An epidemiological comparison between hand eczema and non-hand eczema

Thirty four per cent of 2110 patients with eczema attending a contact dermatitis clinic presented with hand eczema. An epidemiological comparison was made of patients with hand eczema and non-hand eczema (defined as eczema on parts of the body other than the hands). Occupational eczema was significantly more common in the hand eczema than the non-hand eczema group (P = 0.0011). The prevalence of atopy was the same in both groups (13%). The prevalence of irritant contact dermatitis was higher in the hand eczema group (32%) than the non-hand eczema group (13%) (P less than 0.0001). The rate of allergic contact dermatitis was lower in the hand eczema group (23%) than the non-hand eczema group (39%) (P less than 0.0001). The rate of positive patch test reactions was lower in the hand eczema group (41%) than the non-hand eczema group (56%) (P less than 0.0001). Nickel sulphate (8%), cobalt chloride (3%), potassium dichromate (3%), and fragrance mix (4%) were common allergens encountered in hand eczema group. None of these allergens was specifically more prevalent in the hand eczema than the non-hand eczema group. However, the prevalence of allergy to nickel, colophony, epoxy resin and medicaments was significantly higher in the non-hand eczema group.     

Products for hand hygiene and antisepsis: use by health professionals and relationship with hand eczema

Hand hygiene is the most important measure for the prevention of nosocomial infection. We describe the different products available for hygiene and antisepsis of the hands and the use of these products in daily practice. Hand hygiene products such as soaps and detergents are a cause of irritant dermatitis in health professionals. This irritation is one of the principal factors affecting their use in clinical practice. Alcohol-based products are better tolerated and less irritant than soap and water; irritation should not therefore be a limiting factor in the use of these products and they are to be recommended in place of soap and water. Informative and continued education programs could increase their use.     

An epidemiological comparison between occupational and non-occupational hand eczema

Thirty-four per cent of 2110 patients with eczema attending a contact dermatitis clinic had hand eczema. Fifty-five per cent (395 of 721) had contact dermatitis and 45% (326 of 721) had endogenous/unclassifiable eczema. Thirty-five per cent of cases (217 of 721) were occupational eczema. An epidemiological comparison of patients with occupational and non-occupational hand eczema (defined as eczema occurring on the hands up to the wrist line) was made. Hand eczema was more common in males in both groups, and there was a significantly larger proportion of males in the occupational group (65%) than the non-occupational group (51%) (P less than 0.001). The prevalence of a personal or family history of atopy was significantly lower in the occupational group (7%) than the non-occupational group (15%) (P less than 0.005). Irritant contact dermatitis occurred in a larger proportion of patients in the occupational group (76%) than the non-occupational group (39%) (P less than 0.0001). There was no significant difference between the proportions of patients with positive patch test reactions in the occupational group (34%) and the non-occupational group (41%). Potassium dichromate, and epoxy resin allergy occurred significantly, more frequently, in the occupational group whereas fragrance-mix allergy was significantly more frequent in the non-occupational group.     

Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood

A series of 955 persons aged 24-44 years, with atopic dermatitis in childhood, were interviewed in order to identify factors which increase the risk of developing hand eczema in adult life, or aggravate already existing hand eczema. Endogenous (constitutional) factors were in general of greater importance than exogenous factors, viz. chemicals, water, soil and wear (friction). Eczematous involvement of the hands in childhood was of predominant importance. In individuals without such involvement, severe (widespread) dermatitis in childhood was a dominant factor. Other factors, each of them significantly more important than the exogenous ones, were persistent eczema on other parts of the body and dry/itchy skin. The factors female sex, family history of atopic dermatitis and simultaneous bronchial asthma/allergic rhinitis were associated with increased risk of developing hand eczema in adult life, but were of limited importance compared with the other endogenous and the exogenous factors.     

Sensitization in atopic and non-atopic hairdressers with hand eczema

To investigate the capability of atopics to be sensitized to contort allergens, 143 hairdressers With hand eczema, who had been patch tested with The hairdresser's series, were studied. The 125 women and 18 men were grouped according to their personal atopic Status. There were 45 eczematous atopics, 32 mucous membrane atopics and 66 non-atopics, Sensitization to at least one of the hairdressing chemicals was found in 60% of the eczematous atopics, 53% of the mucous membrane atopics and 58% of the non-atopics The commonest sensitizer in each group was glyceryl monothioglycolate followed by para-phenylenediamine and related dyes. None of the 18 men were allergic to nickel but 40% of the women were thus sensitized. Jewelry rather than equipment was thought to be the cause No significant difference was found between the eczematous atopics, mucous membrane atopics and non-atopics in their capacity to be sensitized to hairdressing allergens or to nickel.     

Atopic background in patients with occupational hand eczema

Of 368 patients with hand eczema examined during the years 1978-79, at a Department of Occupational Dermatology, 39% had a history of atopic disease (dermatitis, asthma, or rhinitis). 28% of the patients had or had had atopic dermatitis. The % of atopics in the patient material was highest in the age range 20-24 years, in which 57% of the patients had a history of atopic dermatitis, compared with only 11% in the age range above 35 years. Of all patients with a history of atopy, 22% had developed allergic contact dermatitis, while the corresponding figure for non-atopics was 45% (p less than = 0.001). Positive patch test reactions occurred in a significantly smaller number of individuals with past or present atopic disease than in non-atopics. Atopics had not changed jobs because of hand eczema to a greater extent, but had healed to a lesser extent after change of occupation than non-atopics (p less than 0.01).     

Occupational contact dermatitis in nurses with hand eczema

Occupationally related dermatitis is a common problem in nurses, who are exposed to a wide variety of allergenic and irritant substances. In a group of 44 nurses with hand dermatitis (40 female, 4 male), 18 were thought to have a predominantly allergic contact dermatitis, 15 an irritant dermatitis, 7 other form of eczema, 3 atopic dermatitis and one pompholyx. 10 of the 15 irritant cases were diagnosed as occupational. Of the 18 patients with allergic contact dermatitis, the allergens were thought to be occupationally relevant in 8 cases. In 6 of these 8 the dermatitis was due to natural rubber latex (3) or other rubber chemicals (3). 2 had additional evidence of immediate-type hypersensitivity to natural rubber latex (one was patch test allergic to latex, the other to thiuram mix). Natural rubber latex allergy, both delayed and immediate, is a significant problem, and nurses at risk should be tested for both types of hypersensitivity, as well as being patch tested to standard, rubber and medicaments series.     

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.     

手部湿疹的诊断与评估新进展

手部湿疹是皮肤科的常见病,发病率高,中青年女性多发.其病因复杂多样,刺激原、过敏原、特应性体质等是常见的发病因素.手部湿疹的临床表现多样,瘙痒及疼痛是其主要症状.目前尚无统一的分类方法,包括病因学分类及形态学分类等,临床上更多采用混合模式对手部湿疹进行分类.适当的评分系统可有效评估手部湿疹的严重程度及其疗效,目前常用的评分系统包括:手部湿疹严重指数、Osnabrueck手部湿疹严重指数、职业性接触性皮炎的疾病严重程度指数及皮肤病生活质量指数.手部湿疹主要根据详细采集病史、观察临床表现,结合必要的实验室检查进行诊断.     

Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left–right comparison

OBJECTIVE: Dyshidrotic hand eczema is a therapeutic challenge. A prospective pilot study was performed with left-right comparison in order to investigate whether chemical de-innervation of sudoriferic nerves would be superior to standard therapy with topical corticosteroids. BACKGROUND: Botulinum toxin A (BTXA) is a potent inhibitor of acetylcholine release, that induces eccrine sweat production and release. Inhibition of sweating by other measures such as tap water iontophoresis has been shown to be beneficial in dyshidrotic hand eczema. METHODS: Eight adult patients suffering from dyshidrotic hand eczema (atopic type) were included in a prospective, side-by-side controlled clinical pilot study using topical corticosteroids on both hands in combination with intracutaneous injections of 100 units of BTXA (Botox) on the more severely affected hand on day 1. The dyshidrotic hand eczema was classified using the DASI (Dyshidrotic Eczema Area and Severity Index) before treatment (0), after 1 week, 4 weeks and 8 weeks. RESULTS: Six patients completed the study, two dropped out because of social and personal reasons. The mean DASI score changed from 28 to17 with topical therapy alone and from 36 to 3 with adjuvant BTXA (P < 0.01). Itching and vesiculation were inhibited earlier when using the combination of corticosteroids and BTXA. There was one relapse in the corticosteroid group. Relapses have not been seen in the BTXA group. CONCLUSIONS: Interruption of sweating by BTXA improves the outcome and reduces relapses in patients with dyshidrotic hand eczema. BTXA is antipruritic as well suggesting that it does not only interact with acetylcholine release but substance P.     

Psychosomatic aspects of parent-child relations in atopic eczema in childhood. I. Psychodiagnostic test procedures in parents and children in comparison with somatic findings

A total of 23 children with atopic eczema and 13 control children suffering from non-atopic dermatological disorders were studied. For children between 8 and 14 years the "Hamburg neuroticism and extraversion scale for children and adolescents" (HANES-KJ) was used. In this test no statistically significant differences were observed between children with atopic eczema and children with other dermatological disorders. The mothers and fathers of atopic children were examined for personality profiles using the "Freiburger personality inventory" (FPI). In the FPI, mothers of children with atopic eczema were shown to be less "spontaneous", more "under control" and less "emotional" than the normal population. The fathers of atopic children showed now significant differences compared with the normal population; however, there was a trend towards increased "irritability". In a comparison of FPI profiles within couples with atopic children, mothers showed less "somatic emotional response" in the FPI profile, while the feature "emotional control" was more prominent in the mothers as compared with the respective fathers.(ABSTRACT TRUNCATED AT 250 WORDS)     

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

BACKGROUND: Hand eczema is a skin disease often with a long-lasting and relapsing course. The long-term prognosis in the general population is unknown. OBJECTIVES: The aims were to examine the extent to which hand eczema had persisted and the medicosocial consequences of the disease. METHODS: In a 15-year follow-up of hand eczema, patients diagnosed in a previous population-based study were sent a questionnaire with 20 questions concerning the persistence and course of the disease, and its occupational and medicosocial consequences. RESULTS: Addresses were available for 1115 persons, of whom 868 answered the questionnaire. Sixty-six per cent of the respondents reported periods of hand eczema and 44% reported symptoms during the previous year, with no sex difference. Twelve per cent reported continuous eczema. However, 74% of those reporting symptoms considered that their hand eczema had improved; of these more were women than men (78% vs. 66%, P < 0.01). Twenty people, 3% of those who were gainfully employed in 1983, reported a change to another occupation because of their hand eczema, 15 of these reporting improvement after the job change. A considerable need for medical consultation was reported, as was the influence on psychosocial functions among those who had eczema the previous year, e.g. sleep disturbances (36%) and hampered leisure activities (72%). Job changes related to hand eczema and psychosocial impairment were also reported by individuals who had not sought medical help for their hand eczema. CONCLUSIONS: This study demonstrates a variable and poor long-term prognosis for hand eczema in the general population. One-third sought medical care during follow-up, while the vast majority with ongoing hand eczema experienced negative psychosocial consequences. For about 5%, the hand eczema gave far-reaching consequences including long sick-leave periods, sick pension and changes of occupation.     

Nickel feeding in nickel-sensitive patients with hand eczema.

Ten women with vesicular hand eczema and delayed hypersensitivity to nickel were given 0.5 mg nickel supplements to their diets. The double-blind controlled supplements were given on Monday and Tuesday of each week for at least 1 month. The nickel supplement was lower than that used in previous studies, and only one subject had reproducible flaring of her vesicular dermatitis. We conclude that dietary restriction of nickel is not warranted based on nickel supplement studies, but nickel's role in hand eczema could be clarified by depleting nickel from body stores with chelating agents.     

Prognosis in nickel allergy and hand eczema

63 female patients with nickel allergy and hand eczema were reinvestigated 6 years after the primary investigation. 30% of the patients were healed. Patients with the pompholyx-type eczema had the worst prognosis. The start of hand eczema was not correlated to any particular occupation. There was a strong correlation between a history of metal sensitivity and a positive patch test reaction. High frequencies of personal and family atopy were found, and atopy made the prognosis worse. Determination of serum IgE was not found to be of any use in predicting the prognosis in patients with nickel allergy and hand eczema.