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Siewertsen M, Näslund-Koch C, Duus Johansen J, Simonsen AB, Nguyen TT, Zachariae C, Skov L, Loft N. Psychological burden, anxiety, depression and quality of life in patients with hand eczema: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024. [PMID: 38808968 DOI: 10.1111/jdv.20140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/21/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Living with hand eczema (HE) has been associated with impaired quality of life (QoL), having anxiety and depression but the magnitude of association is not clear. OBJECTIVES The aim of this systematic review and meta-analysis was to determine the psychological burden in terms of anxiety, depression and quality of life in patients with HE. METHODS Several databases were systematically searched. Weighted means with standard deviation (SD) were calculated for disease severity, QoL, depression and/or anxiety scores among patients with HE. For studies presenting QoL, depression and/or anxiety scores in patients with HE and in controls the weighted means were compared with an unpaired t-test. In studies reporting Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI), the correlation between HECSI and DLQI was estimated using Spearman's rank correlation (rs). RESULTS In total, 81 studies encompassing 17,835 patients with HE and 31,541 controls were included. The weighted mean DLQI was 10.66 (SD 8.93) corresponding to a moderate-to-large effect on QoL and a strong correlation (rs: 0.76, 95% CI:0.56-0.87) between DLQI and HECSI was observed. The mean EQ-5D-VAS was significantly lower in patients with HE compared with controls (68.03 (SD 10.52) vs. 80.63 (SD 1.17), p < 0.00001). Patients with HE had higher mean HADS (Hospital Anxiety and Depression Scale) anxiety score (7.4 vs. 5.8, p = 0.0008) than controls but not higher HADS depression score (6.5 vs. 5.7, p = 0.32). Only one study assessed risk of anxiety, depression and suicidal ideation showing an increased odds of all diseases among patients with HE compared with controls. CONCLUSION Hand eczema has a moderate-to-severe impact on quality of life with a strong correlation between disease severity and impact on quality of life. Patients with hand eczema have an impact on QoL comparable to other chronic diseases when measured with generic QoL scoring systems.
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Affiliation(s)
- Mie Siewertsen
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Charlotte Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanne Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Thi Thao Nguyen
- Unit of Social Medicine, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Loft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
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Borg E, Munro D, Thoning H. The management of Chronic Hand Eczema: A retrospective patient record review. Contact Dermatitis 2024; 90:365-371. [PMID: 38164049 DOI: 10.1111/cod.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Chronic Hand Eczema (CHE) is a heterogeneous fluctuating inflammatory disease that represents a significant burden. Effective treatment options for moderate to severe CHE are limited. OBJECTIVES To assess how patients with moderate to severe CHE are treated in clinical practice. METHODS A retrospective, physician-led patient record review assessed the demographic, clinical and treatment characteristics of patients aged ≥18 years with CHE across seven countries. Each participating physician was requested to review records for their three most recent patients with moderate to severe CHE treated with a topical or systemic therapy. RESULTS A total of 264 physicians, of whom 88.6% were dermatologists and 70.1% were predominantly or partly hospital-based, reviewed the records of 792 patients. Signs were present on hands only in 56.4% of patients and the mean time on current treatment was 16.7 months. Overall, 62.9% of patients received systemic therapy and almost one-quarter (23.4%) were treated with a biologic; 28.6% of patients were only treated with topical corticosteroids and/or topical calcineurin inhibitors. CONCLUSION In patients with moderate to severe CHE, most received systemic therapy with one-quarter on biologic therapy. However, given that many of these treatments have limited evidence of efficacy in CHE, there is a need for studies specifically in patients with CHE as well as new therapeutic options.
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Otrofanowei E, Ayanlowo OO, Akinkugbe AO, Oresanya FA. Management Outcomes of Hand Dermatitis in a Tertiary Hospital in Southwest Nigeria. Niger J Clin Pract 2023; 26:1734-1741. [PMID: 38044781 DOI: 10.4103/njcp.njcp_354_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/10/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hand dermatitis (HD) is inflammation of the skin of the hands. It ranges in severity and has a significant impact on quality of life (QoL). The physical and psychosocial burden of the disease is comparable with psoriasis in impairment of the QoL of the patient and depression. Quality of life correlates with disease severity. AIM To evaluate the management outcome of HD with a disease severity tool by the physician and quality of life index. MATERIALS AND METHODS This was a cross-sectional study of a cohort of patients with HD over 24 weeks in the dermatology clinic of a tertiary hospital in Nigeria. Disease severity and quality of life were measured using the physician global assessment (PGA) and dermatology life quality index (DLQI), respectively. These were re-administered 6 weeks after treatment. Results were collated and analyzed. RESULTS One hundred and seventy-seven (13.3%) of 1,329 patients had HD with F/M ratio of 1.2: 1; a mean age of 34.6 ± 7.4 years. Comparing PGA scores at baseline and 6 weeks, a statistically significant improvement was noted P < 0.001. The mean DLQI score at baseline was 10.38 and reduced to 3.02 post-treatment. The difference between the two means of the DLQI was ≥5 from baseline signifying improved quality of life. The domain of symptoms and feelings was the most affected at baseline and most improved afterward. CONCLUSION HD has a significant impact on its sufferers and this correlates with disease severity. Appropriate management improves disease outcome and patients' quality of life.
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Affiliation(s)
- E Otrofanowei
- Department of Medicine, College of Medicine University of Lagos/ Lagos University Teaching Hospital, Ikoyi, Lagos, Nigeria
| | - O O Ayanlowo
- Department of Medicine, College of Medicine University of Lagos/ Lagos University Teaching Hospital, Ikoyi, Lagos, Nigeria
| | - A O Akinkugbe
- Department of Medicine, College of Medicine University of Lagos/ Lagos University Teaching Hospital, Ikoyi, Lagos, Nigeria
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Zalewski A, Krajewski PK, Szepietowski JC. Psychosocial Consequences of Hand Eczema-A Prospective Cross-Sectional Study. J Clin Med 2023; 12:5741. [PMID: 37685808 PMCID: PMC10488619 DOI: 10.3390/jcm12175741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hand eczema (HE) is a chronic inflammatory disease with a high prevalence, negatively influencing patients' quality of life (QoL). It may also affect patients' psychological status. The aim of this study was to assess and characterize the psychological burden of HE, its influence on patients' QoL, and the presence and severity of anxiety and depressive disorders in HE patients. METHODS The study group consisted of 100 adult HE individuals. To assess the severity of the disease, two instruments were used: the Investigator Global Assessment for Chronic Hand Eczema (IGA-CHE) scale and the Hand Eczema Severity Index (HECSI). Assessment of patients' quality of life (QoL) was obtained with the use of the DLQI tool. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires were employed to assess depression and anxiety, respectively, as well as a modified version of the Hospital Anxiety and Depression Scale (HADS-M). RESULTS The mean DLQI value for the whole group reached 11.62 ± 6.35 points (13.27 ± 6.67 points in females and 9.15 ± 4.95 points in males; p = 0.023). A decrease in QoL correlated positively with the severity of the disease and the severity of itch and pain. In 17 patients (17%), a possible diagnosis of depressive disorder was found. Patients scoring higher results on the PHQ-9 and HADS-M depression (D) questionnaires reported greater intensity of the itch (r = 0.363, p < 0.001, and r = 0.237, p = 0.017, respectively) and the pain (r = 0.445, p < 0.001, and r = 0.287, p = 0.004, respectively). The anxiety disorder might possibly be diagnosed in 25% of patients (n = 25). This study revealed a positive correlation between the severity of the anxiety symptoms, measured with the use of both GAD-7 and HADS-M anxiety (A) tools, and the intensity of the pain (r = 0.248, p = 0.013, and r = 0.342, p = 0.001, respectively). The severity of depressive and anxiety symptoms correlated positively with the severity of the disease. CONCLUSIONS The psychosocial burden of HE is an undeniable phenomenon. The disorder influences patients' QoL and may cause mental disturbances such as depression and anxiety disorders.
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Affiliation(s)
| | | | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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Symanzik C, Skudlik C, John SM. Acceptance of skin products in healthcare workers: an empirical investigation. Occup Med (Lond) 2023; 73:29-32. [PMID: 35641115 PMCID: PMC9384166 DOI: 10.1093/occmed/kqac046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID-19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE-especially with increased COVID-19 hygiene regimes. AIMS This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs. METHODS In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires. RESULTS Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively. CONCLUSIONS Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE.
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Affiliation(s)
- C Symanzik
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - C Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - S M John
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
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Symanzik C, Stasielowicz L, Brans R, Skudlik C, John SM. Prevention of occupational hand eczema in healthcare workers during the COVID-19 pandemic: a controlled intervention study. Contact Dermatitis 2022; 87:500-510. [PMID: 35989622 PMCID: PMC9538141 DOI: 10.1111/cod.14206] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Occupational hand eczema (HE) is common among healthcare workers (HCWs) and has - in some regions of the world - increased during the COVID-19 pandemic due to related hygiene measures. OBJECTIVES To evaluate the efficacy of an intervention for HE prevention in HCWs during the pandemic. METHODS A prospective, controlled, unblinded interventional trial was conducted in 302 HCWs. The intervention group (IG) (n = 135) received online-based health education and free access to hand cleansing and hand care products. The control group (CG) (n = 167) did not receive any intervention within the study. At baseline (T0), after three (T1) and six (T2) months, participants completed standardised questionnaires. The Osnabrueck Hand Eczema Severity Index (OHSI) was assessed at T0 and T2. RESULTS During the observation period, there were no new HE cases in the IG (n = 115) and 12 cases (8.8%) in the CG (n = 136). OHSI values at T2 were lower in the IG (b = -1.44, P < 0.001). Daily use of emollients was higher at work (b = 1.73, P < 0.001) and at home (b = 1.62, P < 0.001) in the IG at T2. CONCLUSIONS The intervention was effective in HE prevention and improving skin care behaviour during the COVID-19 pandemic. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cara Symanzik
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | | | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
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Armstrong A, Hahn-Pedersen J, Bartlett C, Glanville J, Thyssen JP. Economic Burden of Chronic Hand Eczema: A Review. Am J Clin Dermatol 2022; 23:287-300. [PMID: 35258783 PMCID: PMC9142418 DOI: 10.1007/s40257-021-00669-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
There has been no extensive synthesis of studies evaluating the cost of chronic hand eczema (CHE). This review evaluated the societal costs, healthcare resource utilisation, missed work time and job loss due to CHE. MEDLINE and 16 other databases and websites were searched in October 2020 for studies meeting prespecified inclusion criteria. Studies conducted in Europe, Australia, New Zealand or the Americas were included. Two reviewers independently assessed titles and abstracts, and full-text papers published in English between 2000 and 2020, for relevance. Data extraction was carried out by one reviewer and checked by a second reviewer. All data were based on costs between 2001 and 2013 but have been inflated to 2020 prices and converted to US dollars and Euros. A total of 30 studies (reported in 33 publications) were included in the synthesis. Mean total societal costs per year per patient ranged from $2549 (€1813) to $10,883 (€7738). Pharmacological therapy was, on average, $28.34 (€20.15) per month in Italy and $36.49 (€25.94) per month for emollients in Switzerland. Yearly treatment costs were $599.05 (€425.92) for drugs, including topical corticosteroids, topical calcineurin inhibitors, other topical treatments and oral treatments, and $178.40 for emollients, in Germany. CHE was associated with hospitalisation costs ranging from $81.86 (€58.20) per patient per month (US) to $105.04 (€74.68) per patient per month (Italy) and $639.59 (€454.75) per year (Germany). Up to 57% of patients took sick leave and up to 25% reported job loss/job change due to CHE. This review confirms the significant cost burden of CHE. Given the paucity of studies estimating the monetary costs of absenteeism, presenteeism and job loss associated with CHE, current mean societal costs are likely underestimated. Uncontrolled disease may also lead to increased costs to patients and society.
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Affiliation(s)
- April Armstrong
- Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | | | - Chris Bartlett
- York Health Economics Consortium Ltd, York, YO10 5NQ, UK.
| | | | - Jacob P Thyssen
- Department of Dermatology Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Capucci S, Hahn-Pedersen J, Vilsbøll A, Kragh N. Impact of Atopic Dermatitis and Chronic Hand Eczema on Quality of Life Compared With Other Chronic Diseases. Dermatitis 2021; 31:178-184. [PMID: 32404625 DOI: 10.1097/der.0000000000000598] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: The aim of this study was to conduct 3 literature reviews to examine the impact of atopic dermatitis (AD) and chronic hand eczema (CHE) on health-related quality of life (HRQoL) compared with other chronic conditions by comparing reported utility scores of 4 commonly used generic HRQoL instruments. A systematic search was performed using PubMed, ScienceDirect, MEDLINE, EMBASE, Health Technology Assessment database, and ScHARRHUD. Inclusion criteria included, but were not limited to, patients of any age, studies from any location, publications reporting utility data based on EuroQoL 5 dimensions, the EuroQoL 5-dimension Visual Analog Scale, the Short-Form Health Survey, and the Short-Form 6 Dimensions in the English language. Inclusion criteria were met by 16 articles for AD, 25 articles for chronic conditions, and 9 articles for CHE. The findings of this review highlight that the disutility and loss in HRQoL of patients with AD and CHE are similar to or higher than other chronic conditions, such as cancer or hepatitis.
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Affiliation(s)
- Silvia Capucci
- From the SDA Bocconi School of Management, Bocconi University, Milan, Italy
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Andrees V, John SM, Nienhaus A, Skudlik C, Brans R, Augustin M, Krensel M. Economic evaluation of a tertiary prevention program for occupational skin diseases in Germany. Contact Dermatitis 2020; 82:361-369. [DOI: 10.1111/cod.13506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health TheoryUniversity of Osnabrück Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück Osnabrück Germany
| | - Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health TheoryUniversity of Osnabrück Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück Osnabrück Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health TheoryUniversity of Osnabrück Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück Osnabrück Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Magdalene Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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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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Affiliation(s)
- Laura Grant
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire UK
| | | | - Kate Burrows
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire UK
| | - Donald V. Belsito
- Columbia University Medical Center, 16th St & Broadway, New York, NY 10027 USA
| | - Elke Weisshaar
- University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Thomas Diepgen
- University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | | | | | - Rob Arbuckle
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire UK
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Baldwin HE, Harper J, Baradaran S, Patel V. Erythema of Rosacea Affects Health-Related Quality of Life: Results of a Survey Conducted in Collaboration with the National Rosacea Society. Dermatol Ther (Heidelb) 2019; 9:725-734. [PMID: 31512178 PMCID: PMC6828914 DOI: 10.1007/s13555-019-00322-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Persistent facial erythema associated with rosacea may negatively impact quality of life (QoL), self-esteem, and self-confidence. We evaluated burden and health-related QoL (HRQoL) impacts of centrofacial erythema of rosacea. Methods A cross-sectional, Web-based survey conducted in collaboration with the National Rosacea Society enrolled adults who self-reported having received a physician diagnosis of rosacea and self-evaluated their current erythema as mild to severe on the validated Subject Self-Assessment for Rosacea Facial Redness. Sociodemographic and clinical characteristics, rosacea symptoms, and their impacts on QoL [validated Impact Assessment for Rosacea Facial Redness (IA-RFR)] and HRQoL [validated Dermatology Life Quality Index (DLQI)] were recorded. Results A total of 708 eligible respondents completed the survey (white/Caucasian, 93.5%; female, 83.1%; mean age, 52.4 years). Respondents had mild (59.2%), moderate (33.2%), or severe (7.6%) erythema. The most bothersome symptoms were persistent facial erythema (69.2%) and blushing/flushing (60.9%). Mean IA-RFR scores showed negative impacts across all severities of erythema. The mean (standard deviation) total DLQI score was 5.2 (6.0) overall [mild erythema, 3.8 (4.9); moderate, 5.7 (5.4); severe, 13.4 (8.9); P < 0.0001]. Conclusion Centrofacial erythema of rosacea represents a substantial HRQoL burden, especially for those with more severe erythema. Funding Allergan plc, Dublin, Ireland.
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Affiliation(s)
| | - Julie Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, AL, USA
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12
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Ribet V, Mielewczyk E, Sirvent A, Georgescu V, Rossi AB. A novel dermo-cosmetic product containing thermal spring water, sucralfate, copper sulfate, and zinc sulfate in the management of hand eczema. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2018; 11:373-381. [PMID: 30038513 PMCID: PMC6053173 DOI: 10.2147/ccid.s157849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The regular use of cosmetic products plays a role in the management of hand eczema (HE) and aids in improving barrier function reducing dryness, roughness, pruritus and improving quality of life (QoL). The aim of this open-label study was to assess the efficacy and the reparative effect of a dermo-cosmetic product on subjects suffering from HE after 7 and 21 days of daily application. Methods The product was a water-in-oil (W/O) emulsion containing the active ingredients Avène thermal spring water, sucralfate, and copper and zinc sulfates. In total, 32 subjects suffering from either contact dermatitis or climatic dermatitis participated in the trial. The modified total lesion symptom score and physician global assessment scores were used to describe the severity of HE. The safety of the product was assessed through clinical scoring. The subjective tolerance, and acceptance, were documented using a self-assessment questionnaire completed by the subjects. The impact of the dermatosis on QoL was evaluated using the Dermatology Life Quality Index. Results After 7 days of application, both the physician and subjects noticed a significant improvement in HE. The formula was very well tolerated and accepted. These benefits were correlated with a significant improvement in QoL. Conclusion The W/O emulsion used in this study demonstrated real benefits for the subjects suffering from contact dermatitis and climatic dermatitis.
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Affiliation(s)
- Virginie Ribet
- Clinical Development Department, Pierre Fabre Dermo-Cosmetics, Toulouse, France,
| | | | | | - Victor Georgescu
- Medical Department, Laboratoires Dermatologiques Avène, Lavaur, France
| | - Ana Beatris Rossi
- Clinical Development Department, Pierre Fabre Dermo-Cosmetics, Toulouse, France,
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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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14
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Küster D, Haufe E, Rethberg C, Bauer A, Seidler A, Schmitt J. Health utilities for controlled and uncontrolled chronic hand eczema in healthcare employees. Contact Dermatitis 2017; 78:18-27. [DOI: 10.1111/cod.12863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Denise Küster
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Eva Haufe
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Constanze Rethberg
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Andrea Bauer
- Clinic and Policlinic for Dermatology; Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Andreas Seidler
- Institute and Outpatient clinic of Occupational and Social Medicine; Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Jochen Schmitt
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
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15
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Le Moigne M, Bulteau S, Grall-Bronnec M, Gerardin M, Fournier JP, Jonville-Bera AP, Jolliet P, Dreno B, Victorri-Vigneau C. Psychiatric disorders, acne and systemic retinoids: comparison of risks. Expert Opin Drug Saf 2017; 16:989-995. [PMID: 28657366 DOI: 10.1080/14740338.2017.1344641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The link between isotretinoin, treatment of a severe form of acne, and psychiatric disorders remains controversial, as acne itself could explain the occurrence of psychiatric disorders. This study aims at assessing the disproportionality of psychiatric adverse events reported with isotretinoin in the French National PharmacoVigilance Database, compared with other systemic acne treatments and systemic retinoids. MATERIALS AND METHODS Data were extracted from the French National PharmacoVigilance Database for systemic acne treatments, systemic retinoids and drugs used as comparators. Each report was subjected to double-blind analysis by two psychiatric experts. A disproportionality analysis was performed, calculating the number of psychiatric ADRs divided by the total number of notifications for each drug of interest. RESULTS Concerning acne systemic treatments: all 71 reports of severe psychiatric disorders involved isotretinoin, the highest proportion of mild/moderate psychiatric adverse events was reported with isotretinoin (14.1%). Among systemic retinoids, the highest proportion of severe and mild/moderate psychiatric events occurred with isotretinoin and alitretinoin. CONCLUSION Our study raises the hypothesis that psychiatric disorders associated with isotretinoin are related to a class effect of retinoids, as a signal emerges for alitretinoin. Complementary studies are necessary to estimate the risk and further determine at-risk populations.
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Affiliation(s)
- M Le Moigne
- a Dermato-Oncology Unit , University Hospital Hôtel-Dieu , Nantes , France
| | - S Bulteau
- b Addictology and Psychiatry Department , 'Behavioral Addictions/Complex Affective Disorders' Clinical Investigation Unit , Nantes , France
| | - Marie Grall-Bronnec
- b Addictology and Psychiatry Department , 'Behavioral Addictions/Complex Affective Disorders' Clinical Investigation Unit , Nantes , France.,c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France
| | - M Gerardin
- d Clinical Pharmacology Department , CEIP, University Hospital Hôtel-Dieu , Nantes , France
| | | | - A P Jonville-Bera
- c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France.,f Regional Pharmacovigilance Center, Department of Clinical Pharmacology , University Hospital of Tours , Tours , France
| | - Pascale Jolliet
- c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France.,d Clinical Pharmacology Department , CEIP, University Hospital Hôtel-Dieu , Nantes , France
| | - Brigitte Dreno
- a Dermato-Oncology Unit , University Hospital Hôtel-Dieu , Nantes , France
| | - C Victorri-Vigneau
- c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France.,d Clinical Pharmacology Department , CEIP, University Hospital Hôtel-Dieu , Nantes , France
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16
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Crane M, Webb D, Watson E, Cunliffe T, English J. Hand eczema and steroid-refractory chronic hand eczema in general practice: prevalence and initial treatment. Br J Dermatol 2017; 176:955-964. [DOI: 10.1111/bjd.14974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M.M. Crane
- GlaxoSmithKline; Research Triangle Park NC U.S.A
- Consultant epidemiologist; Chapel Hill NC U.S.A
| | | | - E. Watson
- GlaxoSmithKline; Research Triangle Park NC U.S.A
- Consultant epidemiologist; Chapel Hill NC U.S.A
| | - T. Cunliffe
- South Tees Hospitals NHS Foundation Trust; Northallerton U.K
| | - J. English
- Nottingham University Hospitals NHS Trust; Nottingham U.K
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17
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Theut Riis P, Thorlacius L, Knudsen List E, Jemec GBE. A pilot study of unemployment in patients with hidradenitis suppurativa in Denmark. Br J Dermatol 2017; 176:1083-1085. [PMID: 27480611 DOI: 10.1111/bjd.14922] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- P Theut Riis
- Department of Dermatology, Health Sciences Faculty, University of Copenhagen, Roskilde Hospital, Køgevej 4, Roskilde, Sjaelland, 4000, Denmark
| | - L Thorlacius
- Department of Dermatology, Health Sciences Faculty, University of Copenhagen, Roskilde Hospital, Køgevej 4, Roskilde, Sjaelland, 4000, Denmark
| | - E Knudsen List
- Department of Dermatology, Health Sciences Faculty, University of Copenhagen, Roskilde Hospital, Køgevej 4, Roskilde, Sjaelland, 4000, Denmark
| | - G B E Jemec
- Department of Dermatology, Health Sciences Faculty, University of Copenhagen, Roskilde Hospital, Køgevej 4, Roskilde, Sjaelland, 4000, Denmark
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18
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Politiek K, Oosterhaven JAF, Vermeulen KM, Schuttelaar MLA. Systematic review of cost-of-illness studies in hand eczema. Contact Dermatitis 2016; 75:67-76. [DOI: 10.1111/cod.12590] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Klaziena Politiek
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
| | - Jart A. F. Oosterhaven
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
| | - Marie-Louise A. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
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Hauber AB, Mohamed AF, Gonzalez JM, Otteson Fairchild A, Zelt SC, Graff O. Benefit-risk tradeoff preferences for chronic hand eczema treatments. J DERMATOL TREAT 2016; 28:40-46. [PMID: 27160959 DOI: 10.1080/09546634.2016.1177161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hand eczema affects approximately 16% of the US population. The long-term prognosis is poor, and 5-7% experience severe chronic hand eczema (sCHE) that interferes with daily activities. Treatments for CHE may be ineffective or associated with adverse events (AEs) that may dissuade patients from pursuing or continuing treatment. For quantification of patient experiences and benefit-risk preferences for outcomes associated with CHE treatments, a web-based discrete choice experiment survey was administered to patients in the United States with a self-reported physician diagnosis of CHE and severe symptoms not resolved with topical agents. Respondents answered a series of treatment choice questions, each requiring evaluation of a pair of hypothetical profiles of medications for sCHE defined by efficacy and risk of several AEs. Improvement in CHE clearing of 25-50% was rated from 1.5 to 3.1 times as important as eliminating a 5% risk of permanent bone problems. The mean maximum acceptable risk of permanent vision problems in exchange for an improvement in CHE clearing of 25-50% ranged from 3.4% to 4.8%. This study demonstrated that patients with CHE rated efficacy improvements associated with treatment of sCHE as more important than eliminating the risks of specific AEs.
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Affiliation(s)
- A Brett Hauber
- a RTI Health Solutions , Research Triangle Park , NC , USA
| | | | | | | | - Susan C Zelt
- b Steifel, a GSK Company , Research Triangle Park , NC , USA
| | - Ole Graff
- b Steifel, a GSK Company , Research Triangle Park , NC , USA
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20
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Braun R, Dotterud LK. Occupational skin diseases from 1997 to 2004 at the Department of Dermatology, University Hospital of Northern Norway (UNN): an investigation into the course and treatment of occupational skin disease 10-15 years after first consultations with a dermatologist. Int J Circumpolar Health 2016; 75:30100. [PMID: 27172061 PMCID: PMC4864832 DOI: 10.3402/ijch.v75.30100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives We investigate the impact of occupational skin disease consultations among outpatients at the Dermatological Department, University Hospital, Northern Norway. Study design From 1997 until 2004, 386 patients with occupational skin disease were examined and given advice on skin care, skin disease treatment, skin protection in further work, and on the legal rights of patients with this disease. Ten to fifteen years later, we wanted to look at these patients in terms of their work situation, the current status of their disease, the help they received from the labour offices, and their subjective quality of life. Material and methods In the autumn of 2011 until the spring of 2012, a number of the patients examined in the period from 1997 to 2004 were selected and sent a questionnaire, which they were asked to answer and return, regarding their work situation and the progress and current status of their occupational disease. Results A total of 153 (77%) patients answered the questionnaire; 71% of these patients were still in work, and further 15% had old-age retired, 13% were working until then; 16% had retired early because of disability; 54% had changed jobs because of their occupational skin disease; 86% of the patients indicated that the skin disease had improved since our previous investigation. Conclusions Our investigation into patients with occupational skin disease documented that the majority of patients who had received professional dermatological consultation and intervention offers were still in the labour market and had good control of their skin disease 10–15 years later. We discovered that 71% of the patients were still employed. 13% had remained in work until they became old age pensioners. Only 16% dropped out of work because of disability. These high percentages may indicate that our intervention has contributed positively to patients’ work conditions and the course of their skin disease.
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Affiliation(s)
- Rosemarie Braun
- Department of Dermatology, University Hospital, Tromsø, Norway; @unn.no
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21
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Cazzaniga S, Ballmer-Weber B, Gräni N, Spring P, Bircher A, Anliker M, Sonntag A, Piletta P, Huber C, Borradori L, Diepgen T, Apfelbacher C, Simon D. Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study. J Eur Acad Dermatol Venereol 2015; 30:628-37. [DOI: 10.1111/jdv.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Cazzaniga
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
- Centro Studi GISED; Bergamo Italy
| | - B.K. Ballmer-Weber
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - N. Gräni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - P. Spring
- Department of Dermatology; University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - A. Bircher
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - M. Anliker
- Department of Dermatology; Cantonal Hospital St. Gallen; St. Gallen Switzerland
| | - A.K. Sonntag
- Department of Dermatology; Cantonal Hospital Aarau; Aarau Switzerland
| | - P. Piletta
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - C. Huber
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - L. Borradori
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
| | - T. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital; Ruprecht Karls University; Heidelberg Germany
| | - C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
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Identifying chinese herbal medicine network for eczema: implications from a nationwide prescription database. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:347164. [PMID: 25685167 PMCID: PMC4320894 DOI: 10.1155/2015/347164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 01/19/2023]
Abstract
Eczema is a highly prevalent dermatological disease that can severely affect the patient's quality of life. Chinese herbal medicine (CHM) is commonly used in combination for eczema due to the complicated pathogenesis. This study aimed to identify a CHM network for the treatment of eczema by using a nationwide database. During 2011, 381,282 CHM prescriptions made for eczema (ICD-9-CM 692.x) were obtained from the National Health Insurance Research Database (NHIRD) in Taiwan and analyzed by using association rule mining and social network analysis. Among 661 available CHMs, 44 important combinations were identified. Among the CHM networks, seven clusters with the predominant traditional Chinese medicine (TCM) pattern were recognized. The largest CHM cluster was used to treat the wind-dampness-heat pattern, and Xiao-Feng-San (24.1% of all prescriptions) was the core of this cluster with anti-inflammation, antioxidation, and antiallergic effects. Lonicera japonica (11.0% of all prescriptions) with Forsythia suspense (17.0% of all prescriptions) was the most commonly used CHM combination and was also the core treatment for treating the heat pattern, in which an antimicrobial effect is found. CHM network analysis is helpful for TCM doctors or researchers to choose candidates for clinical practice or further studies.
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23
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Scalone L, Cortesi P, Mantovani L, Belisari A, Ayala F, Fortina A, Bonamonte D, Borroni G, Cannavò S, Guarneri F, Cristaudo A, De Pità O, Gallo R, Girolomoni G, Gola M, Lisi P, Pigatto P, Satta R, Giannetti A. Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy. Br J Dermatol 2014; 172:187-95. [DOI: 10.1111/bjd.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Scalone
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - P.A. Cortesi
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - L.G. Mantovani
- CHARTA Foundation; Milan Italy
- Faculty of Pharmacy; University of Naples Federico II; Naples Italy
| | | | - F. Ayala
- Department of Dermatology; University of Naples Federico II; Naples Italy
| | - A.B. Fortina
- Pediatric Dermatology Unit; Department of Medicine; University of Padova; Padova Italy
| | - D. Bonamonte
- Department of Biomedical Science and Human Oncology; Unit of Dermatology; University of Bari ‘Aldo Moro’; Bari Italy
| | - G. Borroni
- Clinical-Surgical, Diagnostic and Pediatric Science; Dermatology Unit; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S.P. Cannavò
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - F. Guarneri
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - A. Cristaudo
- Department of Allergological and Occupational Dermatology; San Gallicano Dermatologic Institute, IRCCS; Rome Italy
| | - O. De Pità
- Laboratory of Immunology; Istituto Dermopatico dell'Immacolata (IDI)-IRCCS; Rome Italy
| | - R. Gallo
- Section of Dermatology; DISSAL - Department of Health Sciences; University of Genoa; Genoa Italy
| | - G. Girolomoni
- Department of Medicine; Section of Dermatology and Venereology; University of Verona; Verona Italy
| | - M. Gola
- Allergological and Occupational Dermatology Unit; Department of Critical Care Medicine and Surgery; University of Florence; Florence Italy
| | - P. Lisi
- Department of Medical and Surgical Specialities and Public Health; Section of Clinical, Allergological and Venereological Dermatology; University of Perugia; Perugia Italy
| | - P.D. Pigatto
- Department of Biomedical Science for Health IRCCS Galeazzi Hospital; University of Milan; Milan Italy
| | - R. Satta
- Institute of Dermatology; University of Sassari; Sassari Italy
| | - A. Giannetti
- Division of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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24
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Montano D. Chemical and biological work-related risks across occupations in Europe: a review. J Occup Med Toxicol 2014; 9:28. [PMID: 25071862 PMCID: PMC4113130 DOI: 10.1186/1745-6673-9-28] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/17/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Work-related health inequalities are determined to some extent by an unequal exposure to chemical and biological risk factors of disease. Although their potential economic burden in the European Union (EU-25) might be substantial, comprehensive reviews focusing on the distribution of these risks across occupational groups are limited. Thus, the main objective of this review is to provide a synopsis of the exposure to chemical and biological hazards across occupational groups. In addition, main industrial applications of hazardous substances are identified and some epidemiological evidence is discussed regarding societal costs and incidence rates of work-related diseases. METHODS Available lists of carcinogens, sensitisers, mutagens, reprotoxic substances and biological hazards were consulted. For each work-related hazard the main industrial application was identified in order to assess which ISCO occupational groups may be associated with direct exposure. Where available, information on annual tonnage production, risk assessment of the substances and pathogens, and other relevant data were collected and reported. RESULTS Altogether 308 chemical and biological hazards were identified which may account to at least 693 direct exposures. These hazards concentrate on the following major occupational groups: technicians (ISCO 3), operators (ISCO 8), agricultural workers (ISCO 6) and workers in elementary occupations (ISCO 9). Common industrial applications associated with increased exposure rates relate among others to: (1) production or application of pigments, resins, cutting fluids, adhesives, pesticides and cleaning products, (2) production of rubber, plastics, textiles, pharmaceuticals and cosmetics, and (3) in agriculture, metallurgy and food processing industry, Societal costs of the unequal distribution of chemical and biological hazards across occupations depend on the corresponding work-related diseases and may range from 2900 EUR to 126000 EUR per case/year. CONCLUSIONS Risk of exposure to chemical and biological risks and work-related disease incidence are highly concentrated on four occupational groups. The unequal burden of exposure across occupations is an important contributing factor leading to health inequalities in society. The bulk of societal costs, however, are actually being borne by the workers themselves. There is an urgent need of taking into account the health impact of production processes and services on workers' health.
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Affiliation(s)
- Diego Montano
- Faculty of Medicine, Senior professorship “Work Stress Research”, Duesseldorf University, Universitaetsstr. 1, Duesseldorf, Germany
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25
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Abstract
Psychopathology in patients with DCM is as complex as its clinical forms where the factors are numerous and often intricate. It combines psychophysiological, psychopathological factors, behavioral disorders which can be the cause or the consequence of DCM but also the negative impact on quality of life and the simplest daily activities. DCM affects the quality of life of every patient, regardless of the severity. Women are more affected by the DCM that man older age, male sex, atopy and the existence of a contact sensitization are independent risk factors of severity. Depression may affect up to 10 % of patients, should involve greater attention from dermatologists and general practitioners. Health authorities and all health actors should be aware of interactions between secondary cognitive troubles or inherent to DCM and efforts required in terms of preventive measures. Thus, the presence of psychiatric comorbidity is more common in patients with chronic dermatoses. Today it is considered that the emotional environment, built by the mother - child relationship must be optimal, otherwise the mental stability of body image may be compromised. Diminished self-esteem, affects less well managed and somatic expression of emotional content. Recently, a surprising study showed that most patients with refractory occupational dermatitis were not able to recognize the warning sign of flare or the role of psychological factors in the formation and maintenance of the dermatose. In fact, they rejected their personal responsibility in the occurrence of the new flare. To address this public health problem, health authorities, trainers and caregivers should be aware of the cognitive impact of DCM in these patients and interactions with current means of prevention. The role of obsessive-compulsive washing as part of an anxiety disorder or personality disorder is most likely a contributing or maintaining factor systematically underestimated in the pathogenesis of DCM and in the therapeutic management.
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Affiliation(s)
- M Lahfa
- Service de dermatologie, pôle spécialités médicales, hôpital Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
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