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Mossel RM, Naber RJ, van Manen BCT, Rustemeyer T. The prevalence of hand dermatitis among intensive care unit nurses. Contact Dermatitis 2024; 91:30-37. [PMID: 38702937 DOI: 10.1111/cod.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Healthcare workers are at high risk of developing occupational hand dermatitis (HD) due to their frequent exposure to wet-work and use of gloves. Complaints of HD may interfere with work and cause loss of work productivity, or sick leave, and may have impact on job pleasure and performing daily activities. The prevalence of HD among intensive care unit (ICU) nurses is unknown. OBJECTIVES To investigate the point prevalence and the 1-year prevalence of HD among ICU nurses, and to determine the impact of HD on work and daily activities. METHOD A questionnaire-based cross-sectional study was performed among ICU nurses. Participants were recruited in the Amsterdam University Medical Centre. A symptom-based questionnaire was used to determine HD and atopic predisposition, and an additional questionnaire was used concerning the influence of HD. ICU nurses with an atopic predisposition or symptoms suiting HD were invited for the hand dermatitis consultation hour (HDCH). Data were analysed with logistic regression. RESULTS A total of 184 ICU nurses were included. The point prevalence of HD was 9.8% (95% CI: 5.9-15.0) and the 1-year prevalence was 26.6% (95% CI: 20.4-33.6). Sick leave was reported by 0.5%. HD seemed to have more impact on job pleasure than on work productivity. CONCLUSION The high prevalence rate of HD resulting from our study highlights the need for the prevention of occupational HD among healthcare workers.
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Affiliation(s)
- Rosalin M Mossel
- Department of Dermatology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - René J Naber
- Department of Occupational Health and Safety, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Babs C T van Manen
- Department of Occupational Health and Safety, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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2
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Mahato RK, Singh M, Pathak H, Gogoi NR, Kharbithai R, Chowrasia P, Bora PL, Sarkar T, Jana BK, Mazumder B. Emerging nanotechnology backed formulations for the management of atopic dermatitis. Ther Deliv 2023; 14:543-569. [PMID: 37671556 DOI: 10.4155/tde-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Atopic dermatitis is a prevalent chronic skin inflammation affecting 2.1 to 4.1% of adults globally. The complexity of its pathogenesis and the relapsing nature make it challenging to treat. Current treatments follow European Academy of Dermatology and Venerology guidelines, but advanced cases with recurring lesions lack effective therapies. To address this gap, researchers are exploring nanotechnology for targeted drug delivery. Nanoparticles offer benefits such as improved drug retention, stability, controlled release and targeted delivery through the disrupted epidermal barrier. This integrated review evaluates the current state of AD treatment and highlights the potential of novel nano-formulations as a promising approach to address the disease.
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Affiliation(s)
- Ranjit Kumar Mahato
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Mohini Singh
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Hemanta Pathak
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Niva Rani Gogoi
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Rikynjai Kharbithai
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Pinky Chowrasia
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Pankaj Lochan Bora
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Tumpa Sarkar
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Bani Kumar Jana
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
| | - Bhaskar Mazumder
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, 786004, Assam, India
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3
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Haft MA, Park HH, Lee SS, Sprague JM, Paller AS, Cotton CH, Thyssen JP, Eichenfield LF. Diagnosis and Management of Pediatric Chronic Hand Eczema: The PeDRA CACHES Survey. Paediatr Drugs 2023:10.1007/s40272-023-00574-x. [PMID: 37225932 DOI: 10.1007/s40272-023-00574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Chronic hand eczema (CHE) significantly impacts quality of life. Published literature on pediatric CHE (P-CHE) in North America including knowledge on epidemiology and standard evaluation and management is limited. OBJECTIVE Our objective was to assess diagnostic practices when evaluating patients with P-CHE in the US and Canada, produce data on therapeutic agent prescribing practices for the disorder, and lay the foundation for future studies. METHODS We surveyed pediatric dermatologists to collect data on clinician and patient population demographics, diagnostic methods, therapeutic agent selection, among other statistics. From June 2021 to January 2022, a survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA). RESULTS Fifty PeDRA members responded stating that they would be interested in participating, and 21 surveys were completed. For patients with P-CHE, providers most often utilize the diagnoses of irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis. Contact allergy patch testing and bacterial hand culture are the most used tests for workup. Nearly all utilize topical corticosteroids as first line therapy. Most responders report that they have treated fewer than six patients with systemic agents and prefer dupilumab as first-line systemic therapy. CONCLUSIONS This is the first characterization of P-CHE among pediatric dermatologists in the United States and Canada. This assessment may prove useful in designing further investigations including prospective studies of P-CHE epidemiology, morphology, nomenclature, and management.
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Affiliation(s)
- Michael A Haft
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92130, USA
- Department of Dermatology and Pediatrics, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0869, La Jolla, CA, 92093-0869, USA
| | - Helen H Park
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92130, USA
- Department of Dermatology and Pediatrics, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0869, La Jolla, CA, 92093-0869, USA
| | - Stephanie S Lee
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92130, USA
- Department of Dermatology and Pediatrics, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0869, La Jolla, CA, 92093-0869, USA
| | - Jessica M Sprague
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92130, USA
- Department of Dermatology and Pediatrics, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0869, La Jolla, CA, 92093-0869, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Suite 1600, Chicago, IL, 60611, USA
| | - Colleen H Cotton
- Division of Dermatology, Children's National Hospital, 111 Michigan Avenue, NW, Washington, D.C, 20010, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 2B-430, Washington, DC, 20037, USA
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK 2400, Copenhagen, NV, Denmark
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92130, USA.
- Department of Dermatology and Pediatrics, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0869, La Jolla, CA, 92093-0869, USA.
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4
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Bauer A, Worm M. [New guideline and treatment options for hand eczema]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05143-4. [PMID: 37222755 DOI: 10.1007/s00105-023-05143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/25/2023]
Abstract
Due to its high prevalence and associated socioeconomic consequences, hand eczema is a burden for those affected and for society. The various hand eczema subtypes must be differentiated from each other through structured anamnesis and diagnostics in order to initiate cause-related preventive measures in addition to symptomatic therapy. There are new developments in the diagnosis, prevention, and treatment of hand eczema. The diagnostic possibilities are being expanded through molecular methods. Modern topical and systemic therapies offer promising treatment options for patients with atopic but also chronic hand eczema regardless of the underlying etiology.
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Affiliation(s)
- Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitäts AllergieCentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Deutschland
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5
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Koskelo M, Sinikumpu SP, Jokelainen J, Huilaja L. Risk factors of hand eczema: A population-based study among 900 subjects. Contact Dermatitis 2022; 87:485-491. [PMID: 35980390 DOI: 10.1111/cod.14205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Many risk factors such as atopic dermatitis (AD) have shown to associate with hand eczema (HE). However, studies concerning other atopic diseases, parental or longitudinal risk factors of HE are scarce. OBJECTIVES To examine the association between HE and atopic diseases, parental factors, environmental factors (keeping animals, exposure to moulds) and lifestyle factors (obesity, tobacco smoking, alcohol consumption and physical activity) at population level. METHODS Subjects belonging to the Northern Finland Birth Cohort 1966 Study (NFBC1966) (n = 6830) answered a comprehensive health questionnaire. The data was completed with parental information. RESULTS HE was reported in 900 (13.3%) individuals. All atopic diseases, parental allergy, female gender and obesity increased the risk of HE whereas physical activity decreased the risk of HE. A statistically significant association was not found between HE and tobacco smoking or alcohol consumption. CONCLUSIONS All atopic diseases, not only AD, seem to have influence on the presence of HE. In addition, parental and environmental factors associated with HE.
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Affiliation(s)
- Marjut Koskelo
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland and Medical Research Center, PEDEGO Research Group, University of Oulu, Oulu, Finland
| | - Suvi-Päivikki Sinikumpu
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland and Medical Research Center, PEDEGO Research Group, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Laura Huilaja
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland and Medical Research Center, PEDEGO Research Group, University of Oulu, Oulu, Finland
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6
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Voorberg AN, Loman L, Schuttelaar MLA. Prevalence and Severity of Hand Eczema in the Dutch General Population: A Cross-sectional, Questionnaire Study within the Lifelines Cohort Study. Acta Derm Venereol 2022; 102:adv00626. [PMID: 34664079 PMCID: PMC9631254 DOI: 10.2340/actadv.v101.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Data on chronic hand eczema and severity of hand eczema in the general population is scarce. In this cross-sectional study, a questionnaire was sent to 135,950 Lifelines Cohort Study participants, in order to investigate the prevalence and severity of hand eczema in the Dutch general population. In total, 57,798 subjects were included. The lifetime prevalence of hand eczema was 15.0% (95% confidence interval 14.7-15.3), the 1-year prevalence 7.3% (95% confidence interval 7.1-7.6), and the self-reported physician-diagnosed prevalence 6.1% (95% confidence interval 5.9-6.3). The 1-year prevalence of chronic hand eczema was 4.7% (95% confidence interval 4.5-4.9). The majority (56.9%) of the subjects with hand eczema had almost clear at worst ever and the prevalence of severe to very severe hand eczema at worst ever in the general population was 1.9% (95% confidence interval 1.8-2.1). Future epidemiological studies in the general population should include data about chronic hand eczema and severity of hand eczema, as this can provide perspective on the burden of hand eczema.
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Affiliation(s)
| | | | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, PO Box 30 001 NL-9700 RB Groningen, The Netherlands.
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7
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Thyssen JP, Schuttelaar MLA, Alfonso JH, Andersen KE, Angelova-Fischer I, Arents BWM, Bauer A, Brans R, Cannavo A, Christoffers WA, Crépy MN, Elsner P, Fartasch M, Larese Filon F, Giménez-Arnau AM, Gonçalo M, Guzmán-Perera MG, Hamann CR, Hoetzenecker W, Johansen JD, John SM, Kunkeler ACM, Ljubojevic Hadzavdic S, Molin S, Nixon R, Oosterhaven JAF, Rustemeyer T, Serra-Baldrich E, Shah M, Simon D, Skudlik C, Spiewak R, Valiukevičienė S, Voorberg AN, Weisshaar E, Agner T. Guidelines for diagnosis, prevention and treatment of hand eczema. Contact Dermatitis 2021; 86:357-378. [PMID: 34971008 DOI: 10.1111/cod.14035] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Jacob P Thyssen
- Dep. Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jose H Alfonso
- Dep. of Dermatology, Oslo University Hospital, Oslo, Norway.,Dep. of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Klaus E Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Irena Angelova-Fischer
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Alicia Cannavo
- Contact Dermatitis and Occupational Dermatoses, Hospital de Clínicas "José de San Martín", Buenos Aires University, Argentina
| | | | - Marie-Noelle Crépy
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, Paris, France.,Department of Dermatology, University Hospital of Centre of Paris, Cochin Hospital, AP-HP, Paris, France
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine (IPA) of the German Social Accident Insurance, Department of Clinical and Experimental Occupational Dermatology, Ruhr University Bochum, Bochum, Germany
| | | | - Ana M Giménez-Arnau
- Department of Dermatology, Hopsital del Mar, IMIM , Universitat Autònoma de Barcelona
| | - Margarida Gonçalo
- Clinic of Dermatology - University Hospital and Faculty of Medicine, University of Coimbra, Portugal
| | | | - Carsten R Hamann
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital and Kepler University Linz, Linz, Austria
| | - Jeanne Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Amalia C M Kunkeler
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Sonja Molin
- Division of Dermatology, Queen's University, Kingston, Canada
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Jart A F Oosterhaven
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Mili Shah
- Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Angelique N Voorberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tove Agner
- Dep. Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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8
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Wang J, Tischer C, Standl M, Weidinger S, von Berg A, Herberth G, Yew YW, Heinrich J, Schmitt J, Apfelbacher C. Lifetime prevalence and determinants of hand eczema in an adolescent population in Germany: 15-year follow-up of the LISA cohort study. J Eur Acad Dermatol Venereol 2021; 36:547-556. [PMID: 34779040 DOI: 10.1111/jdv.17814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hand eczema is a common inflammatory skin disorder in both adolescence and adulthood. OBJECTIVES We sought to assess the lifetime prevalence of hand eczema and associated exogenous and endogenous risk factors among adolescents in Germany. METHODS This was a cross-sectional study embedded into a prospective population-based birth cohort in four regions of Germany, which recruited healthy neonates born between November 1997 and January 1999. We included 1736 participants who had completed the 15-year follow-up from birth cohort and 84.6% (1468/1736) had clearly reported whether they have ever had hand eczema. All the data were based on questionnaires and blood tests (immunoglobulin E). Multivariable logistic regression analysis was used to examine endogenous and exogenous factors in relation to the lifetime prevalence of hand eczema among adolescents. RESULTS One thousand four hundred and sixty-eight adolescents (715 girls, 48.7%) were included in the final analysis. The lifetime prevalence of hand eczema among adolescents at the age of 15 was 10.4% (95% confidence interval [CI]: 8.9%-12.1%), with a significantly higher lifetime prevalence among girls than boys (12.7% vs. 8.2%, P = 0.005). Multivariable logistic regression analysis indicated statistically significant associations between the lifetime prevalence of hand eczema and having ever been diagnosed with atopic dermatitis (aOR = 1.8, 95% CI: 1.1-2.8) or having ever had dry skin (aOR = 1.9, 95% CI: 1.1-3.1), respectively. No statistically significant independent associations were found between asthma, hay fever, allergy-related clinical symptoms, immunoglobulin E positivity and other exogenous factors in relation to hand eczema. CONCLUSION Our study fills a research gap on the epidemiological burden of hand eczema among adolescents. One out of ten ever suffered from hand eczema until age 15 years indicating that hand eczema constitutes a significant burden in paediatric populations. The role of atopic dermatitis in hand eczema reinforces previous findings. Exogenous risk factors warrant further investigation.
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Affiliation(s)
- J Wang
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - C Tischer
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University, Magdeburg, Germany.,Institute for Evidence-Based Health Resort Medicine and Health Promotion, State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany.,Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany
| | - G Herberth
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany
| | - Y W Yew
- National Skin Centre, Singapore City, Singapore
| | - J Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich, German Center for Lung Research, Munich, Germany.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - J Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
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9
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Girolomoni G, de Bruin-Weller M, Aoki V, Kabashima K, Deleuran M, Puig L, Bansal A, Rossi AB. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis 2021; 12:20406223211002979. [PMID: 33854747 PMCID: PMC8010850 DOI: 10.1177/20406223211002979] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Atopic dermatitis is a heterogeneous disease and resists classification. In this review, we discuss atopic dermatitis nomenclature and identify morphologic phenotypes, which will facilitate correct diagnoses and development of treatment strategies. We support using the term 'atopic dermatitis' rather than eczema, because it describes the allergic background and inflammation ('itis') as drivers of the disease. Atopic dermatitis has many morphologic manifestations that vary by topographic area affected, age, or race and require consideration in differential diagnosis. Different phenotypes based on morphology and topographic location, ethnicity, and age are discussed. A better-defined phenotype identification for atopic dermatitis will facilitate earlier and correct diagnosis of this complex condition and inform selection of the most appropriate treatment choice in an era in which targeted therapies may generate more individualized patient care.
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Affiliation(s)
- Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Piazzale A. Stefani 1, Verona, 37126, Italy
| | - Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center, Utrecht, Netherlands
| | - Valeria Aoki
- Department of Dermatology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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10
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Quaade AS, Simonsen AB, Halling AS, Thyssen JP, Johansen JD. Prevalence, incidence, and severity of hand eczema in the general population - A systematic review and meta-analysis. Contact Dermatitis 2021; 84:361-374. [PMID: 33548072 DOI: 10.1111/cod.13804] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/14/2022]
Abstract
Accurate assessments of the burden of hand eczema (HE) in the general population are important for public awareness and intervention. The aim of this systematic review and meta-analysis was to provide updated estimates of prevalence and incidence, alongside additional epidemiological endpoints on HE in the general population. PubMed, Embase and Web of Science were searched for studies reporting the prevalence and/or incidence of HE in the general population. Proportion meta-analyses were performed to calculate pooled estimates of prevalence, incidence, severity, and the proportion of individuals with HE and a history of atopic dermatitis. Sixty-six studies were included in the quantitative analysis encompassing 568 100 individuals. The pooled estimates for lifetime, 1-year, and point prevalence were 14.5% (95% confidence interval [CI]: 12.6-16.5), 9.1% (95% CI: 8.4-9.8) and 4.0% (95% CI: 2.6-5.7), respectively. The pooled incidence rate of HE was 7.3 cases/1000 person-years (95% CI: 5.4-9.5). The occurrence of HE was 1.5-2 times higher in females than males. More than one third suffered from moderate/severe disease and around one third had a history of atopic dermatitis. HE was a recurrent, long-lasting disease with an average age at onset of the early- to mid-twenties. In conclusion; HE is a highly prevalent disease in the general population and carries a significant risk of long-term or chronic disease.
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Affiliation(s)
- Anna S Quaade
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne B Simonsen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Silvestre Salvador JF, Heras Mendaza F, Hervella Garcés M, Palacios-Martínez D, Sánchez Camacho R, Senan Sanz R, Apellaniz González A, Giménez-Arnau AM. Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. ACTAS DERMO-SIFILIOGRAFICAS 2021; 111:26-40. [PMID: 32197684 DOI: 10.1016/j.ad.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 12/28/2022] Open
Abstract
Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.
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Affiliation(s)
| | - F Heras Mendaza
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Hervella Garcés
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - D Palacios-Martínez
- Medicina de Atención Primaria, Centro de Salud Isabel II, Parla, Madrid, España
| | | | - R Senan Sanz
- Equipo de Atención Primaria el Clot, Instituto Catalán de la Salud, Barcelona, España
| | - A Apellaniz González
- Departamento de Estomatología, Facultad de Medicina y Enfermería, Euskal Herriko Unibertsitatea-Universidad del País Vasco, Leioa, Bizkaia, España
| | - A M Giménez-Arnau
- Departamento de Dermatología, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, España
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12
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Skin Barrier Dysfunction in Contact Dermatitis and Atopic Dermatitis-Treatment Implications. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00264-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Politiek K, Loman L, Pas HH, Diercks GFH, Lemmink HH, Jan SZ, van den Akker PC, Bolling MC, Schuttelaar MLA. Hyperkeratotic hand eczema: Eczema or not? Contact Dermatitis 2020; 83:196-205. [PMID: 32333380 PMCID: PMC7496397 DOI: 10.1111/cod.13572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/25/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
Background Hyperkeratotic hand eczema (HHE) is a typical clinical hand eczema subtype with a largely unknown pathophysiology. Objective To investigate histopathology, expression of keratins (K), epidermal barrier proteins, and adhesion molecules in HHE. Methods Palmar skin biopsies (lesional and perilesional) were obtained from seven HHE patients and two healthy controls. Moreover, 135 candidate genes associated with palmoplantar keratoderma were screened for mutations. Results Immunofluorescence staining showed a significant reduction of K9 and K14 in lesional skin. Upregulation was found for K5, K6, K16, and K17 in lesional skin compared with perilesional and healthy palmar skin. Further, upregulation of involucrin and alternating loricrin staining, both in an extracellular staining pattern, was found. Filaggrin expression was similar in lesional, perilesional, and control skin. No monogenetic mutations were found. Conclusion Currently, the phenotype of HHE is included in the hand eczema classification system; however, it can be argued whether this is justified. The evident expression of filaggrin and involucrin in lesional skin does not support a pathogenesis of atopic eczema. The upregulation of K6, K16, and K17 and reduction of K9 and K14 might contribute to the underlying pathogenesis. Unfortunately, comparison with hand eczema studies is not possible yet, because similar protein expression studies are lacking.
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Affiliation(s)
- Klaziena Politiek
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendri H Pas
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gilles F H Diercks
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henny H Lemmink
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sabrina Z Jan
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter C van den Akker
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Maria C Bolling
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Lagrelius M, Wahlgren C, Bradley M, Melén E, Kull I, Bergström A, Lidén C. Filaggrin gene mutations in relation to contact allergy and hand eczema in adolescence. Contact Dermatitis 2019; 82:147-152. [DOI: 10.1111/cod.13444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/21/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Maria Lagrelius
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
- Region StockholmCentre for Occupational and Environmental Medicine Stockholm Sweden
| | - Carl‐Fredrik Wahlgren
- Dermatology Unit, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Karolinska University Hospital Stockholm Sweden
| | - Maria Bradley
- Dermatology Unit, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Karolinska University Hospital Stockholm Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
- Department of Clinical Science and EducationStockholm South General Hospital, Karolinska Institutet Stockholm Sweden
- Sachs' Children's Hospital Stockholm Sweden
| | - Inger Kull
- Department of Clinical Science and EducationStockholm South General Hospital, Karolinska Institutet Stockholm Sweden
- Sachs' Children's Hospital Stockholm Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
- Region StockholmCentre for Occupational and Environmental Medicine Stockholm Sweden
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
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16
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Holm JG, Agner T, Clausen ML, Thomsen SF. Determinants of disease severity among patients with atopic dermatitis: association with components of the atopic march. Arch Dermatol Res 2019; 311:173-182. [PMID: 30770978 DOI: 10.1007/s00403-019-01895-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
We aimed to explore the association of key clinical characteristics with disease severity in atopic dermatitis (AD) and its relation to components of the atopic march in a large hospital cohort. Outpatients with AD referred to the Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, between January 2012 and December 2017, were compared based on disease severity (SCORAD); mild (< 25), moderate (25-50) and severe (> 50). A total of 470 AD patients were included: 122 small children (< 4 years of age), 103 children/adolescents (age 4-15 years) and 245 adults (> 15 years of age). A significant difference between severity groups in small children was observed for FLG mutation carrier status (16.7 vs. 30.2 vs. 60.0% mutation carriers among patients with mild, moderate and severe AD, respectively, p = 0.012) and self-rated health (3.2 vs. 2.7 vs. 2.8 with 4 being excellent health, p = 0.022). A significant difference between severity groups in adults was observed for male sex (24.4 vs. 39.8 vs. 52.9%, p = 0.003), serum total IgE (577 vs. 1269 vs. 2379 × 103 IU/L, p < 0.001), blood eosinophil count (0.28 vs. 0.39 vs. 0.61 × 109/L, p < 0.001) and asthma (42.9 vs. 38.8 vs. 72.0%, p < 0.001). Early onset of AD (< 1 year of age) and FLG mutation was associated with more severe disease and high serum total IgE levels. In conclusion, the distribution of key clinical characteristics varies significantly according to the severity of AD measured by SCORAD. Sub-typing of AD patients related to determinants of disease severity may be helpful in establishing prognosis and targeted treatment of AD.
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Affiliation(s)
- Jesper Grønlund Holm
- Department of Dermato-venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Tove Agner
- Department of Dermato-venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maja-Lisa Clausen
- Department of Dermato-venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Simon D, Wollenberg A, Renz H, Simon HU. Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019. Int Arch Allergy Immunol 2019; 178:207-218. [DOI: 10.1159/000497383] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/30/2019] [Indexed: 11/19/2022] Open
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18
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Heller E, Murthy AS, Jen MV. A slime of the times: Two cases of acute irritant contact dermatitis from homemade slime. Pediatr Dermatol 2019; 36:139-141. [PMID: 30152559 DOI: 10.1111/pde.13617] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe two cases of acute-onset erythema, peeling, and pruritus or tenderness isolated to the palmar surface of the hands. A detailed exposure history revealed significant periods of contact with homemade slime; given the clinical findings and timing of exposure, acute contact dermatitis of the hands was suspected. Symptoms and clinical findings resolved after avoidance of the suspected causative contactants. There are few if any reported cases of contact dermatitis to homemade slime in the literature; this serves to highlight the importance of a thorough exposure history in the evaluation of hand dermatitis.
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Affiliation(s)
- Elizabeth Heller
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aditi S Murthy
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Melinda V Jen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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19
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Yew YW, Thyssen JP, Silverberg JI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol 2018; 80:390-401. [PMID: 30287309 DOI: 10.1016/j.jaad.2018.09.035] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the commonality of different atopic dermatitis (AD) signs and symptoms. OBJECTIVE To determine the prevalences of AD characteristics and differences by region and age. METHODS A systematic review was performed of all published studies in MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii that analyzed the proportion of AD characteristics. Two reviewers performed a review study titles and/or abstracts and data abstraction. RESULTS In all, 101 studies reported proportion of AD features with sufficient data for meta-analysis. The most prevalent AD features were pruritus, lichenification, and xerosis. There were differences in AD characteristics by study region. Flexural involvement was less commonly reported in India, the Americas, and Iran. Studies from East Asian reported more erythroderma and truncal, extensor, scalp, and auricular involvement. Studies from Southeast Asia reported more exudative eczema, truncal involvement, lichenification, and prurigo nodularis. Studies from Iran reported more head, face, and neck involvement; pityriasis alba; and xerosis. Studies from Africa reported more papular lichenoid lesions, palmar hyperlinearity, ichthyosis, and orbital darkening. LIMITATIONS Heterogeneity between studies and limited reporting of certain AD clinical characteristics. CONCLUSIONS AD characteristics are heterogeneous and vary by region and age.
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Affiliation(s)
- Yik Weng Yew
- Institute of Dermatology, National Skin Centre, Singapore
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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20
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Cazzaniga S, Ballmer-Weber BK, Gräni N, Spring P, Bircher A, Anliker M, Sonntag AK, Piletta P, Huber C, Diepgen TL, Apfelbacher C, Naldi L, Borradori L, Simon D. Chronic hand eczema: A prospective analysis of the Swiss CARPE registry focusing on factors associated with clinical and quality of life improvement. Contact Dermatitis 2018; 79:136-148. [DOI: 10.1111/cod.13041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Simone Cazzaniga
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
- Centro Studio, Italian Group for Epidemiological Research in Dermatology (GISED); Bergamo Italy
- Graduate School for Cellular and Biomedical Sciences; University of Bern; Bern Switzerland
| | - Barbara K. Ballmer-Weber
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
- Faculty of Medicine; University of Zurich; Zurich Switzerland
- Allergy Unit, Clinic of Dermatology and Allergology; Cantonal Hospital St Gallen; St. Gallen Switzerland
| | - Nora Gräni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - Philippe Spring
- Department of Dermatology; University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - Andreas Bircher
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - Mark Anliker
- Clinic of Dermatology and Allergology; Cantonal Hospital St Gallen; St Gallen Switzerland
- Hautärzte am Graben; Winterthur Switzerland
| | | | - Pierre Piletta
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Caroline Huber
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
- Dermatology Office; Versoix Switzerland
| | - Thomas L. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital, Ruprecht Karls University; Heidelberg Germany
| | - Christian Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - Luigi Naldi
- Centro Studio, Italian Group for Epidemiological Research in Dermatology (GISED); Bergamo Italy
- Department of Dermatology; San Bortolo Hospital; Vicenza Italy
| | - Luca Borradori
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
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21
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Ortiz Salvador JM, Subiabre Ferrer D, García Rabasco A, Esteve-Martínez A, Zaragoza Ninet V, Alegre de Miquel V. Hand eczema in children. Clinical and epidemiological study of the population referred to a tertiary hospital. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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22
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Eccema de manos en niños. Estudio clínico-epidemiológico de la población remitida a un hospital terciario. An Pediatr (Barc) 2018; 88:309-314. [DOI: 10.1016/j.anpedi.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/22/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022] Open
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Abstract
Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.
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Affiliation(s)
- Justine Fenner
- Department of Dermatology, Mt Sinai West, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Nanette B Silverberg
- Department of Dermatology, Mt Sinai West, Icahn School of Medicine at Mt Sinai, New York, NY.
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24
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Minami T, Fukutomi Y, Sekiya K, Akasawa A, Taniguchi M. Hand eczema as a risk factor for food allergy among occupational kitchen workers. Allergol Int 2018; 67:217-224. [PMID: 28874315 DOI: 10.1016/j.alit.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND An increasing number of studies in children is highlighting the importance of transdermal routes of exposure to food allergens through damaged skin in the pathogenesis of food allergies. However, data on this in adults are limited. A few case-series studies has documented development of food allergy among kitchen workers with hand eczema after direct contact exposure to foods. METHODS To explore the significance of hand eczema as a risk factor for food allergies in adults at the epidemiological level, we performed a cross-sectional web-based questionnaire survey on kitchen workers whose exposures were classed as occupational (cooks and food handlers, n = 1592) or non-occupational (housewives, n = 1915). Logistic regression was used to explore the association between the presence/severity of hand eczema and the risk of food allergy after adjustment for potential confounders. RESULTS Current hand eczema and current diagnosed food allergy were more common among occupational kitchen workers (OKW) than among non-occupational kitchen workers (NOKW) (32.3%-vs-29.9% and 9.9%-vs-3.8%, respectively). Current hand eczema was significantly associated with increased risk of current diagnosed food allergy in OKW (adjusted odds ratio 2.4, 95% CI 1.6-3.7). Those with more severe hand eczema were more likely to suffer from allergic symptoms for foods, and diagnosed food allergy. CONCLUSIONS This study illustrates a significant public health problem in the adult population, documenting a major impact of hand eczema on the ongoing adult food allergy epidemic.
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25
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Marron SE, Tomas-Aragones L, Navarro-Lopez J, Gieler U, Kupfer J, Dalgard FJ, Lien L, Finlay AY, Poot F, Linder D, Szepietowski JC, Misery L, Jemec GBE, Romanov D, Sampogna F, Szabo C, Altunay IK, Spillekom-van Koulil S, Balieva F, Ali FM, Halvorsen JA, Marijuan PC. The psychosocial burden of hand eczema: Data from a European dermatological multicentre study. Contact Dermatitis 2018; 78:406-412. [PMID: 29464713 DOI: 10.1111/cod.12973] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 12/31/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND The essential physical role, visibility and social importance of the hands place a major psychological burden on patients with hand eczema. OBJECTIVES The aim of this study was to identify the psychological, social and clinical characteristics of patients with hand eczema, in particular the prevalences of depression, anxiety, suicidal ideation, and comorbidities. MATERIALS AND METHODS Data on patients with hand eczema were analysed from a large European multicentre study conducted with dermatology outpatients from 13 countries. Groups of patients and controls were compared to analyse the psychological burden of hand eczema. RESULTS Female patients with hand eczema had higher Hospital Anxiety and Depression Scale (HADS) scores for anxiety (n = 86, median = 7.0) than controls (n = 900, median = 5.0, P = .02), and for depression (median = 4.0) than controls (3.0, P < .001). Patients with high suicidal ideation, with low socioeconomic status and who were widowed or divorced were more likely to fulfil the HADS criteria for anxiety [odds ratio (OR) > 1, P = .038, P < .001, and P < .001, respectively]. The median Dermatology Life Quality Index score was 7.0 (n = 68). DISCUSSION This study identifies a specific psychological burden experienced by hand eczema patients, highlighting the need for focused psychosocial interventions. Physicians in particular should be aware of the need to identify anxiety and depression in female patients.
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Affiliation(s)
- Servando E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Lucia Tomas-Aragones
- Department of Psychology, University of Zaragoza, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Jorge Navarro-Lopez
- Bioinformation Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Uwe Gieler
- Department of Dermatology, Justus Liebig University, Giessen, Germany
| | - Jörg Kupfer
- Institute of Medical Psychology, Justus Liebig University, Giessen, Germany
| | - Florence J Dalgard
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Andrew Y Finlay
- Department of Dermatology and Wound Healing, Cardiff University School of Medicine, Cardiff, UK
| | - Françoise Poot
- Department of Dermatology, ULB Hospital ERASME, Brussels, Belgium
| | - Dennis Linder
- Section of Biostatistics, University of Oslo, Oslo, Norway
| | | | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Francesca Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Csanad Szabo
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Ilknur K Altunay
- Department of Dermatology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey
| | | | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - Faraz M Ali
- Department of Dermatology and Wound Healing, Cardiff University School of Medicine, Cardiff, UK
| | - Jon A Halvorsen
- Department of Dermatology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pedro C Marijuan
- Bioinformation Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
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Ruff S, Engebretsen K, Zachariae C, Johansen J, Silverberg J, Egeberg A, Thyssen J. The association between atopic dermatitis and hand eczema: a systematic review and meta‐analysis. Br J Dermatol 2018; 178:879-888. [DOI: 10.1111/bjd.16147] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
Affiliation(s)
- S.M.D. Ruff
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
| | - K.A. Engebretsen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
- National Allergy Research Centre (Department of Dermatology and Allergy) Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
| | - C. Zachariae
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre (Department of Dermatology and Allergy) Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
| | - J.I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences Feinberg School of Medicine at Northwestern University Chicago IL U.S.A
| | - A. Egeberg
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
- National Allergy Research Centre (Department of Dermatology and Allergy) Herlev and Gentofte Hospital University of Copenhagen Kildegaardsvej 28 DK‐2900 Hellerup Denmark
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Cazzaniga S, Apfelbacher C, Diepgen T, Ofenloch R, Weisshaar E, Molin S, Bauer A, Mahler V, Elsner P, Schmitt J, Ballmer‐Weber B, Spring P, Naldi L, Borradori L, Simon D. Patterns of chronic hand eczema: a semantic map analysis of the
CARPE
registry data. Br J Dermatol 2017; 178:229-237. [DOI: 10.1111/bjd.15660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. Cazzaniga
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
- Centro Studi GISED Bergamo Italy
| | - C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
| | - T. Diepgen
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - R.F. Ofenloch
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - E. Weisshaar
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - S. Molin
- Department of Dermatology and Allergy Ludwig Maximilian University Munich Germany
| | - A. Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - V. Mahler
- Department of Dermatology University Hospital of Erlangen Friedrich Alexander University Erlangen‐Nuremberg Erlangen Germany
| | - P. Elsner
- Department of Dermatology and Dermatological Allergy Friedrich Schiller University Jena Jena Germany
| | - J. Schmitt
- Centre for Evidence‐based Healthcare Medical Faculty Carl Gustav Carus Technical University Dresden Dresden Germany
| | - B.K. Ballmer‐Weber
- Allergy Unit Department of Dermatology University Hospital Zürich Zurich Switzerland
| | - P. Spring
- Department of Dermatology University Hospital of Lausanne CHUV Lausanne Switzerland
| | - L. Naldi
- Centro Studi GISED Bergamo Italy
- Department of Dermatology Papa Giovanni XXIII Hospital Bergamo Italy
| | - L. Borradori
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - D. Simon
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
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28
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Lund TT, Agner T. Hand Eczema: Treatment Options. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lachapelle JM, Gimenez-Arnau A, Metz M, Peters J, Proksch E. Best practices, new perspectives and the perfect emollient: optimizing the management of contact dermatitis. J DERMATOL TREAT 2017; 29:241-251. [DOI: 10.1080/09546634.2017.1370074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Ana Gimenez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma, Barcelona, Spain
| | - Martin Metz
- Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jill Peters
- Integrated Dermatology Service, Ipswich Hospital NHS Trust, Ipswich, United Kingdom
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30
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Halling-Overgaard AS, Zachariae C, Thyssen JP. Management of Atopic Hand Dermatitis. Dermatol Clin 2017; 35:365-372. [DOI: 10.1016/j.det.2017.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Heede NG, Thuesen BH, Thyssen JP, Linneberg A, Szecsi PB, Stender S, Menné T, Johansen JD. Hand eczema, atopic dermatitis and filaggrin mutations in adult Danes: a registry-based study assessing risk of disability pension. Contact Dermatitis 2017; 77:95-105. [DOI: 10.1111/cod.12786] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/16/2017] [Accepted: 02/05/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Nina G. Heede
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Betina H. Thuesen
- Research Centre for Prevention and Health, the Capital Region of Denmark; 2600 Glostrup Denmark
| | - Jacob P. Thyssen
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark; 2600 Glostrup Denmark
- Department of Clinical Experimental Research; Rigshospitalet; 2600 Glostrup Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine; University of Copenhagen; 2200 Copenhagen Denmark
| | - Pal B. Szecsi
- Department of Clinical Biochemistry; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Steen Stender
- Department of Clinical Biochemistry; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Torkil Menné
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
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Minamoto K, Watanabe T, Diepgen TL. Self-reported hand eczema among dental workers in Japan - a cross-sectional study. Contact Dermatitis 2016; 75:230-9. [PMID: 27523777 DOI: 10.1111/cod.12656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dental workers are considered to have a high risk of developing occupational hand eczema. OBJECTIVES To estimate the prevalence of work-related hand eczema and associated risk factors in dental workers in Japan. METHODS A self-administered questionnaire was sent by mail to all dental clinics of Kumamoto City, Japan. In addition, patch testing with 24 dentistry-related allergens was offered. RESULTS In total, 46.4% of dental workers (n = 528: response 31.4%, based on 97 clinics) reported a lifetime history of chronic hand eczema. The 1-year prevalence was 36.2%. According to logistic regression analysis, the most important risk factors for the 1-year prevalence were a personal history of atopic dermatitis [odds ratio (OR) 4.7, 95% confidence interval (CI): 2.2-8.8], asthma and/or allergic rhinitis (OR 2.0, 95%CI: 1.3-3.0), dry skin (OR 1.7, 95%CI: 1.1-2.7), shorter duration of work (OR 2.0, 95%CI: 1.2-3.5 for up to 10 years versus >20 years), and washing hands >10 times per day (OR 1.6, 95%CI: 1.0-2.5). Fifty-four workers were patch tested. Rubber chemicals and acrylates were the most frequent occupationally relevant contact allergens. CONCLUSIONS Dental workers in Japan have a high prevalence of hand eczema. Health education to prevent hand eczema and more frequent patch testing are needed.
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Affiliation(s)
- Keiko Minamoto
- Department of Public Health, Faculty of Life Sciences, Graduate School of Kumamoto University, Kumamoto 860-8556, Japan. ,
| | | | - Thomas L Diepgen
- Department of Social Medicine, Occupational & Environmental Dermatology, University of Heidelberg, 69115 Heidelberg, Germany
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33
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Heede N, Thyssen J, Thuesen B, Linneberg A, Johansen J. Predictive factors of self-reported hand eczema in adult Danes: a population-based cohort study with 5-year follow-up. Br J Dermatol 2016; 175:287-95. [DOI: 10.1111/bjd.14476] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 01/10/2023]
Affiliation(s)
- N.G. Heede
- Department of Dermato-Allergology; The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; Kildegårdsvej 28 2900 Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermato-Allergology; The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; Kildegårdsvej 28 2900 Hellerup Denmark
| | - B.H. Thuesen
- Research Centre for Prevention and Health; The Capital Region of Denmark; Copenhagen Denmark
| | - A. Linneberg
- Research Centre for Prevention and Health; The Capital Region of Denmark; Copenhagen Denmark
- Department of Clinical Experimental Research; Rigshospitalet; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - J.D. Johansen
- Department of Dermato-Allergology; The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; Kildegårdsvej 28 2900 Hellerup Denmark
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34
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Ekzemerkrankungen in der Adoleszenz. Hautarzt 2016; 67:287-92. [DOI: 10.1007/s00105-016-3764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Lagrelius M, Wahlgren CF, Matura M, Kull I, Lidén C. High prevalence of contact allergy in adolescence: results from the population-based BAMSE birth cohort. Contact Dermatitis 2015; 74:44-51. [PMID: 26538115 DOI: 10.1111/cod.12492] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 09/02/2015] [Accepted: 09/21/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Contact allergy is common among adults. However, little is known about the prevalence in adolescents. OBJECTIVES To assess the prevalence of allergy to common contact allergens in Swedish adolescents in the general population. PARTICIPANTS AND METHODS The BAMSE cohort is a population-based birth cohort with the main aim of studying the risk factors for asthma, rhinitis, and atopic dermatitis. Patch testing was performed at the 16-year follow-up. The test (TRUE Test(®) ) was applied at home, and removed 2 days later by nurses, who recorded and photographed the results. Dermatologists made final assessments on the basis of photographs and protocols. RESULTS Two thousand two hundred and eighty-five participants (88% of all 16-year follow-up participants) were patch tested; 15.3% had at least one positive reaction. Contact allergy was more common in girls than in boys (17.0% versus 13.4%, p = 0.018). Sensitization to nickel was most common (7.5%), followed by sensitization to fragrance mix I (2.1%) and p-tert-butylphenol formaldehyde resin (1.9%). Nickel allergy was more frequent in girls (9.8% versus 4.9%, p < 0.001). Solitary sensitization to cobalt was more common than co-sensitization to nickel and cobalt. CONCLUSIONS The prevalence of contact allergy in adolescents is of almost the same high magnitude as in adults. The applied method was feasible in the population-based setting.
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Affiliation(s)
- Maria Lagrelius
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65, Stockholm, Sweden
| | - Carl-Fredrik Wahlgren
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Mihály Matura
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, SE-118 83, Stockholm, Sweden.,Sachs' Children's Hospital, SE-118 83, Stockholm, Sweden
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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36
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Apfelbacher C. Onset and severity of atopic dermatitis, atopy and hand eczema in adolescents. Br J Dermatol 2015; 173:1121-2. [DOI: 10.1111/bjd.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Dr.-Gessler-Str. 17 93051 Regensburg Germany
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