corticosteroids. Conclusions Although the results were unexpected based on previous studies of alitretinoin in the treatment of PPP, this study provided no evidence to support further exploration of alitretinoin in the treatment of severe PPP.

Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study

Abstract: Acitretin has been used off-label for years to treat chronic hand eczema, but acitretin is less often prescribed as alitretinoine was approved. This study evaluates both retinoids in a daily practice cohort of patients with severe chronic hand eczema in terms of drug survival and reasons for discontinuation. Patients using alitretinoin or acitretin between 01-01-1994 and 01-08-2015 were included in this retrospective daily practice study and analyzed by Kaplan-Meier drug survival curves. Potential determinants were analyzed by Cox regression analyses. Ninety-five patients were treated with alitretinoin and 109 patients with acitretin. The main reasons for discontinuation were adverse events and cleared hand eczema, 29.5 and 27.4% in alitretinoin versus 43.1 and 23.9% in acitretin. Patients with hyperkeratotic hand eczema had most often a good effect of treatment: 68.3% in alitretinoin and 50.7% in acitretin treatment. The drug survival rates of alitretinoin and acitretin after 12, 24, 36, and 52 weeks were 69.3, 45.1, 19.6, 7.0% and 74.3, 45.5, 33.8, 23.2%, respectively. Alitretinoin and acitretin are effective treatment options for patients with hand eczema. However, both treatments were more effective in patients with hyperkeratotic hand eczema. Fewer patients discontinued alitretinoin compared with acitretin due to adverse events.

The Role of the Skin Barrier in Occupational Skin Diseases

Abstract: Occupational skin diseases (OSDs) are the second most common occupational diseases worldwide. Occupational contact dermatitis (OCD) is the most frequent OSD, and comprises irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), contact urticaria and protein contact dermatitis. There are many endogenous and exogenous factors which affect the development of OCD, including age, sex, ethnicity, atopic skin diathesis, certain occupations and environmental factors. One of the most important contributing causes is skin barrier dysfunction. The skin provides a first-line defense from environmental assaults and incorporates physical, chemical and biological protection. Skin barrier disturbance plays a crucial role in various skin diseases such as atopic dermatitis (AD), ichthyosis, ICD and ACD. Genetic factors, such as filaggrin gene (FLG) mutations, and external factors, such as skin irritants interfering with stratum corneum structure and composition, may lead to abnormalities in skin barrier function and increased vulnerability to skin diseases. FLG encodes the cornified envelope protein, filaggrin, which is involved in skin barrier function. FLG mutation is associated with the development of OCD. High-risk occupations for OCD include health care workers, hairdressers and construction workers. There are often multiple contributing causes to OCD, as workers are exposed to both irritants and allergens. AD is also associated with skin barrier disruption and plays an important role in OCD. ICD often precedes and facilitates the development of ACD, with impairment of the skin barrier contributing to the concurrence of ICD and ACD in many workers with OCD.

Self‐reported hand eczema among dental workers in Japan – a cross‐sectional study

Abstract: SummaryBackground 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.

Clinical patterns and associated factors in patients with hand eczema of primarily occupational origin.

Abstract: Background Hand eczema (HE) is the most common skin disease acquired at work. It presents in different clinical patterns. Objective To classify different types of HE according to their clinical pattern and associated factors in patients taking part in a tertiary individual prevention programme (TIP) for occupational skin diseases. Methods In a retrospective cohort study, the medical records of 843 patients taking part in the TIP were evaluated. HE was classified into three clinical subtypes: vesicular HE, hyperkeratotic HE and HE with erythema and desquamation. Results About 723 patients (85.8%) suffered from HE. Female TIP patients with HE were significantly younger (OR 0.97, 95% CI 0.96–0.99) and had a higher prevalence of flexural eczema (OR 1.60, 95% CI 1.15–2.23) and an atopic HE component (OR 1.84, 95% CI 1.36–2.48) than men. Vesicular HE was more common in women (OR 1.44, 95% CI 1.07–1.94) and significantly associated with hyperhidrosis (OR 1.69, 95% CI 1.23–2.33), flexural eczema (OR 1.37, 95% CI 0.99–1.89) and an atopic HE component (OR 1.93, 95% CI 1.44–2.61). Hyperkeratotic HE was more frequent in men (OR 3.70, 95% CI 2.27–6.25) and associated with older age (OR 1.04, 95% CI 1.02–1.06). The cohort of patients with HE characterized by erythema and desquamation was very heterogeneous. Vesicular HE was significantly associated with tobacco smoking (OR 1.94, 95% CI 1.40–2.68), while hyperkeratotic HE was significantly less common in smokers (OR 0.38, 95% CI 0.22–0.65). Conclusion Environmental and individual factors are associated with different clinical patterns of HE in patients taking part in the TIP. They may influence the prognosis and should be considered in the individual management of disease. Tobacco smoking may be in particular a risk factor for vesicular HE.

Hand eczema among hairdressing apprentices in Denmark following a nationwide prospective intervention programme: 6-year follow-up.

Abstract: Summary Background Hand eczema is the commonest occupational skin disease in Denmark, and hairdressing is a high-risk profession. In 2008–2010, a clinically controlled, prospective intervention study aimed at reducing the development of hand eczema was conducted at hairdressing schools in Denmark. The findings showed that significantly fewer apprentices in the intervention group developed hand eczema over a period of 18 months. Objectives To investigate the long-term effect of the intervention. Methods Two hundred and eighty-four participants were identified from the original dataset, and were sent a questionnaire. Results No difference was seen between the intervention and control groups. This may partly be attributable to the two groups no longer being well matched, and improved work habits in the control group. Overall, there was an improvement in work habits. Participants had a 1-year prevalence of hand eczema of 22.4%. Reaction to hair dye was reported for 24.5%, and 35.5% had left the trade; 36.4% used gloves when shampooing, and 21.3% stated that they cut hair before colouring it. Conclusions The effect of the intervention was not visible after 6 years, but an overall improvement in work habits was seen.

Drug survival of cyclosporine in the treatment of hand eczema: a multicentre, daily use study

Abstract: Background Hand eczema is a common condition; it is often chronic and can be difficult to treat. Cyclosporine is used off-label to treat severe hand eczema; however, the evidence for this treatment is scarce. Objective To examine the drug survival of cyclosporine in a daily practice cohort of patients with chronic hand eczema. Methods This retrospective daily use study included hand eczema patients who were treated with cyclosporine between 01-06-1999 and 01-06-2014 in two Dutch university hospitals. Patient and treatment characteristics were retrospectively collected from medical charts. First treatment episodes were analysed by means of Kaplan-Meier drug survival curves. Possible determinants of drug survival were analysed by Cox regression models. Treatment effectiveness was analysed with a retrospective physician's global assessment. Results A total of 102 patients were treated with cyclosporine. The median drug survival rate was 0.86 years (10.3 months). The overall drug survival rate after 6 months, 1, 2 and 3 years were 61.7%, 45.2%, 18.6% and 13.9% respectively. Main reasons for discontinuation were adverse events, especially early in treatment, and ineffectiveness. After 3 months, a good response to treatment was recorded in 62.9% of the patients. Conclusion Cyclosporine had a median drug survival of 10.3 months. Especially patients with recurrent vesicular hand eczema showed a good treatment response.

Drug survival of methotrexate treatment in hand eczema patients: results from a retrospective daily practice study.

Abstract: for the negative result of CEA in the Bowenoid lesions (Fig. 2b). Therefore, to confirm the cell lineage of Bowenoid cells, Ber-EP4 and CK5/6 staining were added. EMPD has been reported to stain positive with Ber-EP4, whereas Bowen’s disease stains negative. CK5/6 are positive in Bowen’s disease, but negative in EMPD. The Bowenoid cells in our case demonstrated the characteristic immunohistochemical features of Paget cells (Fig. 2c, d). These results indicate that the Bowenoid cells in our case were not derived from keratinocytes. In summary, our detailed pathological examination, in addition to the literature review, has clarified the immunohistochemical profiles of EMPD with Bowenoid features. We propose that Ber-EP4 and CK5/6 staining can improve the diagnostic accuracy when the clinician suspects atypical cases of Bowenoid EMPD.

Career Advice for Young Allergy Patients.

Abstract: Background: One-third of all young persons entering the work force have a history of atopic disease. Occupationally induced allergy and asthma generally arise in the first few months on the job, while pre-existing symptoms tend to worsen. Young persons with a history of an atopic disease should receive evidence-based advice before choosing a career. Methods: We systematically searched PubMed for cohort studies investigating the new onset of asthma, rhinitis, or hand eczema among job trainees from before the start of training and onward into the first few years on the job. The search revealed 514 articles;we read their abstracts and selected 85 full-text articles for further analysis. 24 of these met the inclusion criteria. Results: According to present evidence, atopy and a history of allergic disease (allergic rhinitis, atopic dermatitis) are the main risk factors for occupationally induced disease. The predictive value of a personal history of allergic diseases for the later development of an occupationally induced disease varies from 9% to 64% in the studies we analyzed. It follows that only young people with severe asthma or severe atopic eczema should be advised against choosing a job that is associated with a high risk of allergy, e.g., hairdressing or working with laboratory animals. Young people with a history of other atopic diseases should be counseled about their individual risk profile. Conclusion: In view of the relatively poor predictive value of pre-existing atopic disease, secondary prevention is particularly important. This includes frequent medical follow-up of the course of symptoms over the first few years on the job. If sensitization or allergic symptoms arise, it should be carefully considered whether exposure reduction will enable the apprentice to stay on the job.

Workplace screening for hand dermatitis: a pilot study.

Abstract: Background Health care workers (HCWs) are at increased risk for developing occupational skin disease (OSD) such as dermatitis primarily due to exposure to wet work. Identification of risk factors and workplace screening can help early detection of OSD to avoid the condition becoming chronic. Aims To determine risk factors and clinical findings for hand dermatitis using a workplace screening tool. Methods Employees at a large teaching hospital in Toronto, Canada, were invited to complete a two-part hand dermatitis screening tool. Part 1 inquired about hand hygiene practices and Part 2 comprised a visual assessment of participants' hands by a health professional and classification as (i) normal, (ii) mild dermatitis or (iii) moderate/severe dermatitis. Risk factors were determined using chi-square and Cochran-Armitage analysis on a dichotomous variable, where Yes represented either a mild or moderate/severe disease classification. Results There were 183 participants out of 643 eligible employees; response rate 28%. Mild or moderate/severe dermatitis was present in 72% of participants. These employees were more likely to work directly with patients, have worked longer in a health care setting, wash hands and change gloves more frequently, wear gloves for more hours per day, have a history of eczema or dermatitis and report a current rash on the hands or rash in the past 12 months. Conclusions There was a high percentage of HCWs with dermatitis and risk factors for dermatitis. These findings argue for increased attention to prevention and early identification of hand dermatitis and support further testing of the workplace screening tool.

Colonisation with methicillin-resistant Staphylococcus aureus and associated factors among nurses with occupational skin diseases.

Abstract: Objectives To evaluate the prevalence of colonisation with methicillin-resistant Staphylococcus aureus (MRSA), associated factors and the effectiveness of decolonisation procedures among nurses with occupational skin diseases (OSD). Methods In a retrospective cohort study, the medical records of 319 nurses from Germany who were screened consecutively for MRSA when participating in a tertiary individual prevention programme (TIP) for severe OSD between July 2009 and December 2014 were evaluated. Results 90.3% of nurses with severe OSD suffered from hand eczema. 43 were colonised with MRSA on admission (13.5%), mainly in the nose (n=35, 81.4%). However, the hands were affected in more than half of the MRSA carriers (n=24, 55.8%). Risk factors for MRSA colonisation were atopic skin diathesis (OR 2.01, 95% CI 1.03 to 3.92, p=0.049) and presence of atopic dermatitis on other body parts than the hands (OR 4.33, 95% CI 2.23 to 8.43, p Conclusions Nurses with OSD have a twofold to threefold higher prevalence of MRSA colonisation than what has been reported for point-prevalence screenings among healthcare workers in Germany. Atopic skin diathesis, atopic dermatitis and severe hand eczema are the main risk factors. Thus, prevention and treatment of OSD could be important elements in reduction of colonisation with MRSA among nurses and transmission to others.

Patch Test as a Diagnostic Tool in Hand Eczema.

Abstract: Introduction Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country. Aim To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing. Materials and methods This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher's-exact test. Results Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate. Conclusion Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.

Contact Allergens Causing Hand Eczema in Ethnic Kashmiri Population: A Study of 7-years.

Abstract: Background: Hand eczema is one of the commonest eczemas encountered in dermatology practice. Contact allergens responsible for causing hand eczema vary from one geographical area of the world to another. Aim: The study tries to identify the commonest allergens causing hand eczema in ethnic Kashmiri population. Material and Methods: A total of 800 patients were patch tested at a sole patch testing facility for the local population over a 7-year period out of which 278 were diagnosed with hand eczema. The morphological type of hand eczema was noted and the patch testing results were analyzed. Past or present relevance of the patch-test result to the clinical diagnosis was also analyzed. Results: Hand eczema was the most common type of eczema patch tested over the 7-year period, constituting 34.75% of the patch-tested population. A positive patch-test result was obtained in 135 patients (48.5%) out of which it was found to be clinically relevant in about 65% cases. Nickel and potassium dichromate were found to be the two commonest allergens causing hand eczema in our population with positive patch test reactions in 45 and 27 patients respectively. Females showed a much higher incidence of hand eczema as well as higher patch test positivity than males (54.1% vs. 38.1%). Conclusions: Hand eczema with a positive patch-test report was found to be much more common in females than males and nickel and potassium dichromate were seen to be the commonest allergens causing hand eczema in ethnic Kashmiri population.

Clinical Features and Awareness of Hand Eczema in Korea

Abstract: 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. (Ann Dermatol 28(3) 335∼343, 2016)

Systemic antihistamines--a common outside the guidelines therapeutic strategy in hand eczema management.

Abstract: Background Hand eczema (HE) is the most common skin disease affecting hands. Although the current treatment guidelines do not recommend use of systemic antihistamines as routine therapy, they seem to be widely used by physicians handling with this problem. Objective The aim of the study was to investigate the attitude to prescribe systemic antihistamines in HE. Material and methods A 10-item questionnaire was distributed among physicians participating in regional dermatological conferences. 127 valid questionnaires were analysed. Results A total of 127 physicians participated in the survey. 124 (97.6%) responders prescribe antihistamines in HE and 16 (12.6%) subjects declared routine use of oral antihistamines in the HE management. Significantly more dermatologists than other specialists used antihistamines in the treatment of HE accompanying atopic dermatitis (77.8% vs. 54.5%, P < 0.01) and dermatologists significantly more commonly used antihistamines in HE due to their anti-inflammatory properties (40.3% vs. 20.0%, P = 0.02). Regarding the type of eczema, antihistamines were prescribed most frequently in acute allergic HE (n = 92, 72.4%) and in HE accompanying atopic dermatitis (n = 86, 67.7%). Conclusions Despite the lack of the large, randomized, controlled studies on the effectiveness of the systemic antihistamines in the treatment of HE, this type of therapy seems to be prevalently used among the physicians.

Impact of hand eczema severity on quality of life: a hospital based cross-sectional study

Abstract: Introduction: Hands are important organs of expression, communication, and are necessary for household and workrelated activity. Thus, hand eczema can deteriorate quality of life. This study aims to find impact of hand eczema severity on quality of life. Methods: A cross-sectional study was done in a tertiary care hospital in Punjab from January to July, 2014. A total of 69 hand eczema patients of either gender aged ≥16 years were enrolled after taking an informed consent. Disease severity was assessed by hand eczema severity index (HECSI) score; and quality of life by dermatology life quality index (DLQI) questionnaire. The data was evaluated using statistical tests like frequency, chi-square, oneway ANOVA, t-test etc. Results: Out of 69 patients, 63.8% were males and 36.2% females. The commonest age group affected was 21-40 years (55.1% cases). Aggravating factors were reported by 76.8% patients, the commonest trigger being summer season (47.8%) followed by soaps and detergents (21.7%). The mean±S.D. for DLQI was 6.22±5.42 and for HECSI was 18.54±17.05. There was no statistically significant impact of age, occupation and duration of disease on DLQI or disease severity except gender (p-value being 0.028 for DLQI; 0.035 for HECSI). There was no significant correlation between HECSI score and DLQI. Conclusion: Majority of the patients with hand eczema had a significant impairment of their quality of life. There was a statistically significant impact of gender on hand eczema severity; although no correlation was found between DLQI and HECSI score in this study.

Method for producing medicine of skin diseases

Abstract: The present invention relates to a method of preparing a naturopathic medication for skin and scalp diseases (psoriasis, atopic dermatitis, seborrheic dermatitis, eczema, vitiligo, hives, acute vesiculobullous hand eczema, acne, hair loss, damaged hair, scalp inflammation, and dandruff). In particular, as a first solution containing composite extracts extracted from fifteen types of plants, and a second solution containing Cordyceps militaris extracts are separately prepared, the naturopathic medication can be used to treat refractory skin and scalp diseases for the main ingredients of the first solution and the second solution. In the preparation process of the Cordyceps militaris extracts, the extracts are prepared to be completely free of hyphae, polymeric materials and the like through two concentrate liquid-forming processes and filtering processes. The pure Cordyceps militaris extracts thus produced further enhance the efficacy of the second solution and are further effective in treating skin diseases (psoriasis, atopic dermatitis, seborrheic dermatitis, eczema, vitiligo, hives, acute vesiculobullous hand eczema, acne, hair loss, damaged hair, scalp inflammation, and dandruff).

Occupational skin diseases from 1997 to 2004 at the Department of Dermatology, University Hospital of Northern Norway (UNN): an investigation into the course and treatment of occupational skin disease 10-15 years after first consultations with a dermatologist.

Abstract: Objectives . We investigate the impact of occupational skin disease consultations among outpatients at the Dermatological Department, University Hospital, Northern Norway. Study design . From 1997 until 2004, 386 patients with occupational skin disease were examined and given advice on skin care, skin disease treatment, skin protection in further work, and on the legal rights of patients with this disease. Ten to fifteen years later, we wanted to look at these patients in terms of their work situation, the current status of their disease, the help they received from the labour offices, and their subjective quality of life. Material and methods . In the autumn of 2011 until the spring of 2012, a number of the patients examined in the period from 1997 to 2004 were selected and sent a questionnaire, which they were asked to answer and return, regarding their work situation and the progress and current status of their occupational disease. Results . A total of 153 (77%) patients answered the questionnaire; 71% of these patients were still in work, and further 15% had old-age retired, 13% were working until then; 16% had retired early because of disability; 54% had changed jobs because of their occupational skin disease; 86% of the patients indicated that the skin disease had improved since our previous investigation. Conclusions . Our investigation into patients with occupational skin disease documented that the majority of patients who had received professional dermatological consultation and intervention offers were still in the labour market and had good control of their skin disease 10–15 years later. We discovered that 71% of the patients were still employed. 13% had remained in work until they became old age pensioners. Only 16% dropped out of work because of disability. These high percentages may indicate that our intervention has contributed positively to patients’ work conditions and the course of their skin disease. Keywords: dermatitis; occupational; dermatitis; contact; hand eczema; quality of life; sick leave/working disability; education; professional; retraining (Published: 10 May 2016) Citation: Int J Circumpolar Health 2016, 75: 30100 - http://dx.doi.org/10.3402/ijch.v75.30100

Clinico-epidemiological study on metal-induced contact dermatitis from North India

Abstract: Objective To determine the prevalence of metal sensitization and different clinical patterns in suspected patients of metal induced contact dermatitis. Methods This was an epidemiological study during which a total of 100 patients suspected and provisionally diagnosed as having contact dermatitis to metals were subjected to a patch test with Indian Standard Battery developed by CODFI (Contact and Occupational Dermatoses Forum of India). Results were read after 48hrs of application and a second reading, if required, was taken after 72-96hrs. Results Most of the patients in this series presented with hand eczema (40%), which was followed by dermatitis localized to site of contact with metal (20%) and facial dermatitis including eyelid dermatitis (15%). Twenty-seven patients showed positive reactions to metal allergens. Cross-sensitivity was low and three patients or 11.11% showed sensitization to two metal allergens. No patient showed sensitization to all the three metals. Conclusion Nickel was the commonest metal allergen identified and it was relevant in 100% of the cases. It showed a strong female preponderance. Patch testing is hence a helpful diagnostic aid in identifying the agents responsible for contact dermatitis and a sincere effort should be made to determine clinical relevance of the test results in every case.

A study of patch testing in subjects with hand eczema of different occupational groups

Abstract: Background: Hand dermatitis is a common dermatological disorder in different occupational groups. Patch Testing serves as an important tool for identifying allergens responsible for contact dermatitis. Methods: A study of patch testing was conducted in patients of hand eczema of different occupational groups with aim to identify allergens for particular occupational groups. Study was conducted as an observational study of patch testing in patients of hand eczema who attended skin OPD in our hospital in one year duration. After detailed history and complete examination, patch testing was done by Indian Standard Series in 45 Patients of hand dermatitis. There were eight farmers, eight masons, five housewives, four diamond workers, eight miscellaneous labourers and 12 patients of varied non-specific occupations. Grading was done using ICDRG criteria at 48 and 72 hrs. Results: Among 45 patients, 35 were male and 10 female. Positive patch test was seen in 62.2% of patients with parthenium being the most common allergen (27%), followed by potassium dichromate (18.2%). There were extreme positive results in five, strong positive in ten and weak positive in rest positive results. 87.5 % occupation-allergen co-relation was seen in farmers followed by 50 % among masons. Only two patients showed variation in reading between 48 hr and 72 hr. Conclusions: Our study showed good correlation between occupation and positive patch test especially among farmers and masons. Many other non-specific allergens were also found positive and exposure to those can be prevented to avoid hand eczema in different occupational groups.

Frequency of allergic contact dermatitis in hand eczema patients with European standard and corticosteroid series

Abstract: Objective To determine the frequency of allergic contact dermatitis in patients with hand eczema by patch testing with European standard and corticosteroid series. Patients and methods One hundred and five patients of either sex having hand eczema, aged 12 years or above were enrolled in the study from dermatology outdoor department. After taking informed consent, patch test was performed a fortnight after complete resolution of signs and symptoms of eczema and after complete withdrawal of the drugs. Patch testing was done with European standard and corticosteroid series. Readings were taken 48, 72 and 120 hours after patches removal. Patch test reactions were graded according to international contact dermatitis research group criteria. Data was analyzed according to age, sex and percentages of positive patch test results. Results Allergic reaction was recorded in 48.6% of patients with European standard series and 11.4% of patients with corticosteroid series. Common allergens detected with European standard series were potassium dichromate (21%), cobalt chloride (12%) and nickel sulphate (12%). Common allergens detected with corticosteroid series were tixocortol-21-pivalate (8.6%) and hydrocortisone-17-butyrate (4.76%). Conclusion Almost half (48.6%) of the patients showed allergic reaction with European standard series and 11.4% of the cases gave positive results with corticosteroid series. Patch test needs to be performed with corticosteroid and European standard series in patients with hand eczema not responding to therapy.

Common Contact Sensitizers among Patients with Hand Eczema: A Multicenter-Study in Nepal

Abstract: Introduction: Allergic contact dermatitis in Nepal is not an uncommon disorder. Patch testing is a well established method of diagnosing allergic contact dermatitis. Patients with contact dermatitis are well known to have impaired quality of life which often leads to frequent dermatological consultations. Objective: Lack of data from Nepal has prompted us to undertake this study with the aims to know the frequency of allergic contact dermatitis and the commonest contact allergens among the patients with Hand eczema attending the out-patient department of dermatology, B.P. Koirala Institute of Health Sciences and Kathmandu Medical College Teaching Hospital. Material and Methods: A total of 256 patients were included in the study. Out of them 195 with hand eczema agreed to participate and undergo patch testing. The antigens used included the Indian standard series of patch test allergens approved by Contact and Occupational Dermatoses Forum of India. Results: Hundred and ten cases (56.4%) were patch test positive (PTP) at 48 as well as 96 hours to at least one allergen. PTP was seen more commonly in females. The most common allergen in females was nickel sulphate followed by cobalt chloride, gentamicin and mercapto mix while males were positive to potassium dichromate, followed by epoxy resin, fragrance mix and nickel sulphate. Conclusion: Patch testing has proved a useful tool for the detection of allergic contact dermatitis and for identification of contact allergens. When positive reactions correlate with environmental exposure the test usually assists the physician in establishing the cause of dermatitis, hence treating the patients and improving their quality of life. Nepal Journal of Dermatology, Venereology & Leprology, Vol.14(1) 2016, pp.14-17

Hand Dermatitis: Utilizing Subtype Classification to Direct Intervention

Abstract: Hand dermatitis is a common inflammatory skin condition with typical clinical signs including redness, hyperkeratosis, scaling, edema, vesicles, and fissuring. It often becomes chronic and disabling, leading to significant morbidity, disability, and economic loss. The pathogenesis of hand dermatitis is multifactorial, and the treatment is challenging. The most common exogenous cause of hand dermatitis is contact with irritants such as soap and water, leading to an irritant contact dermatitis. Atopic dermatitis is a significantly associated endogenous cause of hand dermatitis. Exposure to a contact allergen is also an important cause of hand dermatitis, and it is recommended that all patients with persistent or treatment refractory hand dermatitis undergo patch testing, especially prior to the initiation of systemic immunosuppressive therapy. Preventative measures including the identification and elimination of irritants or allergens are essential in all cases of hand dermatitis. In addition, a stepwise approach of escalating therapy is advised. Initially, we recommend frequent application of emollients, along with the use of a potent topical corticosteroid daily for up to 6 weeks. A concomitant short, 1–2-week course of oral steroids may also be needed in severe cases to achieve rapid resolution. Once well controlled, maintenance therapy with either twice weekly topical corticosteroid application or topical calcineurin inhibitor application may be indicated for cases of chronic dermatitis. If topical corticosteroids are ineffective and the patient has access to phototherapy, we would next recommend a course of localized PUVA or UVB therapy. In severe, refractory cases of hand dermatitis unresponsive to topical steroids and phototherapy, systemic therapy such as an oral retinoid or immunosuppressive medication may be considered.