Therapie berufsbedingter Hauterkrankungen

Hand eczema is one of the most frequent skin diseases. About 5-10% of population has chronic hand eczema. In addition, hand eczema accounts for more than 90% of occupational skin diseases. The therapy of hand eczema is expensive and often leads to a loss in quality of life. The therapy is complex, not always successful and can lead in the worst case to the patient being forced to give up or change their profession. We review the therapeutic options to treat occupational hand eczema.     

Fractional photothermolysis treatment of digital cutis laxa reverses hand disability

In this case study, we present a safe and novel treatment for a patient with soft tissue hand disability caused by severe and chronic lupus and cutis laxa (CL). This patient was a woman in her 50s with a 20‐year history of systemic lupus erythematous (SLE) and multiple sclerosis who developed hand disability because of the drastic loss of firmness in her soft tissue, extending from the dermis down to the ligaments. The likely cause was CL with SLE synovitis, exacerbated by corticosteroid tapering. Fractional photothermolysis (FP) LASER (Fraxel DUAL 1550/1927; Solta Medical) therapy profoundly alleviated her joint locking in addition to improving the firmness of the overlying skin to reverse her hand disability. This case illustrates a novel approach to CL hand treatment and the profound impact the treatment had on the patient's disabled hand. FP therapy is quick and safe, and its medical application to skin and joints should be further explored.     

Occupational allergic contact dermatitis to methyldibromoglutaronitrile in hand degreasing toilet paper

We inform about a case of occupational allergic contact dermatitis (OACD) to methyldibromoglutaronitrile (MDBGN) in industrial hand degreasing moist toilet paper. To our knowledge, this is the first published case of OACD to MDBGN in industrial hand degreasing toilet papers. A cause-effect relationship seems to be clearly established. We believe that physicians must keep in mind that MDBGN is a strong allergen either mixed or as a single component of industrial moist toilet papers. MDBGN must be taken into account for OACD at an appropriate work environment.     

Frictional hyperkeratotic hand dermatitis responding to Grenz ray therapy

Frictional hyperkeratotic hand dermatitis (FHHD) is an unusual form of chronic eczema relating to repeated frictional trauma. This form of hand eczema is often occupationally related and recalcitrant to therapy. We describe the case of FHHD in a 48-year-old dermatologic surgeon. The eruption was resistant to all topical and protective modalities, but responded completely to 6 sessions of Grenz ray treatment. No recurrence has been noted for over 4 years since completion of therapy. We suggest that Grenz ray treatment is a safe and effective option in treating this form of chronic hand dermatitis.     

Pyogenic granuloma on the hand subsequent to friction blister in a hand surgeon

A case of pyogenic granuloma in a 62-year-old hand surgeon secondary to friction blister is reported. He developed a fast growing, hypertrophic inflammatory papule consisting of exceptionally richly vascularized granular tissue. This dusky red lesion was located on the thenar part of the hand. We find no prior report of PG attributed to friction blister.     

Determinants of current hand eczema: results from case–control studies nested in the PACO follow‐up study (PACO II)

Background: Hand eczema is often a result of the interplay of exogenous and endogenous risk factors. Epidemiological studies demonstrating the interrelationship between these factors are lacking. Objective: To analyse risk factors associated with current hand eczema and current irritant hand eczema in two case–control studies nested in a long‐term follow‐up study in the car industry. Patients/Materials/Methods: Eligible participants were individuals who had been followed until the end of their apprenticeship in the original cohort study (1990–1998, N = 1909). Participants were interviewed and underwent dermatological examination. Two case–control studies were nested within the cohort, one using current hand eczema cases (n = 110) and one using current irritant hand eczema cases (n = 57). Multivariable modelling was performed. Results: The only significant finding was a positive association of atopic skin diathesis with hand eczema in both studies. Wet work ≥2 hr/day was positively related to current irritant hand eczema. Age and having an office job were inversely related to hand eczema. Conclusions: Atopic skin diathesis was the most important determinant of hand eczema. Constitution seems to play a dominant role compared with environmental and occupational hazards in a setting where skin protection measures are well established.     

Stasis dermatitis of the hand associated with an iatrogenic arteriovenous fistula

Stasis dermatitis is a cutaneous finding associated with chronic venous failure resulting in venous stasis. Arteriovenous fistula in the hand may cause a chronic venous stasis. We report a case of stasis dermatitis of the hand associated with an iatrogenic arteriovenous fistula. Stasis dermatitis should be considered as a potential complication of iatrogenic arteriovenous fistula.     

Multiple synovial swellings in BT leprosy. A case report

A case of Leprosy with multiple synovial swellings has been reported. Rarely these swellings may be an initial presentation and at sites other than dorsum of hand or ankle as was in this case. The literature on the subject is briefly reviewed.     

Recurrent herpes simplex virus type 2 infection of the hand complicated by persistent lymphoedema

A 33-year-old, immunocompetent woman had recurrent herpes simplex virus reactivation of the right hand presenting with a cellulitis-like picture. She continued to have monthly debilitating recrudescences for more than 3 years until an adequate dosage of prophylactic antiviral therapy was achieved. After 2 years of repeated episodes she had chronic dull pain and developed persistent acquired lymphoedema of the left hand and forearm, which is an extremely rare complication. This case highlights the need for herpes simplex infection of the hand to be included in the differential diagnosis of bacterial cellulitis in order for appropriate and prompt therapy to be achieved.     

Mycetoma caused by Nocardia caviae in the first Brazilian patient

Background  Mycetoma is a chronic subcutaneous mycosis caused by exogenous fungi or actinomycetes. This infection has a progressive course and shows a typical clinical characteristic of tumefaction, draining sinuses, and grains. Infection initiation is related to local trauma and can spread to muscle, underlying bone, and adjacent organs. Nocardia brasiliensis is the most frequent actinomycete isolated, while N. caviae is a rare agent. Methods  We present a case of mycetoma in a 37‐year‐old African‐American man on the right hand. The infection had been apparent for four years prior to the consultation. When the infection did not respond to antibiotic therapy, the patient was referred to the Dermatology department. Routine laboratory studies were normal. X‐ray examination of the hand showed an osteolytic lesion on the hand bones. On skin biopsy culture, on Sabouraud Dextrose Agar at 28 °C, a colony was isolated which was further identified as N. caviae by biochemical and hydrolysis testing. Results The patient was treated with oral trimethoprim/sulfamethoxazole (TMP/SMZ) 160/800 mg twice a day for 10 months. Four months after the beginning of the therapy, the subject exhibited clinical improvement and functional recovery of the hand. Five‐year follow‐up X‐ray examination of the hand showed no osteolytic lesion on the hand bones. Conclusion We report the first mycetoma case caused by N. caviae in our country with an unusual location on the hand. The patient showed clinical improvement with oral TMP/SMZ.     

Cinnamon allergy in a baker

Contact dermatitis in bakers is usually irritant in origin, but there are a large number of potential allergens to which bakers can be exposed. A case is presented of allergic hand dermatitis due to cinnamon.     

Mycetoma of the hand

A case with a rare localization of mycetoma, on the hand, is described. A 31-year-old male patient developed this condition in 5 months after injury with a rope. Surgical treatment for a phlegmon of the left hand was ineffective. After microscopic and bacteriologic studies the dermatologists have diagnosed a pseudomycotic (actinomycotic) mycetoma of the left hand and lower third of the left arm. Streptomycin, penicillin, and actinolysate therapy essentially improved the course of the process. A review of literature on the etiology, epidemiology, clinical picture and therapy of mycetoma is presented.     

The concurrence of subacute cutaneous lupus erythematosus and hand‐foot syndrome in a patient undergoing capecitabine chemotherapy

We describe an unusual case of subacute cutaneous lupus erythematosus concurrent with hand‐foot syndrome, apparently associated with capecitabine treatment. We hypothesise that subacute cutaneous lupus erythematosus and hand‐foot syndrome may occur in a novel overlap syndrome.     

Blastomycosis-like pyoderma in association with recurrent vesicular hand eczema: good response to acitretin

Blastomycosis-like pyoderma, also known as pyoderma vegetans, is an uncommon disease characterized by vegetating skin lesions mimicking blastomycosis or warty tuberculosis, often associated with staphylococcal and streptococcal infections. It is more commonly observed in elderly patients with impaired immunological capacity, and is often unresponsive to various therapeutic modalities. We describe a case of BLP that occurred on the palmar aspect of the left hand in an elderly female, affected with recurrent vesicular hand eczema. The disease resolved completely following the administration of oral acitretin 25 mg/day for 10 weeks.     

Allergic contact dermatitis from cardamom

A case is presented of a confectioner with a chronic hand dermatitis and positive patch test reactions to cardamom and certain terpenoid compounds present in the dried ripe seeds of cardamom. Cardamom is a popular traditional flavouring agent for baked goods and confectionery. Dermatitis from skin exposure to cardamom has to the best of our knowledge not been reported. We report one case of allergic contact dermatitis to cardamom elicited by terpenes present in the seeds.     

Traumatic Amputation of a Supernumerary Digit: A 16-Year-Old Boy's Perspective of Suture Ligation

Abstract:   Traditionally, the duplicated digit in an infant with polydactyly is managed by suture ligation and the digit is allowed to auto-amputate. However, painful neuromas may result from this commonly used technique and sharp excision has been suggested as a superior alternative. We present a case of a 16-year-old male who requested revascularization after a traumatic partial amputation of a supernumerary digit on his left hand. He requested revascularization because suture ligation of a duplicated digit on his right hand as an infant had resulted in a neuroma and considerable pain.     

Unilateral hyperhidrosis with accompanying contralateral anhidrosis

Localized unilateral or segmental hyperhidrosis is a rare form of increased sweat production of unknown origin. Most reported cases have occurred in otherwise healthy people, with none of the typical triggering factors found in essential hyperhidrosis. The localization of segmental hyperhidrosis is usually the forearm or forehead. We report a case of unilateral hyperhidrosis on the right sides of the forehead, and nose, and the palmar surface of the right hand with anhidrosis on the left hand.     

Reflex sympathetic dystrophy syndrome in a child

Reflex sympathetic dystrophy syndrome (RSDS) is a painful condition that usually follows regional trauma. We report the case of a 13-year-old girl that was seen for a painful swelling of the right hand associated with palmar hyperhidrosis, which occurred after a trauma to the hand. Bone scan images showed early tissue abnormality, which was more significant on the right hand and wrist, as well as moderate bone uptake on the right side. Nonsteroidal anti-inflammatory drugs and alternating hot and cold baths led to a marked improvement. RSDS occurs following trauma or subsequent to various diseases or drug intake. This syndrome is related to impaired tissue microvasculature under the influence of abnormal sympathetic reflex hyperactivity. Bone scan is the diagnostic procedure of choice in RSDS, but it may be normal. Physiotherapy should be preferred in pediatric cases.     

Fragrance allergy and hand eczema - a review

Because hand eczema and fragrance allergy are common both among patients and in the general population, simultaneous occurrence by chance must be expected. Fragrances are ubiquitous and a part of many domestic and occupational products intended for hand exposure. The present review is based on a systematic literature research using both a manual and a Medline based search. The search identified 39 studies, including epidemiological patch test studies, general population patch test studies, case studies, and studies of occupational groups. The published data indicate a possible association between fragrance allergy and hand eczema. In future studies, a more detailed exposure assessment is needed, combined with patch test studies among patients with hand eczema tested with relevant fragrance allergens, as well as experimental control exposure studies to specific fragrance allergens on the hands. As exposures to fragrances on the hands are often simultaneous exposures to irritants, this combined exposure approach needs to be considered.     

Cyclosporin A responsive chronic severe vesicular hand eczema.

A patient with an otherwise recalcitrant chronic vesicular hand eczema responded with a dramatical improvement within 2 weeks of cyclosporin A (CsA) therapy 5.0 mg/kg daily. The patient was still free of eczema in spite of reducing the CsA dose to 2.5 mg/kg daily. CsA therapy was finally stopped due to a moderate increase in blood pressure, resulting in rapid recurrence of the hand eczema. The case report clearly demonstrates that oral CsA should be considered in patients with severe hand eczema that cannot be controlled on conventional immunosuppressive treatments.