Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis

Summary Background Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick‐leave periods and need for changes of work and re‐training put an economic burden on society, and there is an interest indeveloping cost‐effective epidemiological surveillance instruments such as a screening questionnaire. Objectives In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self‐reported signs. Methods Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist (‘gold standard’) were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. Results Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the ‘gold standard’. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0·62 and a specificity of 0·87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0·87 and a specificity of 0·79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a κ‐value of 0·65 (95% CI 0·55–0·75), and the poorest was for papules with 0·47 (95% CI 0·32–0·62). Conclusions It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking ‘Do you have hand eczema?’ had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.     

Validation of self-reporting of hand eczema among Danish hairdressing apprentices

Background. Hairdressing apprentices have a high incidence of hand eczema. Most studies use self‐reported hand eczema as a cost‐effective method to estimate the prevalence of hand eczema. No validation studies on self‐reported hand eczema among hairdressing apprentices exist. Objectives. To evaluate the validity of self‐reporting of hand eczema among Danish hairdressing apprentices. Methods. During their first 2 weeks of training, 502 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire including questions regarding, for example, current hand eczema, and they were all clinically examined for hand eczema three times during the first part of their education by use of the Hand Eczema Severity Index. The validity of self‐reporting of hand eczema was measured with the clinical examination as the gold standard. Results. The sensitivity of self‐reporting of hand eczema was 70.3%, and the specificity was 99.8%. The positive predictive value was 96.3%, and the negative predictive value was 98.5%. Conclusions. We found good agreement between self‐reporting of hand eczema and clinical examination. There was good sensitivity and high specificity. Self‐reporting of hand eczema among hairdressing apprentices is considered to be a valid method for estimating the prevalence of hand eczema, although it might underestimate the true prevalence.     

The use of protective gloves and the prevalence of hand eczema, skin complaints and allergy to natural rubber latex among dental personnel in the county of Uppsala, Sweden

During the past decade, there has been an increasing problem with acrylate allergy and natural rubber latex (NRL) allergy among dental personnel. The aim of the present study was to evaluate the prevalence of these problems among dentists, dental nurses and dental hygienists in Uppsala county, Sweden. The study was based on a self-administered questionnaire sent to 690 persons with 527 responders (76%). The most common skin problem was dry skin, fissures and/or itching on the hands. Of the 72 persons (13.6%) reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested with the TRUE Test standard series and the Swedish dental screening series. In the patch tested group, 9.8% reacted to 1 or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, we found 7.2% to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% connected them to the place of work and 28.8% related them to the use of gloves.     

Assessment of severity of hand eczema: discrepancies between patient- and physician-rated scores

BACKGROUND: In clinical practice or trials on hand eczema the severity of this disease can be 'measured' in different ways: by means of a physician-rated clinical severity score, a patient-rated clinical severity score or by an indicator of the burden of disease. We assume that the patient-rated severity score corresponds more with the (change in) burden of disease than with the physician-rated severity score. OBJECTIVES: To demonstrate how physicians and patients differ in their assessment of the severity of hand eczema as seen in a physician-rated severity score, patient-rated severity score and a burden of disease questionnaire. METHODS: We used data from an open-label randomized controlled trial which was set up in two university hospital dermatology departments in the Netherlands, specializing in hand eczema. One hundred and fifty-eight patients with moderate to severe chronic hand eczema were included. The main outcome measures were the physician-rated severity score, based on five visible aspects of hand eczema (desquamation, erythema, vesicles, infiltration, fissures), the patient-rated severity score (a self-rating scale), a burden of disease questionnaire (the Dermatology Life Quality Index, DLQI) and the correlations between these parameters, both at inclusion and over time. RESULTS: Only desquamation and infiltration were significantly correlated with patient-rated severity score. Patient-rated severity score correlated with seven of 10 DLQI items, but it did not correlate with the items regarding influence on clothes worn, impairment of sporting activities, and problems associated with treatment of the skin. The majority of patients showed improvement in all parameters after treatment. However, the improvement in patient-rated severity score was not clearly correlated with changes in physician-rated severity score. Except for DLQI item 1 (itch, soreness, pain, stinging), none of the changes in burden of disease was correlated with changes in patient-rated severity score. For each DLQI item, change over time correlated weakly with decreases in several, but not all, components of the physician-rated severity score. CONCLUSIONS: Disease severity can be expressed by different scores; these scores are not clearly correlated, and measure different aspects. Patient satisfaction is not guaranteed when treatment is focused solely on the visible aspects of hand eczema. Instead, burden of disease has a greater impact.     

Filaggrin loss-of-function mutation R501X and 2282del4 carrier status is associated with fissured skin on the hands: results from a cross-sectional population study

Background Filaggrin metabolites act as osmolytes and are important for skin hydration. Carriers of filaggrin loss‐of‐function mutations have a higher prevalence of atopic dermatitis and dry skin. There is also evidence to suggest that filaggrin mutations increase the risk of hand eczema in atopic individuals. In our clinic, we have observed a distinct phenotype of hand eczema in patients with filaggrin mutation carrier status, characterized by fissured dermatitis on the dorsal aspect of the hands and with only sparse involvement of the palms including fine scaling. Objectives To investigate whether filaggrin loss‐of‐function mutations are associated with skin fissures on the hands and/or fingers in the general population. Methods Participants in a population‐based study were questioned about skin symptoms, genotyped for filaggrin mutation, patch tested for nickel allergy and skin prick tested. Results In an adjusted logistic regression analysis, filaggrin mutation status was significantly associated with fissured skin on the hands and/or fingers in adults (odds ratio 1·93, 95% confidence interval 1·05–3·55) and showed a nearly significant negative interaction with atopic dermatitis (P = 0·055), suggesting that the effect was predominantly in subjects without atopic dermatitis. Conclusions Filaggrin loss‐of‐function mutations seem not only to increase the risk of atopic dermatitis and dry skin but also the risk of fissures on the hands and/or fingers in subjects without atopic dermatitis. Prophylactic emollient therapy should be particularly encouraged in filaggrin loss‐of‐function mutation carriers.     

Comparison of oral psoralen-UV-A with a portable tanning unit at home vs hospital-administered bath psoralen-UV-A in patients with chronic hand eczema: an open-label randomized controlled trial of efficacy

OBJECTIVE: To study whether oral psoralen-UV-A (PUVA) with a portable tanning unit at home is as effective as hospital-administered bath PUVA in patients with chronic hand eczema. DESIGN: Open-label randomized controlled trial, with a 10-week treatment period and an 8-week follow-up period. SETTING: Two university hospital dermatology departments in the Netherlands, specializing in hand eczema. PATIENTS: One hundred fifty-eight patients with moderate to severe chronic hand eczema (more than 1 year in duration). INTERVENTIONS: Oral PUVA using methoxsalen capsules and a simple portable commercial facial tanning unit, or hospital-administered bath PUVA with trioxsalen. MAIN OUTCOME MEASURES: The primary outcome was clinical assessment by a hand eczema score (evaluation of desquamation, erythema, vesiculation, infiltration, fissures, itch, and pain, each on a 4-point scale) after 10 weeks of treatment. The secondary outcome was hand eczema score at 8 weeks of follow-up, after completion of treatment. The tertiary outcome was travel cost and time off work. RESULTS: Both groups showed a comparable and substantial decrease in hand eczema score (meaningful clinical improvement). This decrease was maintained during the follow-up period. Patients treated with oral PUVA at home had lower travel costs and less time off work. CONCLUSIONS: Oral PUVA at home has a clinically relevant efficacy, similar to that of hospital-administered bath PUVA. This effect was maintained during an 8-week follow-up period. It resulted in lower travel costs and less time off work.     

Exposures related to hand eczema: a study of healthcare workers

Background. Hand eczema is common in healthcare workers, owing to intensive exposure to wet work and skin irritants. Targeted interventions and vocational guidance based on documented exposures and risk factors are needed. Objectives. The aims of the study were to investigate the relationship between exposures (domestic and at work) and prevalence and severity of hand eczema. Methods. Self‐administered questionnaires were sent to 3181 healthcare workers in Denmark. Results. Two thousand two hundred and sixty‐nine (71%) workers responded to the questionnaire. Frequent hand washing was significantly related to the presence of hand eczema. Having children < 4 years old in the household was also related to the presence of hand eczema. A lower prevalence of hand eczema was found among those using moisturizers at work, and a higher prevalence was found among those using moisturizers at home. Conclusions. Although healthcare workers are recommended to use disinfectants when the hands are not visibly dirty, hand washing is still significantly related to hand eczema. Frequent hand washing may be a question of behavioural habits, and a focus for future guidance should be on changing hand washing habits. Attention should also be paid to healthcare workers with small children at home. The preventive effect of moisturizers used during working hours should be tested in future follow‐up studies.     

Do hairdressers in Denmark have their hand eczema reported as an occupational disease? Results from a register‐based questionnaire study

Background. Occupational hand eczema is common in hairdressers, owing to wet work and chemicals. Objectives. To estimate whether hairdressers in Denmark have their hand eczema reported as an occupational disease and to clarify the reasons for not reporting. Methods. A register‐based study was performed, comprising trained hairdressers (n = 7840), using a self‐administered postal questionnaire including questions on hand eczema and it being reported as an occupational disease. A response rate of 67.9% (n = 5324) was obtained. Results. Overall, 2186 respondents ever had hand eczema; 71.3% were apprentices at the time of hand eczema onset. The majority (61.9%) had had hand eczema several times and 21.3% (almost) all of the time, but only 20.7% had reported their hand eczema as being occupational to the National Board of Industrial Injuries (Denmark). A positive association between severity of hand eczema and filing a report was found (odds ratio 19.2; 95% confidence interval 8.18–45.06). The main reasons for not reporting were ‘I thought it would eventually get better’ (40.4%) and ‘My doctor didn't tell me it was possible to report it' (26.6%). Conclusions. Hand eczema is considerably under‐reported as an occupational disease; the perception of hand eczema among hairdressers and the lack of reporting from doctors are the main reasons for this.     

Wet work exposure and hand eczema among healthcare workers: a cross‐sectional study

Hand eczema is common among healthcare workers. One reason is high exposure to soap and water. To prevent the spreading of infections more rigorous hygiene procedures have been implemented in healthcare during the last decade. The purpose of this study was to see how the use of disposable gloves, alcoholic hand disinfectants, and soap is associated with hand eczema. An electronic questionnaire was sent to all hospital employees in southern Sweden. Only the respondents working as nurses, assistant nurses and physicians were included in the analyses. In this group 21% had had hand eczema during the last 12 months, which is higher compared to the general population. 30% washed their hands with soap more than 20 times per day at work, 54% used non‐sterile disposable gloves for more than 2 hours per day, and 45% used alcoholic hand disinfectant more than 50 times per day. Hand eczema was more common among those who more often used soap, and among those who used disposable gloves for longer times. However hand eczema was not associated with the use of alcoholic disinfectants. This study shows that hand eczema still is common in healthcare workers. Educational programmes directed at prevention of hand eczema are needed.     

Flare-up of dermatitis following patch testing is more common in polysensitized patients

Background: To estimate the prevalence of nickel allergy, self‐reports are sometimes used in epidemiological studies. Self‐reports are practical and may facilitate estimation of prevalence provided that the questions are validated. Objectives: To investigate the validity of self‐reported nickel allergy. Methods: Three hundred and sixty‐nine women, aged 30–40 years, from the general population participated in the study. The participants answered a questionnaire before a clinical examination and patch testing. The two questions being validated were ‘Are you sensitive/hypersensitive/allergic to nickel?’ and ‘Do you get a rash from metal buttons, jewellery or other metal items that come in direct contact with your skin?’ Results: Patch test showed nickel‐positive reaction in 30% of the subjects. Self‐reported prevalence of nickel allergy as indicated by the two respective questions was 40% and 35%. Positive predictive values for the two questions were 59% (95% CI 50–67) and 60% (95% CI 51–69). History of childhood eczema was over‐represented among women with ‘false‐positive’ self‐reported nickel allergy (P = 0.008). Self‐reported hand eczema or ‘high wet exposure’ did not influence the validity. Conclusions: The validity of self‐reported nickel allergy is low. The questions regarding nickel allergy overestimate the true prevalence of nickel allergy.     

Hand eczema in Swedish adults - changes in prevalence between 1983 and 1996

Hand eczema is the most frequent occupational skin disease. Our aim was to study changes in its prevalence in Swedish adults. Cross-sectional studies were performed in 1983 and 1996. Random samples from the population of Gothenburg, Sweden, aged 20-65 y, were drawn from the population register. Data were collected with a postal questionnaire, which was identical in the two studies. The response rate was 83.5% (16,708 out of 20,000) in 1983 and 73.9% (2218 out of 3000) in 1996. The reported 1 y prevalence of hand eczema decreased from 11.8% in 1983 to 9.7% in 1996 (p < 0.01), a large difference being found in the youngest age group. Reported childhood eczema increased from 10.4% to 12.4%, however (p < 0.01). Of those with childhood eczema 27.9% and 25.2% reported hand eczema, compared to 10.0% and 7.5% among those without childhood eczema. In total 76.8% were gainfully employed in 1983 and 68.3% in 1996 (p < 0.001). In 1983 23.0% were employed in "high-risk" occupations for hand eczema compared to 19.4% in 1996 (p < 0.001). Even though the increase in childhood eczema was largest in the youngest group, there was a large decrease in the prevalence of hand eczema in that age group among both sexes. The study indicates that the prevalence of hand eczema in Swedish adults had decreased between 1983 and 1996 despite an increasing prevalence of childhood eczema. Secular changes in reporting hand eczema and childhood eczema may explain some of the changes, but a decreased occupational exposure to skin irritants is a probable cause, implying that occupational factors may be important predictors of hand eczema.     

Hand eczema in car mechanics

To estimate the prevalence of hand eczema, a questionnaire was distributed to 901 male car mechanics. Of the 801 persons who responded, 15% reported hand eczema on some occasion in the previous 12 months, and 57% admitted dry skin on the hands. In a 2nd part of the study, those who reported hand eczema were examined and patch tested with a standard series and a special "car mechanics' series". The most common diagnosis was irritant contact dermatitis, 55%, and 2nd was allergic contact dermatitis, 19%. 35/105 (33%) had a total of 51 positive patch test reactions, all to substances in the standard series, except for 2 persons who reacted to oxidized d -limonene. The most frequent reactions were to thimerosal (9%), nickel (8%) and colophony (5%). One plausible explanation for the high prevalence of nickel allergy was the common use of nickel-plated tools. 5 individuals had a history of contact urticaria, but scratch tests were negative. It was concluded that car mechanics are at high risk for contact dermatitis on the hands, irritant as well as allergic.     

Hospital employees and skin problems

A total of 1481 hospital employees answered a questionnaire on atopy, hand eczema, and dry chapped hands. Out of 864 (58.7%) responders, 17% claimed to suffer from hand eczema. There was not significantly more hand eczema among women (17.6%) than men (15.7%). Atopic disposition was present in 17.5% of responders, of whom a significantly higher number (36.4%) claimed to have hand eczema. Dry chapped hands seemed to be a problem in 33.1%, mainly among nurses, assistant nurses and laboratory assistants. Technicians and X-ray assistants (38%) and kitchen workers (35.7%) claimed to suffer significantly more from hand eczema than others. Their working conditions were inspected. Following examination by a dermatologist, irritant contact eczema was diagnosed in 11 of 17, and occupational eczema in 3. None of the janitors or technical workers (all men) had hand eczema.     

Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital

Background. Hand eczema is common in the nursing profession, and has been reported widely in various parts of the world. Objectives. The aim of this study was to determine the prevalence and severity of hand eczema among nurses working in a regional hospital in Hong Kong, as well as its psychosocial impact and any possible associated risk factors. Patients/materials/methods. The study took the form of a self‐report questionnaire survey; 1240 nurses in a regional hospital were asked to participate in the survey by completing the questionnaire and returning it anonymously within 2 weeks. Results. Seven hundred and twenty‐four nurses returned the questionnaire (a response rate of 59%). The prevalence of hand eczema among the respondents was 22.1% (160/724). More than 90% had moderate to severe hand eczema. Itchiness and dryness were the most common symptoms. Occupational work, housework, mood, social activities and sleep were particularly affected. Multinomial logistic regressions showed that a personal or family history of atopy and a hand washing frequency of >20 times per day were independent risk factors for hand eczema. Conclusions. Hand eczema is common and severe among Hong Kong nurses. The results of this study suggest that hand eczema is an important problem for nurses and that preventive measures should be emphasized.     

Hand eczema in 45 bakers - a clinical study

The skin of bakers is heavily exposed to dough, spices, water and detergents. This is follow-up of a previous Swedish questionnaire study showing bakers to have a 3-fold increased risk of hand eczema. The aims were to establish diagnoses and to study consequences of hand eczema. From a cohort study of 2226 bakers, a random sample among bakers reporting hand eczema was examined. Of 60 randomly selected bakers reporting a history of hand eczema, 52 attended an examination comprising a standardized interview, documentation of clinical skin signs, patch testing and prick testing with standard and bakery series, and serum analyses. In all, 45 bakers confirmed a history of hand eczema, for which 11 (24%) had been on sick leave, with a median duration of 14 weeks. 13 (29%) had changed their occupation due to skin disease, 19 had positive patch test reactions to standard contact allergens - and 5 to bakery contact allergens. 16 bakers had positive prick tests to standard allergens, 10 to bakery allergens, of whom 9 reacted to flours. Since considerable medical and social consequences of hand eczema are seen, thorough diagnosis of contact allergy and IgE-mediated allergy in bakers, as well as preventive measures, are essential.     

Nickel allergy as risk factor for hand eczema: a population-based study

Summary Background In population‐based studies using self‐reported nickel allergy, a hand eczema prevalence of 30–43% has been reported in individuals with nickel allergy. In a previous Swedish study, 958 schoolgirls were patch tested for nickel. In a questionnaire follow up 20 years later no association was found between nickel allergy and hand eczema. Objectives To investigate further the relation between nickel allergy and hand eczema. Methods Three hundred and sixty‐nine women, still living in the same geographical area, now aged 30–40 years, were patch tested and clinically investigated regarding hand eczema. Results Patch testing showed 30·1% nickel‐positive individuals. The adjusted prevalence proportion ratio (PPR) for hand eczema after age 15 years in relation to nickel patch test results was 1·03 (95% confidence interval, CI 0·71–1·50). A history of childhood eczema was reported by 35·9%, and the PPR for hand eczema in relation to childhood eczema was 3·68 (95% CI 2·45–5·54). When analysing the relation separately in women with and without a history of childhood eczema a statistical interaction was found. The hand eczema risk was doubled in nickel‐positive women without a history of childhood eczema, with a PPR of 2·23 (95% CI 1·10–4·49) for hand eczema after age 15 years. Conclusions A doubled risk for hand eczema was found in nickel‐positive women without a history of childhood eczema. When analysing all participants, there was no statistically significant difference between nickel‐positive and nickel‐negative women regarding occurrence of hand eczema. The most important risk factor for hand eczema was childhood eczema. The risk for hand eczema in nickel‐positive women may previously have been overestimated.     

Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metal workers

This study was performed as part of PROMETES (Swiss Prospective Metal Worker Eczema Study) to examine the role of atopy as a possible risk factor for the development of hand eczema in trainee metal workers. In a cohort of 201 young men without any skin problems at the start of their apprenticeship, 9.5% developed signs of dermatitis on their hands within a period of 6 months. The 2. 5-year incidence was 23%. We did not find a significantly increased risk for hand eczema in those participants with an atopic skin diathesis according to the atopy score of Diepgen et al. (Dermatosen 1991; 39: 79-83) Analysis of individual atopic signs and symptoms showed reported metal reactivity to have a significant influence on the onset of early skin damage within 6 months, whereas a history of flexural eczema appeared to be significantly related to the overall incidence over 2.5 years.     

Contact urticaria from latex in healthcare workers

BACKGROUND: Latex allergy is an important medical problem for an increasing number of patients. It has been documented as causing immediate hypersensitivity reactions ranging from mild urticaria to life-threatening anaphylaxis after cutaneous, mucosal or visceral exposure. Recent studies in northern Europe and the USA suggest that between 2.8 and 16.9% of healthcare workers are affected by latex hypersensitivity type I reactions. OBJECTIVES: To test the prevalence of contact urticaria from latex gloves in a group of healthcare workers, to examine the factors associated with latex allergy and to evaluate some diagnostic methods used in latex allergy. METHODS: A total of 929 employees of the surgical units who used latex gloves on a regular basis, at least once a day, were invited to participate in this study including administration of a questionnaire, a prick test with a commercial extract of latex, a prick test with latex glove eluate, a use test, RAST and an immunoblotting system; moreover, a prick test with a group of common inhalant allergens and a prick-by-prick test with fresh fruit (banana, kiwi, avocado, chestnut) were employed. RESULTS: Of the 929 staff sent questionnaires, 313 (33.5%) replied; of those who responded, 118 gave a history of hand problems such as itch, erythema, wheals when wearing gloves, dryness and irritation most marked on the backs of the hands. Among these 118 workers, 16 refused skin testing and examination of blood, so 102 subjects were studied for latex allergy; 21/118 (17.8%) healthcare workers were found to be latex allergic. Eighty-one staff members gave a history of hand problems worsened by wearing gloves but were not latex allergic on testing. Those healthcare workers who completed the questionnaire and answered negatively (195/313) were not tested for latex allergy. Prick tests with the commercial solution were positive in 11 of the 21 subjects studied; prick tests with the eluate of glove, RAST and the use test were positive in all workers; 10 of the 21 sera showed positive immunoblot results. Atopy and a preexisting irritant contact eczema of the hands were present in a high percentage of the workers. CONCLUSION: In this study of healthcare personnel, we found that allergic contact urticaria from latex was present in 21 workers of the 313 (6.7%) who responded to the questionnaire and of the 102 (20.5%) who were tested for latex allergy. Atopy and irritant contact eczema of the hands were frequent in these subjects. Skin prick testing with latex glove eluate and the use test seem to be more sensitive than in vitro testing, particularly immunoblotting, and are biologically more relevant; skin testing with glove eluate must be preferred to testing with a commercial extract.     

The hands in health and disease of individuals with filaggrin loss-of-function mutations: clinical reflections on the hand eczema phenotype

During the last 2 years, we have performed filaggrin genotyping in patients with eczema seen in our hand eczema clinic. We present pictures of healthy and diseased hands from individuals with filaggrin gene (FLG) mutations to describe a clinical entity of hand eczema. We show that xerosis and hyperkeratosis on the dorsal aspects of the hands and fingers, as well as palmar hyperlinearity, should alert the clinician about a possible inherited barrier abnormality of the skin resulting from FLG mutations. The series of photographs range from the hands of an individual with FLG mutations but no history of eczema, to the hands of individuals with typical and atypical filaggrin hand eczema, and finally to the hands of an individual with FLG mutations and hand eczema caused by exposure to irritants and allergens. We briefly discuss this possible subtype of hand eczema, present pathomechanisms, and indicate the signs that should alert the clinicians about a possible inherited skin barrier defect.     

Long-term effectiveness of secondary prevention in geriatric nurses with occupational hand eczema: the challenge of a controlled study design

Background. The high prevalence of occupational dermatoses indicates the need for effective and sustainable prevention strategies. Objectives. To evaluate the long‐term effectiveness of secondary prevention in geriatric nurses. Patients/Methods. One hundred and two geriatric nurses with occupational hand eczema participated in an interdisciplinary prevention programme [intervention group (IG)]. Members of the control group (CG) (n = 107) were medically treated by local dermatologists. Six years after intervention (T2), data on job continuation, skin lesions and skin protection behaviour were obtained by standardized questionnaires and compared with baseline values (T0) and data from a 3‐month follow‐up (T1). Results. At T2, 65.3% of the IG and 56.8% of the CG still worked as geriatric nurses; 6.9% of the IG and 13.6% of the CG had given up work because of occupational hand eczema. The skin status improved in both cohorts. The data indicated a lower frequency of skin lesions and morphological signs in the IG, for example vesicles (IG, 12.8%; CG, 40.0%; χ² = 7.00, degrees of freedom = 1, p = 0.008). Conclusions. The results indicate long‐term effects regarding job continuation and disease severity, although few results showed statistical significance. It is outlined that controlled long‐term studies aiming at proving the general effectiveness of secondary prevention are no longer feasible in Germany, as the statutory accident insurance has led to a legal entitlement of all patients affected by occupational hand eczema to immediate preventive intervention.