Hand eczema: causes, course, and prognosis I

Background:  Hand eczema is a common dermatosis. The course is often protracted. The prognosis is not well described.
Objective:  To describe in detail a consecutive cohort of hand eczema patients with regard to aetiology and morphology as well as the dynamics of the hand eczema.
Patients and Methods:  This prospective study included 522 consecutive patients (175 men and 347 women with hand eczema) seen in 1 year in a private practice of dermatology. 425 (81%) of the patients were patch tested in relation to the current study. Most of the remainder had been previously patch tested.
Results:  38% had mild dermatitis, 49% had dermatitis of moderate severity, and 11% had severe dermatitis. 23% had had dermatitis for more than 10 years. 33% had irritant contact dermatitis, 13% of the men and 20% of the women had allergic contact dermatitis, and 15% of the men and 16% of the women had atopic dermatitis. For 34% of the men and 29% of the women, the dermatitis was certainly or possibly occupational. There was no relationship to smoking.
Conclusions:  The majority of this cohort of hand eczema patients had long-standing disease. Irritant contact dermatitis was the most common aetiological diagnosis.     

FS07.1A survey of occupational hand eczema in Denmark

Background:  The need for prevention to reduce the number of occupational hand eczema is high. Occupational hand eczema is the most frequently recognised work‐related disease in Denmark. Previous findings have shown that almost half of all cases develop a chronic condition with persistent dermatitis, and the annual cost to society is immense.
Aims:  The aim of this study was to survey the trends and development of occupational hand eczema in Denmark and thereby help to ensure future successful prevention of chronic disabling occupational hand eczema.
Methods:  758 patients with recognised occupational hand eczema were included prospectively in the period October 2001‐ November 2002. Data on diagnoses, disease duration, severity, absence from work and occupation was obtained from The Danish National Board of Industrial Injuries and an additional questionnaire was administered by mail.
Results:  621 patients answered the questionnaire (response rate 82%). Irritant contact dermatitis was the most frequent diagnosis and the female/male ratio was 2:1. High prevalence was found in particularly wet occupations. 19 per cent had sick leave more than 5 weeks per year and the mean disease duration was 4.8 years (median 2.1 years). 68.2% had chronic changes.
Conclusion:  The results showed a marked gender difference in the pattern of diagnosis and occupation. The impact of occupational hand eczema is still high with prolonged absence from work and a high percentage of chronic disease. The results of the study give important suggestions for future preventive strategies for health authorities.     

Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients

Background and Objectives:  Hand eczema is a chronic disease with negative impact on quality of life (QoL). In this study, QoL in hand eczema patients is assessed and related to age, sex, severity, and diagnostic subgroups.
Methods:  A total of 416 patients with hand eczema from 10 European patch test clinics participated in the study. Data on QoL were obtained from a self-administered questionnaire using the Dermatology Life Quality Index (DLQI). Severity was assessed by a scoring system (Hand Eczema Severity Index, HECSI) as well as frequency of eruptions and sick leave due to hand eczema.
Results:  No significant difference was found between males and females with respect to QoL [DLQI median values and 25/75 percentiles for males and females being 7.0 (3–14) and 8.0 (3–13), respectively], although males were more severely affected than females ( P < 0.025). A significant positive correlation was found for hand eczema severity and age ( P < 0.001), while no significant correlation was found for QoL and age. QoL was found increasingly reduced when sick leave was getting higher ( P < 0.001). A statistically significant correlation between QoL (as measured by DLQI) and hand eczema severity as measured by HECSI was found ( P < 0.001). No significant difference in QoL was found between diagnostic subgroups.
Conclusions:  QoL was found markedly negatively affected in hand eczema patients and was significantly correlated to disease severity. No significant difference in QoL was found between males and females, in spite of significantly more severe eczema in males, indicating that QoL in female patients is more easily affected.     

FS08.4Prognosis of hand eczema – a 15‐year follow‐up

Aims: To study long‐term prognosis of hand eczema and to identify factors of importance for the prognosis.
Methods: A cohort of 1238 individuals with verified hand eczema diagnosis was established by a population‐based prevalence study in Gothenburg, Sweden, in 1982–83. In 1998 a questionnaire was mailed to all individuals with available addresses (n = 1115). The response ratio was 78%(868/1115).
Results: 66% reported periods of hand eczema since 1983, and 44% during the past year. 12% stated continuous symptoms. No significant difference was found between the sexes. 74% of those who reported symptoms after 1983 considered that their hand eczema had improved. Significant differences in the persistence of hand eczema were related to the age at onset of hand eczema, skin atopy, and the extension of eczema at examination. Contact allergy related significantly to occurrence of hand eczema during the year before follow‐up. 32% had visited a doctor, 7% reported sick leave periods, 2% sick pension and 3% change of occupation due to hand eczema.
Conclusions: In this population‐based study, a majority of individuals with hand eczema reported periods of eczema during a 15‐year follow‐up, implying that hand eczema is a longstanding disease. Young age at onset, history of childhood eczema and extension of the hand eczema were prognostic factors. Hand eczema did entail consequences like change of occupation, sick leave or pension in more than 10% during a 15‐year period.     

Hand eczema in geriatric nurses in Germany – prevalence and risk factors

Background and objectives:  The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany.
Methods:  1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians.
Results:  Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86).
Conclusions:  Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease.     

Type I and Type IV allergy to unfractionated heparin and low-molecular-weight heparin with no reaction to recombinant hirudin

Aim:  To investigate the risk of adult hand eczema and possible influence on later working life in persons with childhood atopic dermatitis.
Method:  After reviewing medical records from the school healthcare in Stockholm regarding individuals born 1960–69, 600 individuals where signs of atopic dermatitis were noted ("cases") and 600 matched controls without eczema or allergic disease ("controls") were identified. 405 cases and 378 controls answered a questionnaire regarding past and present skin disease, choice of job, exposure at work and possible change of job due to eczema.
Results: Hand eczema was more than 3 times more common among cases, 42%, compared to controls, 13%(p < 0.001). Hand eczema during the past 12 months was reported by 24% of the cases and 9% of the controls (p < 0.001). The proportion of individuals working in jobs with high‐risk for hand eczema was equal between the groups, as well as exposure to water, detergents, chemicals and hand washing. Among the cases 9% reported change of job due to eczema compared to 2% of controls (p < 0.001) and sick leave 10% compared to 2%(p < 0.001).
Conclusions: Childhood atopic dermatitis is a risk factor for hand eczema. As the proportion of individuals in jobs with high‐risk for hand eczema and the exposure was the same in cases and controls measures preventive measures are important to reduce consequences like sick leave and change of job.     

FS02.6Patch test reactivity to nickel sulphate and fragrance mix in unselected children

Aim:  To investigate the occurrence of hand eczema after 20 years in schoolgirls previously patch‐tested to nickel.
Methods:  In 1982–83, 960 schoolgirls, aged 8, 11 and 15 years, were investigated for the occurrence of nickel allergy (Larson‐Stymne B and Widström L, Contact Dermatitis 1985:13:289–293). The girls were patch‐tested and the prevalence of nickel allergy was 9%. Twenty years later, the same individuals have received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. After two reminders, the response rate was 81%.
Results:  In total 17.5% of the girls reported hand eczema after the age of 15. The 1‐year prevalence of hand eczema was 12.6%. Of the previously patch‐tested schoolgirls who answered the questionnaire, 63 were sensitive to nickel. In this study, the prevalence of hand eczema among those 63 was 16%, compared to 17% in the non‐sensitive group (NS). Excluding persons with atopic dermatitis, the prevalence of hand eczema was 12.5% in the nickel‐sensitive group, and 10% among the others (NS). 32% of the persons who had had atopic dermatitis reported hand eczema after 15 years of age, compared to 10% of those with no history of atopic dermatitis (p < 0.001).
Conclusion:  Contact allergy to nickel in early childhood (8–15 years) did not seem to increase the prevalence of hand eczema later in life. The prevalence of hand eczema was increased by a factor of three among those with a history of atopic dermatitis, which is in accordance with earlier reports.     

Clinical characteristics and consequences of hand eczema - an 8-year follow-up study of a population-based twin cohort

Background:  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.
Patients/Methods:  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.
Results:  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%.
Conclusions:  The clinical picture and consequences of hand eczema vary; however, the majority experience chronic symptoms.     

Etiology and prognosis of hand eczema in a dermatology clinic in China: a follow-up study

Background:  Prognosis of hand eczema (HE) has not been reported in China.
Objectives:  To investigate the etiology and outcome of HE in 655 consecutive patients patch tested with European standard series in Peking University Hospital in a 2-year period.
Methods:  All patients were re-examined at 1 year after patch testing, and prognosis of dermatitis was evaluated by the rate of clearance of skin symptoms for at least 3 months without relapse before the evaluation.
Results:  Of 599 patients examined, 82 (13.7%) were HE. Allergic, irritant, and unclassified HE accounted for 23.2%, 17.1%, and 51.3% of HE, respectively. The overall clearance rate of HE was much lower than that of eczema elsewhere (18.3% versus 29.6%, P  < 0.05, chi-squared test). 35.7% of patients with allergic HE and 26.3% with irritant HE cleared their lesions, of those with unclassified HE only 11.9% ( P  < 0.05, chi-squared test). The lowest healing rate (5.7%) was found in unclassified HE patients with disease duration over 6 months.
Conclusions:  The outcome of HE was worse than eczema elsewhere. Allergic HE had a better prognosis than unclassified HE. Longer disease duration was the main risk factor for poor prognosis of unclassified HE.     

Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis

Background:  Occupational hand dermatitis (OHD) is a common and often chronic condition. Usage of topical corticosteroids is limited in long-term therapy because of potential side-effects. New treatment options are highly appreciated.
Objective:  To study efficacy and safety of tacrolimus in patients suffering from OHD.
Patients and Methods:  In a prospective, open, multicentre study, 29 patients with OHD of predominantly mild-to-moderate severity were treated with tacrolimus ointment (Protopic^® 0.1%) during a 4-week active treatment period with twice daily application followed by a 2-month optional treatment period. Efficacy was evaluated by the use of a standardized hand eczema score and by clinical severity rating, conducted on all study visits (screening, baseline and weeks 2, 4, 6, and 12). Adverse events were recorded for safety evaluation.
Results:  The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Finally, 12 (44%) patients were clear of hand eczema. Worsening of the dermatitis occurred in 2 patients (7%). Clinical grading indicated improvement too. Overall tolerability was good.
Conclusion:  Topical tacrolimus might be an efficacious treatment option for chronic OHD. Blinded and randomized controlled studies are necessary to confirm the results of this pilot study.     

Contact hypersensitivity and allergic contact dermatitis among school children and teenagers with eczema

Background:  Patch testing is an essential procedure in the investigation of eczema in children.
Objectives:  To analyse the frequency of contact hypersensitivity and allergic contact dermatitis among Polish children with eczema.
Patients/methods:  During an allergy screening programme involving 9320 children aged 7 and 16 years, 12.6% reported symptoms of chronic/recurrent eczema. From this group, a representative sample of 229 eczema children underwent patch testing: 96 children aged 7 years and 133 teenagers aged 16 years. Patch testing was with 10 allergens: methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), nickel sulfate, mercury ammonium chloride, thimerosal, cobalt chloride, potassium dichromate, lanolin, fragrance mix I, Myroxylon pereirae (balsam of Peru), and colophonium.
Results:  49.4% tested children were found patch test (PT) positive. 43.8% of 7 year olds with eczema were PT positive, with sensitization to nickel sulfate (30.2%), thimerosal (10.4%), cobalt chloride (8.3%), fragrance mix I (7.3%), MCI/MI (6.3%), potassium dichromate (6.3%), M.   pereirae (3.1%), mercury ammonium chloride (2.3%), and colophonium (1.0%). 52.6% teenagers were PT positive, with sensitization to nickel sulfate (23.3%), thimerosal (27.8%), cobalt chloride (10.5%), potassium dichromate (6.0%), mercury ammonium chloride (2.3%), M. pereirae (1.5%), and MCI/MI (0.8%). The final diagnosis of allergic contact dermatitis was confirmed in 36% of 7 year olds and 26% of 16 year olds.
Conclusions:  Every second child with eczema is PT positive, whereas every third child is finally diagnosed with allergic contact dermatitis.     

Contact sensitisation in hand eczema patients–relation to subdiagnosis, severity and quality of life: a multi-centre study

Background: Contact sensitisation has been identified as a factor associated with poor prognosis for patients with hand eczema.
Objectives: To study implications of contact sensitisation with respect to severity, quality of life (QoL) and subdiagnosis of hand eczema.
Methods: The study was performed as a multi-centre, cross-sectional study from 10 European clinics. All patients were patch tested, and severity of hand eczema assessed by Hand Eczema Severity Index. A multi-variate analysis was performed to explore which factors influenced severity, QoL and sick leave.
Results: A total 416 patients were included, and 63% had contact sensitisation to one or more of the tested allergens. More women (66%) than men (51%) were sensitized. No significant association was found between sensitisation to specific allergens, disease severity, QoL or diagnostic subgroups. High age, male sex, atopic eczema and presence of contact sensitisation were independent risk factors for increased severity as measured by Hand Eczema Severity Index. Furthermore, the severity of hand eczema increased by the number of contact sensitisations detected ( P = 0.023). High age and personal history of atopic eczema were independent risk factors for low QoL, as measured by Dermatology Life Quality Index, and atopic eczema as well as allergic contact dermatitis as subdiagnosis was associated with increased sick leave.
Conclusion: Diagnostic subgroups were not found to be related to specific allergens. Contact sensitisation was found to be a risk factor for increased severity of hand eczema, as did high age, male sex and atopic eczema.     

Usefulness of skin-prick tests in children with hand eczema: comparison with their use in childhood and adult eczema

BackgroundHand eczema is not uncommon in children but it is rarely studied using skin-prick tests. Few reports have addressed their usefulness in children and none has specifically analyzed their use in children with hand eczema.Material and methodsWe performed a retrospective study of all children up to 16 years of age with hand eczema who were assessed in the Department of Dermatology at Hospital General Universitario in Alicante, Spain with the standard GEIDAC panel over a 5-year period. We compared the epidemiologic data and results of skin-prick tests in this group with those obtained in children with eczema at any site and in adults with hand eczema.ResultsThe study included a total of 1695 patients: 141 (8.3%) children and 1533 (91.7%) adults. Hand eczema was diagnosed in 496 (31.9%) adults and 32 (22.7%) children. Positive results were obtained in skin-prick tests in 50% of children with hand eczema compared with 37.6% of children with eczema at any site and 50.6% of adults with hand eczema. The current relevance of the positive allergens found in children with hand eczema (76.2%) was greater than that observed in children with eczema at any site (61%) or in adults with hand eczema (43%). The most common allergens in children with hand eczema were kathon CG and fragrance mix I, whereas in the other 2 groups metals were the most common. The most common final diagnosis in children with hand eczema was allergic contact dermatitis (34.3%), which proved to be more common than atopic dermatitis.ConclusionsWe recommend the use of skin-prick tests in all children with chronic hand eczema.     

Patch testing in children with hand eczema. A 5-year multicentre study in Spain

Background. Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children. Objectives. The aim of this study was to determine the prevalence of contact allergy in children with hand eczema, and to identify the most frequent allergens and their relevance. Material and methods. We performed a 5‐year retrospective study of children (aged 0–15 years) with hand eczema tested with the Spanish baseline series at the Dermatology Departments of 11 Spanish hospitals. Results. During the study period, 11 729 patients were patch tested, of whom 480 were children. Hand eczema was present in 111 (23.1%) of the children and in 3437 (30.5%) of the adults. Of the children with hand eczema, 46.8% had at least one positive reaction in the patch tests. Current relevance was found for 78% of the allergens detected. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix I. Allergic contact dermatitis was the most frequent diagnosis (36%), followed by atopic dermatitis. Conclusions. Allergic contact dermatitis was the most usual diagnosis in our series of children with hand eczema. We recommend patch testing of all children with chronic hand eczema, as is already performed in adults.     

FS08.3Health‐related quality of life and hand eczema

Aims:  The aims were to study health‐related quality of life (HRQL) in patients with hand eczema, and to compare two different instruments for assessment of HRQL.
Methods:  100 consecutive hand eczema patients (51 females and 49 males) at an occupational dermatology clinic completed the generic questionnaire Short Form‐36 (SF‐36), and the dermatology specific Dermatology Life Quality Index (DLQI). To compare the instruments factor analysis, with a polychoric correlation matrix as input, was performed, thus taking the ordinal aspect of the data into account.
Results:  HRQL was affected by hand eczema, measured with both SF‐36 and DLQI. The mean (SD) sum scores of DLQI was 7.4 (5.8), no difference between genders. However, the SF‐36 showed more impaired HRQL for females than for males in the mental health dimension. There was a high correlation between the instruments for physical health, but lower for mental health.
Conclusions:  Hand eczema has an impact on HRQL, and both SF‐36 and DLQI are suitable instruments. Our conclusion from the factor analysis is that the SF‐36 measures mental health better than the DLQI. The choice of instrument to be used in a specific study depends on the purpose of the study. A generic instrument has the advantage of making comparisons with other diseases possible. The SF‐36 also appears suitable for use in hand eczema studies where gender differences in HRQL are of interest.     

Measurement of patient-relevant benefits in the treatment of chronic hand eczema – a novel approach

Background:  The assessment of patient-relevant treatment benefit gains importance in treatment evaluation. The 'Patient Benefit Index' (PBI) is a validated instrument for the assessment of such benefits in patients with skin diseases. Patients rate the importance of specific treatment needs before treatment and benefits achieved after treatment. To date, no specific instrument for chronic hand eczema (CHE) has been published.
Objectives:  Development and validation of a specific PBI for treatment evaluation in patients with CHE.
Methods:  Items reflecting disease burden and treatment needs were collected in 20 patients with CHE. Relevant items were selected by an expert panel of dermatologists, psychologists, and patients. The resulting 'Patient Benefit Index for chronic hand eczema' (PBI-HE) was validated in an open label treatment study with alitretinoin in n  = 249 patients.
Results:  Cronbach's alpha was 0.93. High convergent validity was demonstrated for clinical improvement and treatment success (Spearman r  = 0.60–0.78, P  < 0.001); 84.3% of patients reached a PBI ≥ 1, indicating more than minimum patient-relevant benefit of alitretinoin. Feasibility was high, with a rate of missing data < 1%.
Conclusions:  The PBI-HE is a feasible, reliable, and valid instrument for the assessment of patient-relevant treatment benefits in CHE.     

The efficacy of '0.05% Clobetasol + 2.5% zinc sulphate' cream vs. '0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema: a double-blind study

Background Many therapeutic modalities have been suggested for treatment of the chronic hand eczema. Despite good immediate efficacy of some of these treatments, there is high recurrence of the dermatitis following cessation of the treatment. Aim Regarding the beneficial effects of the zinc sulfate on the skin, we designed a double blind study to evaluate the efficacy of the ‘0.05% Clobetasol + 2.5% zinc sulphate’ cream versus ‘0.05% Clobetasol alone’ cream in the treatment of the chronic hand eczema. Subjects and Methods This study was a double‐blind, right to left, prospective, clinical trial. In total, 47 patients with chronic hand eczema admitted to dermatology center of Isfahan University of Medical Sciences were selected and their right hand or left hand were selected at random to be treated with either the ‘0.05% Clobetasol + 2.5% zinc sulphate’ cream or ‘0.05% Clobetasol alone’ cream twice daily for 2 weeks. All of the patients were treated for 2 weeks and were followed up at weeks 2, 4, 6 and 8 after starting the treatment. For determining the severity of chronic hand eczema, we assessed and scored 4 different characteristics of the lesions including redness; scaling; lichenification and pruritus. The data were analyzed using SPSS program (release 13) and statistical tests including Mann‐Whitney test. Results Overall, 47 patients (94 samples) were evaluated. All of these patients had similar and symmetrical lesions on their right and left hands. Out of them, 35 patients were females and 12 patients were male. In all of the evaluated characterisitics, the ‘0.05% Clobetasol + 2.5% zinc sulphate’ cream was more effective than ‘0.05% Clobetasol alone’ cream (P < 0.05). The recurrence rate of eczema was significantly lower in the group treated with this combination treatment (P < 0.05). Conclusion With regard to the encouraging results of the combination treatment with Clobetasol + zinc sulphate, we suggest that in a more extensive clinical trial, the efficacy of this treatment against chronic hand dermatitis be evaluated. In addition, evaluation of this combination therapy against other inflammatory dermatosis seems to be logical.     

Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema

Background  Hand eczema is a long-lasting disease with a high prevalence in the background population. The disease has severe, negative effects on quality of life and sometimes on social status. Epidemiological studies have identified risk factors for onset and prognosis, but treatment of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system for hand eczema is needed.
Objectives  The present study attempts to characterize subdiagnoses of hand eczema with respect to basic demographics, medical history and morphology.
Methods  Clinical data from 416 patients with hand eczema from 10 European patch test clinics were assessed.
Results  A classification system for hand eczema is proposed.
Conclusions  It is suggested that this classification be used in clinical work and in clinical trials.     

Does tobacco smoking influence the occurrence of hand eczema?

Background  Tobacco smoking is known to influence various inflammatory skin diseases and an association between tobacco smoking and hand eczema has been proposed in some studies.
Objectives  To examine a possible association between reported current tobacco smoking and the occurrence of hand eczema.
Subjects and methods  Previously collected questionnaire data on the occurrence of hand eczema in three occupational cohorts and corresponding controls from the general population were studied. The questionnaires used included questions on 1-year prevalence of hand eczema and questions on smoking habits. For one occupational group, hairdressers and their controls, information on amount of smoking was obtained. Information on age, sex and history of atopy was also available.
Results  In total, answers regarding smoking and hand eczema were obtained from 13 452 individuals. Out of 3493 smokers, 437 (12·5%) reported hand eczema compared with 1294 out of 9959 nonsmokers (13·0%) ( P  =   0·51). With regard to the number of cigarettes smoked, 22·6% of the hairdressers smoking more than 10 cigarettes per day reported hand eczema compared with 17·4% of those smoking 0–10 cigarettes per day ( P  =   0·01). Corresponding figures for the controls were 14·5% and 11·7%, respectively ( P  =   0·06).
Conclusions  No clear association was found between 1-year prevalence of hand eczema and smoking. Heavy smoking, more than 10 cigarettes per day, may give a slightly increased risk of hand eczema. Further studies with information on the amount of tobacco consumption and on possible confounders are needed to evaluate smoking as a risk factor for hand eczema.     

Patients with vulval pruritus: patch test results

Background:  Persistent vulval pruritus is a frequent problem and patients may not show signs of a primary vulval dermatosis. Allergic contact sensitivity is an important factor in such patients but may also occur as a secondary event in women with vulval dermatoses.
Objectives:  We aim to describe women with vulval pruritus who were evaluated for vulval dermatoses. We patch tested to help define or exclude allergens.
Methods:  In a 3-year period, 50 women with vulval pruritus were examined for existence of vulval dermatosis. All the patients were patch tested to the European Baseline Series, medicaments, preservatives, vehicles, cosmetics and products they routinely used.
Results:  Ages of the patients ranged from 22 to 62 years (mean 39.9 ± 9 years) and duration of the diseases ranged from 0.5–360 months (mean 56.1 ± 65.6 months). 52% of the women had at least 1 positive patch test. 8 patients (16%) had 1 or more relevant allergic positive reactions. The relevant allergens were usually cosmetics, preservatives and medicaments.
Conclusions:  Women with vulval pruritus were patch tested to help define or rule our allergens. Contact allergy incidence in these patients is high. The relevant allergens were usually cosmetics, preservatives and medicaments.