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Grant L, Seiding Larsen L, Burrows K, Belsito DV, Weisshaar E, Diepgen T, Hahn-Pedersen J, Sørensen OE, Arbuckle R. Development of a Conceptual Model of Chronic Hand Eczema (CHE) Based on Qualitative Interviews with Patients and Expert Dermatologists. Adv Ther 2020; 37:692-706. [PMID: 31956966 PMCID: PMC7004418 DOI: 10.1007/s12325-019-01164-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Chronic hand eczema (CHE) is a relapsing inflammatory dermatologic disease. Signs and symptoms can have a significant impact on patients' health-related quality of life (HRQoL). The aim of this study is to characterize the core signs, symptoms and impacts of CHE to develop a conceptual model. METHODS A structured literature search and qualitative interviews with 20 adult CHE patients in the US and 5 expert dermatologists were conducted to explore the patient experience of CHE signs, symptoms and impacts. Findings were used to support the development of a conceptual model. RESULTS There was a paucity of CHE qualitative research in the literature, supporting the need for the prospective qualitative research. The primary signs and symptoms identified from the literature review and interviews included itch, dryness, cracking, pain, thickened skin and bleeding. The most salient impacts included embarrassment and appearance concerns, frustration, impacts on work and sleep disturbance. Saturation was achieved for all signs, symptoms and impact concepts. CONCLUSIONS Findings from this literature review and in-depth qualitative interviews supported the development of a comprehensive conceptual model documenting the signs, symptoms and impacts relevant to CHE patients. Such a model is of considerable value given the lack of existing studies in the literature focused on the qualitative exploration of the CHE patient experience. Limitations included the patient sample being only from the US and not including some CHE subtypes.
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Dissemond J, Bültemann A, Gerber V, Jäger B, Münter C, Kröger K. [Further definitions and spelling of the wound treatment]. Hautarzt 2019; 68:415-417. [PMID: 28275811 DOI: 10.1007/s00105-017-3956-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang X, Shi XD, Li LF, Zhou P, Shen YW. Classification and possible bacterial infection in outpatients with eczema and dermatitis in China: A cross-sectional and multicenter study. Medicine (Baltimore) 2017; 96:e7955. [PMID: 28858126 PMCID: PMC5585520 DOI: 10.1097/md.0000000000007955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known about the classification and bacterial infection in outpatients with eczema and dermatitis in China.To investigate the prevalence of eczema and dermatitis in outpatients of dermatology clinics in China, examine classification and proportion of common types of dermatitis and the possible bacterial infection, and analyze the possible related factors.Outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in mainland China from July 1 to September 30, 2014, were enrolled in this cross-sectional and multicenter study. Among 9393 enrolled outpatients, 636 patients (6.7%) were excluded because of incomplete information.The leading subtypes of dermatitis were unclassified eczema (35.5%), atopic dermatitis (13.4%), irritant dermatitis (9.2%), and widespread eczema (8.7%). Total bacterial infection rate was 52.3%, with widespread eczema, stasis dermatitis, and atopic dermatitis being the leading three (65.7%, 61.8%, and 61.4%, respectively). Clinically very likely bacterial infection has a significant positive correlation with disease duration, history of allergic disease, history of flexion dermatitis, and severe itching.Atopic dermatitis has become a common subtype of dermatitis in China. Secondary bacterial infection is common in all patients with dermatitis, and more attentions should be paid on this issue in other type of dermatitis apart from atopic dermatitis.
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Oh SH, Bae BK, Kim TG, Kwon YS, Lee JH, Lee KH. Effective Treatment of Facial Redness Caused by Atopic Dermatitis Using Intense Pulsed Light Systems. Dermatol Surg 2010; 36:475-82. [PMID: 20236297 DOI: 10.1111/j.1524-4725.2010.01482.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Werfel T. [Classification, trigger factors and course of chronic hand eczema]. MMW Fortschr Med 2009; 151:31-34. [PMID: 19827441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Chronic Disease
- Dermatitis, Allergic Contact/diagnosis
- Dermatitis, Allergic Contact/etiology
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/etiology
- Dermatitis, Contact/diagnosis
- Dermatitis, Contact/etiology
- Dermatitis, Contact/therapy
- Dermatitis, Occupational/diagnosis
- Dermatitis, Occupational/etiology
- Diagnosis, Differential
- Eczema/classification
- Eczema/etiology
- Eczema/therapy
- Hand Dermatoses/classification
- Hand Dermatoses/etiology
- Hand Dermatoses/therapy
- Humans
- Proteins/adverse effects
- Quality of Life
- Recurrence
- Skin Tests
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Blondeel A. [Eczematous dermatitis: contact or/and atopy...]. REVUE MEDICALE DE BRUXELLES 2008; 29:383-388. [PMID: 18949992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The diagnosis of eczema and its etiology is mainly based on patient's history and meticulous clinical examination. The careful anamnesis should include all personal and familial signs of atopy and all patient's contacts mainly localised on the eczematous skin. Many investigations may help us to better understanding of this complex problem: blood examination (total IgE, Rast), prick-tests, epicutaneous or patch-tests (PT), semi-open tests (SOT) for potentially irritant products and repeated open application tests (ROAT) made by the patient himself. This tests will never be made systematically but always depends on the patient's history and the clinical examination.
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Buchanan P, Courtenay M. Topical treatments for managing patients with eczema. Nurs Stand 2007; 21:45-50. [PMID: 17633342 DOI: 10.7748/ns2007.06.21.41.45.c4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article describes the management of patients with eczema and emphasises how to assess the skin and prescribe treatments appropriately.
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Fischer T. [The correct name is eczema!]. LAKARTIDNINGEN 2006; 103:1634; author reply 1634. [PMID: 16800094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Williams HC, Johansson SGO. Two types of eczema—or are there? J Allergy Clin Immunol 2005; 116:1064-6. [PMID: 16275377 DOI: 10.1016/j.jaci.2005.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 08/10/2005] [Indexed: 10/25/2022]
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Frydenberg AR, Buttery JP, Royle J. Determining the rate of varicella vaccine rash in children with moderate-severe eczema. J Paediatr Child Health 2005; 41:561-3. [PMID: 16398837 DOI: 10.1111/j.1440-1754.2005.00721.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the rate and severity of vesicular reactions following varicella vaccine in children with moderate-severe eczema. Secondary endpoints included the rates and severity of local reactions and eczema severity change within 42 days of vaccination. METHODS Prospective open intervention pilot study of varicella vaccine in children aged 12 months to 13 years with moderate-severe eczema. Children were given varicella vaccine alone and followed for 42 days after vaccination. RESULTS Fifty children, aged 12 months to 10.5 years were recruited, with complete follow-up for 48. A vesicular rash with a single lesion occurred in one child (2.1% (95% CI: 0, 11.1%)), 10 days following vaccination. Local reactions, including erythema, swelling and tenderness, were reported in eight children (16.7%). A flare-up of moderate-severe generalized eczema was reported in one child (2.1%) during the first week following varicella vaccine. CONCLUSIONS Vesicular rash and local reactions following varicella vaccination were no more common or severe in children with moderate-severe eczema than that reported in the published literature in children without eczema. Eczema in the 42 days following vaccination did not appear to increase in severity.
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Falade AG, Olawuyi JF, Osinusi K, Onadeko BO. Prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 6- to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood. Med Princ Pract 2004; 13:20-5. [PMID: 14657614 DOI: 10.1159/000074046] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2002] [Accepted: 03/01/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and eczema in Nigerian children aged 6-7 years. SUBJECTS AND METHODS A cross-sectional study of selected children in primary schools in Ibadan, Nigeria was conducted using phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) format. Standardized questionnaires were distributed to parents and guardians of 2,325 children aged 6-7 years in 31 primary schools randomly selected among 272 in Ibadan. RESULTS Data was collected from 1,704 children (797 boys and 907 girls; M:F ratio 1:1.14), giving a participation rate of 73.3%. Both recent rhinoconjunctivitis and wheeze were reported by 5.1%, and itchy flexural rash in the past 12 months was reported by 8.5%. The cumulative prevalences of reported symptoms of wheezing, rhinitis and eczema were 7.2, 11.3 and 10.1%, respectively. These symptoms were basically the same among the boys and girls (rhinitis 11.4 vs. 11.2%; eczema 10.7 vs. 9.5%), except for wheezing, which was higher in boys (9.0%) than girls (5.6%), p = 0.015. Current symptoms of rhinitis and atopic eczema were associated with current wheeze and severe wheezing, whereas current symptoms of allergic rhinoconjunctivitis were only associated with severe wheezing attacks. One or more current symptoms occurred in 13.2% of the children, and all three symptoms were reported by 0.5%. CONCLUSION The study demonstrates a high prevalence of atopic conditions among children 6-7 years old in Ibadan, Nigeria, with more than three fifths of the children who had current wheezing also showing symptoms of other atopic diseases. Children with allergic rhinoconjunctivitis were more likely to have severe wheezing attacks if they had developed atopic eczema before 2 years of age.
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Kang YC, Lee S, Ahn SK, Choi EH. Clinical manifestations of hand eczema compared by etiologic classification and irritation reactivity to SLS. J Dermatol 2002; 29:477-83. [PMID: 12227480 DOI: 10.1111/j.1346-8138.2002.tb00312.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hand eczema is a common skin disease. Because of its variable etiologies and clinical manifestations, it is difficult to determine the etiology from the clinical manifestation. Among the contact allergens, nickel is the most common. Patients with hand eczema and a nickel allergy have a poorer prognosis than patients without a nickel allergy. The reason is still uncertain; suggestions include persistent exposure to nickel or a weak skin barrier. The purpose of our study was to identify the characteristic clinical manifestations by etiology and to compare the skin barrier state between patients with nickel allergies and those without them. Ninety-three patients were classified into 4 types; irritation contact type, allergic contact type, atopic type and mixed type. After the sodium lauryl sulfate (SLS) test to compare the skin barrier state, visual score and transepidermal water loss (TEWL) were measured and analyzed statistically. From this study, it was not possible to ascertain a statistical difference, however a few characteristic clinical manifestations according to etiology can be stated. There was no difference in the visual scoring system or the TEWL after the SLS irritation test between the nickel-allergy group and the non-allergy group. Therefore, we believe that the poor prognosis of hand eczema with nickel allergy may be due to the nickel allergy itself rather than skin barrier state.
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Abstract
SUMMARY. Childhood rates for admission and readmission for asthma are highest under the age of 5 years. From a registration study in 0-4-year-olds, 100 patients (68 male) were admitted to hospital for asthma and followed for 1 year, yielding a total of 136 admissions. To examine factors that may play a role in admissions and readmissions, histories and laboratory tests for atopic status at initial presentation, and clinical data on admission were evaluated. Age groups 0-1 year (n = 54) and 2-4 years (n = 46) were analyzed separately, of whom 20 (37%) and 9 (20%) patients, respectively, had at least one readmission. In the age group 2-4 years, patients with antibodies against inhalant allergens, determined by radioallergosorbent test (RAST), had a significantly higher risk of readmission (RR = 1.54; 95% CI, 1.22-1.95). In the age group 0-1, year prevalence of sensitization to inhalant allergens was low (20% vs. 72% in age group 2-4 years) and constituted only a slight risk (P = 0.097) for readmission. A history of eczema showed a negative association in the age group 0-1 year. Treatment of the first admission did not differ between children only admitted once and those requiring readmission. In both age groups, clinical features at admission did not differ significantly between first and subsequent admissions, and neither did length of stay. Number of readmissions were higher in the age group 0-1 year than in the age group 2-4 years (27/81 (33%) vs. 9/55 (16%), P = 0.028), with no indication of a lower threshold for admission. In the age group 0-1 year, 60% of the readmissions occurred within 2 months of first hospitalization. Moreover, in the age group 0-1 year a trend was observed that inhaled steroids were prescribed less frequently on discharge following first admission in those children who were readmitted than in the children who had a first admission only (4/20 (20%) vs. 15/34 (44%), P = 0.073). More "aggressive" therapy with anti-inflammatory drugs and close medical follow-up after discharge seem to be indicated.
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Abstract
Older people face many problems in terms of skin care and can suffer from a number of distressing conditions. Annabel Smoker describes the management of the most common chronic conditions and suggests ways that nurses can assist older patients or their carers to alleviate or prevent these conditions.
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Abstract
Patients with intractable eczema are often referred for patch testing to exclude contact dermatitis. If this is excluded, then a diagnosis of endogenous eczema is made. At our clinic, we find a sizeable proportion of these patients do not fit any of the known patterns of endogenous eczema. These patients are given the diagnosis of unclassified endogenous eczema and make up 8% of the patients seen at our Occupational and Contact Dermatitis Clinic. There is little information available on this group of patients, with no mention of this problem in the recent dermatological literature. Since March 1996, we have further investigated these patients, to develop some understanding of this category. 12 of 34 patients reviewed over this period had an elevated IgE level above 100 IU/ ml. Thus, despite no past history or family history of eczema, asthma or hayfever, at least 1/3 of these patients are probably suffering from atypical, late onset atopic dermatitis. Patients were later contacted by telephone (average 2 years) to assess the natural history of this condition. In 20 of the 31 patients contacted, their eczema had either improved or resolved. We think that this important category of eczema needs to be recognized and further investigated.
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Watts J. Out on a limb. NURSING TIMES 1998; 94:63, 66. [PMID: 10036521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Duarte I, Terumi Nakano J, Lazzarini R. Hand eczema: evaluation of 250 patients. AMERICAN JOURNAL OF CONTACT DERMATITIS : OFFICIAL JOURNAL OF THE AMERICAN CONTACT DERMATITIS SOCIETY 1998; 9:216-23. [PMID: 9810022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Hand eczema (HE) is a chronic multifactorial dermatosis with the presence of endogenous and exogenous factors in its pathogenesis. The etiologic diagnosis of hand eczema is often difficult. OBJECTIVES The objectives of this study were (1) to detect clinical history and clinical examination data capable of differentiating HE types; (2) to determine the importance of patch tests for the etiologic diagnosis of HE; and (3) on the basis of the definitive diagnosis of HE type with the aid of patch tests, to obtain relevant data for appropriate patient guidance for the control of HE. METHODS A total of 250 patients with HE were studied over a period of 3 years (1993 to 1995). All patients were submitted to the battery of patch tests. RESULTS AND CONCLUSIONS The results obtained led to the following conclusions: (1) Women are more predisposed to HE. (2) Work under moist conditions favors HE. (3) With respect to the regional location of HE, any region may be involved in any type of HE; however, involvement of the dorsal region is more common in allergic contact dermatitis (ACD), followed by contact dermatitis owing to primary irritation (ICD) and atopic dermatitis (AD). Location of HE on the dorsal surface of the fingers was mainly observed in ACD, followed by ICD and AD. (4) Patch tests should be part of the investigative routine of HE etiology. (5) The presence of allergy to metals in the clinical history of the patient is a relevant feature, because patch tests confirmed sensitization to nickel in 89% of cases. (6) Rubber components have high sensitization frequency in patients with HE. (7) When the patient reports worsening of HE after the use of rubber gloves, this indicates a probable sensitization to rubber components, mainly in patients with AD.
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Abstract
An update on skin care for patients with chronic leg ulcers
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Grosshans E. [The allergic skin]. LA REVUE DU PRATICIEN 1996; 46:968-73. [PMID: 8762233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The main cutaneous manifestation of allergy is eczema. In atopic dermatitis, the epidermal Langerhans cells express receptors for IgE and the eczematous lesions may be associated with other atopic disorders such as asthma or pollinosis. In contact dermatitis, the epidermal Langerhans' cells play the role of antigen-presenting cells; the antigens eliciting the eczematous lesions may be of occupational, vestimentary, cosmetical, therapeutical or other environmental origin. Epicutaneous test procedures enable their identification. Paraptic eczema is a concept including all the cutaneous and systemic complications of contact dermatitis.
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Abstract
This article outlines the principles of the treatment and management of eczema including the practical aspects of nursing patients with eczema. Awareness of basic dermatological nursing skills is important for all nurses as is an understanding of how to provide support and advice to patients and their families.
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Altekrueger I, Ackerman AB. "Eczema" revisited. A status report based upon current textbooks of dermatology. Am J Dermatopathol 1994; 16:517-22; discussion 523-31. [PMID: 7802166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Tamiya Y. [Hand eczema. The clinical classification of the roles of exogenous and endogenous factors in each type]. NIHON IKA DAIGAKU ZASSHI 1994; 61:286-94. [PMID: 8083333 DOI: 10.1272/jnms1923.61.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hand eczema is one of the most common dermatological disorders. Although it is a general term referring to eczematous dermatitis of the hands, it actually covers a wide range of diseases. The classification of hand eczema is controversial even now, as definitions of individual diseases have not yet been established. It is well-known that exogenous factors, such as chemicals or water, are associated with the occurrence of hand eczema. In this study, we focused on endogenous factors, especially personal or family history of atopy as a causative factor in hand eczema. According to exogenous and endogenous factors, we classified hand eczema into three types: atopic dermatitis, contact dermatitis and dysidrosis. This classification is useful because it makes the definition of each disease clear. Skin-humidity and sebum measurement are simple and rapid methods of determining personal atopy, skin condition and the effect of treatment on hand eczema patients.
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Goh CL, Chua-Ty C, Koh SL. A descriptive profile of eczema in a tertiary dermatological referral centre in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 1993; 22:307-15. [PMID: 8373109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A retrospective study of 25,448 new cases of patients with various types of eczemas seen over a two-year period (1989-1990) was conducted. This represented 34.1% of new cases (74,589) seen at the Centre. The M:F ratio was 1:1. Occupational and ethnic distribution did not differ from that of the total outpatient population. 67% were endogenous eczema. Among the endogenous eczema, the majority (70%) were either non-specified endogenous eczema, hand and feet eczema or atopic dermatitis. 13.7% were contact dermatitis. Of these, 50% were non-specified contact dermatitis, 39% were irritant contact dermatitis and 11% were allergic contact dermatitis. Unskilled workers (19.1%) and housewives (12%) had the highest proportion for contact dermatitis. Exfoliative dermatitis (0.5% of all eczemas) was commonest among the elderly (68.3%) and Malays (19.7%). The prevalence of endogenous eczema had increased sharply from 31% in 1973 to 67% in 1989/90. In contrast, the proportion of exogenous eczemas over all eczemas seen has decreased from 48% to 15.4% (1973 to 1989/90).
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