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Jang JH, Joh HC, Song CH, Kim KY, Jue MS, Ro YS, Ko JY. Comparative Study of Efficacy Between Cyclosporine and Alitretinoin in Patients With Chronic Hand Eczema. Dermatitis 2024; 35:258-265. [PMID: 37870578 DOI: 10.1089/derm.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background: Systemic remedies such as cyclosporine, methotrexate, and retinoids are off-license treatment options that are considered for severe chronic hand eczema (CHE) that is resistant to first-line treatment. Objectives: The objective of this study was to determine the optimal treatment of CHE patients, including those with atopic Dermatitis®, and to compare the efficacy between cyclosporine and alitretinoin. Methods: This study was retrospective and included CHE patients who visited the Department of Dermatology at Hanyang University Seoul Hospital in Korea between March 2013 and February 2020. Results: A total of 95 CHE patients was included in this study. In the cyclosporine treatment group, there were more patients with severe baseline Investigator Global Assessment (IGA) (P = 0.033) and higher immunoglobulin E (IgE) level (P = 0.019). The mean recurrence duration was 15.9 weeks in the alitretinoin group and 22.9 weeks in the cyclosporine group, the difference between which was not statistically significant. In a subgroup analysis according to treatment drug, only the low IgE group showed a better recurrence profile for alitretinoin treatment compared to cyclosporine treatment (P = 0.039). When comparing the cumulative recurrence rate during the treatment period and subsequent follow-up periods, the cyclosporine group showed a greater incidence of recurrence than the alitretinoin group in all follow-up periods. The results of our study are consistent with the previously reported efficacy of alitretinoin. Despite the rapid response in the cyclosporine group, 12 weeks of CHE treatment with alitretinoin showed superior efficacy compared to cyclosporine treatment. Conclusions: Both alitretinoin and cyclosporine groups showed efficacy in patients with CHE. Cyclosporine is an alternative treatment of CHE that is refractory to alitretinoin or relapses after its use, especially in the presence of atopic Dermatitis®.
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Affiliation(s)
- Jin Hyun Jang
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Hae Chang Joh
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Hwa Song
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Ki Yeon Kim
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Mihn Sook Jue
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Daejeon Eulji Medical Center, Eulji University College of Medicine, Daejeon, Korea
| | - Joo Yeon Ko
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
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Bauer A, Brans R, Brehler R, Büttner M, Dickel H, Elsner P, Fartasch M, Herzog C, John SM, Köllner A, Maul JT, Merk H, Molin S, Nast A, Nikolakis GD, Schliemann S, Skudlik C, Weisshaar E, Werfel T, Zidane M, Worm M. S2k-Leitlinie Diagnostik, Prävention und Therapie des Handekzems: S2k guideline diagnosis, prevention and therapy of hand eczema. J Dtsch Dermatol Ges 2023; 21:1054-1076. [PMID: 37700403 DOI: 10.1111/ddg.15179_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie S2k‐Leitlinie „Diagnostik, Prävention und Therapie des Handekzems (HE)“ gibt auf der Grundlage eines evidenz‐ und konsensbasierten Ansatzes konkrete Handlungsanweisungen und Empfehlungen für die Diagnostik, Prävention und Therapie des HE. Die Leitlinie wurde auf der Grundlage der deutschen Leitlinie „Management von Handekzemen“ aus dem Jahr 2009 und der aktuellen Leitlinie der European Society of Contact Dermatitis (ESCD) „Guidelines for diagnosis, prevention and treatment of hand eczema“ aus dem Jahr 2022 erstellt. Allgemeines Ziel der Leitlinie ist es, Dermatologen und Allergologen in der Praxis und Klinik eine akzeptierte, evidenzbasierte Entscheidungshilfe für die Auswahl sowie Durchführung einer geeigneten und suffizienten Therapie für Patienten mit Handekzemen zur Verfügung zu stellen. Die Leitlinie basiert auf zwei Cochrane‐Reviews zu therapeutischen und präventiven Interventionen beim HE. Die übrigen Kapitel wurden überwiegend basierend auf nicht systematischen Literaturrecherchen durch die Expertengruppe erarbeitet und konsentiert. Die Expertenkommission bestand aus Mitgliedern von allergologischen und berufsdermatologischen Fachgesellschaften und Arbeitsgruppen, einer Patientenvertretung und Methodikern. Im Rahmen einer Konsensuskonferenz am 15.09.2022 wurden die Vorschläge für die Empfehlungen und Kernaussagen unter Verwendung eines nominalen Gruppenprozesses konsentiert. Der strukturierte Konsensfindungsprozess wurde professionell moderiert. Die vorliegende Leitlinie hat eine Gültigkeit bis zum 22.02.2028.
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Affiliation(s)
- Andrea Bauer
- Klinik für Dermatologie und Poliklinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Richard Brans
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für Interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Randolf Brehler
- Allergologie, Berufsdermatologie und Umweltmedizin an der Hautklinik, Universitätsklinikum Münster, Münster, Deutschland
| | | | - Heinrich Dickel
- Bochum Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Peter Elsner
- Privatpraxis für Dermatologie und Allergologie, SRH Krankenhaus Gera, Gera, Deutschland
| | - Manigé Fartasch
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Institut der Ruhr-Universität Bochum, Bochum, Deutschland
| | - Claudia Herzog
- Universitätskrebszentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Swen-Malte John
- Fachbereich Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für interdisziplinäre dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Arno Köllner
- Dermatologische Gemeinschaftspraxis, Duisburg, Deutschland
| | | | - Hans Merk
- Professor für Dermatologie und Allergologie, ehemaliger Direktor der Hautklinik, RWTH Aachen, Deutschland
| | - Sonja Molin
- Abteilung für Dermatologie, Fachbereich Medizin, Queen's University, Kingston, Kanada
| | - Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Evidenzbasierte Medizin (dEBM), Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Georgios D Nikolakis
- Klinik für Dermatologie, Venerologie, Allergologie und Immunologie, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | | | - Christoph Skudlik
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für Interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Elke Weisshaar
- Berufsdermatologie, Abteilung Dermatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thomas Werfel
- Klinik für Dermatologie und Allergologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Miriam Zidane
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Evidenzbasierte Medizin (dEBM), Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
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Bauer A, Brans R, Brehler R, Büttner M, Dickel H, Elsner P, Fartasch M, Herzog C, John SM, Köllner A, Maul JT, Merk H, Molin S, Nast A, Nikolakis GD, Schliemann S, Skudlik C, Weisshaar E, Werfel T, Zidane M, Worm M. S2k guideline diagnosis, prevention, and therapy of hand eczema. J Dtsch Dermatol Ges 2023; 21:1054-1074. [PMID: 37700424 DOI: 10.1111/ddg.15179] [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: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.
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Affiliation(s)
- Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Randolf Brehler
- Department of Allergy, Occupational Dermatology and Environmental Medicine, University Hospital Münster, Münster, Germany
| | | | - Heinrich Dickel
- Bochum Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Peter Elsner
- Privat practice for dermatology and allergology, SRH Hospital Gera, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University Bochum, Bochum, Germany
| | - Claudia Herzog
- University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Swen-Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Sonja Molin
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, Canada
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georgios D Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | | | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Upadhaya P, Lamenza FF, Shrestha S, Roth P, Jagadeesha S, Pracha H, Horn NA, Oghumu S. Berry Extracts and Their Bioactive Compounds Mitigate LPS and DNFB-Mediated Dendritic Cell Activation and Induction of Antigen Specific T-Cell Effector Responses. Antioxidants (Basel) 2023; 12:1667. [PMID: 37759970 PMCID: PMC10525528 DOI: 10.3390/antiox12091667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Berries have gained widespread recognition for their abundant natural antioxidant, anti-inflammatory, and immunomodulatory properties. However, there has been limited research conducted thus far to investigate the role of the active constituents of berries in alleviating contact hypersensitivity (CHS), the most prevalent occupational dermatological disease. Our study involved an ex vivo investigation aimed at evaluating the impact of black raspberry extract (BRB-E) and various natural compounds found in berries, such as protocatechuic acid (PCA), proanthocyanidins (PANT), ellagic acid (EA), and kaempferol (KMP), on mitigating the pathogenicity of CHS. We examined the efficacy of these natural compounds on the activation of dendritic cells (DCs) triggered by 2,4-dinitrofluorobenzene (DNFB) and lipopolysaccharide (LPS). Specifically, we measured the expression of activation markers CD40, CD80, CD83, and CD86 and the production of proinflammatory cytokines, including Interleukin (IL)-12, IL-6, TNF-α, and IL-10, to gain further insights. Potential mechanisms through which these phytochemicals could alleviate CHS were also investigated by investigating the role of phospho-ERK. Subsequently, DCs were co-cultured with T-cells specific to the OVA323-339 peptide to examine the specific T-cell effector responses resulting from these interactions. Our findings demonstrated that BRB-E, PCA, PANT, and EA, but not KMP, inhibited phosphorylation of ERK in LPS-activated DCs. At higher doses, EA significantly reduced expression of all the activation markers studied in DNFB- and LPS-stimulated DCs. All compounds tested reduced the level of IL-6 in DNFB-stimulated DCs in Flt3L as well as in GM-CSF-derived DCs. However, levels of IL-12 were reduced by all the tested compounds in LPS-stimulated Flt3L-derived BMDCs. PCA, PANT, EA, and KMP inhibited the activated DC-mediated Interferon (IFN)-γ and IL-17 production by T-cells. Interestingly, PANT, EA, and KMP significantly reduced T-cell proliferation and the associated IL-2 production. Our study provides evidence for differential effects of berry extracts and natural compounds on DNFB and LPS-activated DCs revealing potential novel approaches for mitigating CHS.
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Affiliation(s)
- Puja Upadhaya
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
| | - Felipe F. Lamenza
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
- Department of Microbiology, The Ohio State University, Columbus, OH 43210, USA
| | - Suvekshya Shrestha
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
- Department of Microbiology, The Ohio State University, Columbus, OH 43210, USA
| | - Peyton Roth
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
| | - Sushmitha Jagadeesha
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
| | - Hasan Pracha
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
| | - Natalie A. Horn
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
| | - Steve Oghumu
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (P.U.); (F.F.L.); (S.S.); (P.R.); (S.J.); (H.P.); (N.A.H.)
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Veronese F, Esposto E, Airoldi C, Gramaglia C, Zeppegno P, Zavattaro E, Savoia P. Prevalence of Self-Reported Hand Eczema Signs among Healthcare Workers after the Third Wave of COVID-19 Pandemic: A Survey in a Northern Italy Hospital. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1054. [PMID: 37374258 DOI: 10.3390/medicina59061054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background: Proper hand hygiene is one of the enhanced preventive measures immediately proposed to avoid the spreading of the severe acute respiratory syndrome coronavirus-2, also known as COVID-19. Objectives: The objective of this study was to estimate the prevalence of self-reported hand eczema signs and symptoms among healthcare workers in a Northern Italy University Hospital after the third wave of the COVID-19 pandemic. Materials and methods: A cross-sectional study was conducted in June 2021. The hospital workers were invited to complete an online questionnaire through a link sent via institutional e-mail to both health personnel and support staff. Results: Eight-hundred and sixty-three subjects completed the questionnaire; 51.1% of them self-reported suffering from at least one hand skin lesion. One-hundred thirty-seven responders declared that they changed their hand hygiene habits, and 88.9% of them carried out these modifications both in occupational and domestic environments. In detail, a change in terms of daily hand washing frequency is reported as follows: before the COVID-19 pandemic, only 27.8% and 10.1% of responders washed their hands 10-20 and 20+ times per day, respectively, while after the pandemic, the percentage increased to 37.8% and 45.8%, respectively. When comparing the health care workers with the administrative staff, we observed a statistically significative difference (p = 0.0001) in the daily hand washing frequency among the two groups, with a higher value in health care personnel. Accordingly, a higher prevalence of hand eczema signs (52.8% versus 45.6%) was detected in the healthcare group. Conclusions: We underline the potential role of the pandemic in the spread of hand eczema as an occupational disease and the need to implement its prevention.
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Affiliation(s)
- Federica Veronese
- SCDU Dermatologia, AOU Maggiore della Carità, C.so Mazzini 18, 28100 Novara, Italy
| | - Elia Esposto
- SCDU Dermatologia, AOU Maggiore della Carità, C.so Mazzini 18, 28100 Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Elisa Zavattaro
- Department of Health Sciences, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Paola Savoia
- Department of Health Sciences, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
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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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Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: a systematic review. Int Arch Occup Environ Health 2023; 96:345-354. [PMID: 36409350 DOI: 10.1007/s00420-022-01937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence, risk factors, and prevention of occupational contact dermatitis (OCD), as well as risk factors and consequences of OCD among professional cleaners. METHODS A systematic review following PRISMA guidelines was performed using Medline, EMBASE, and Cochrane Library. RESULTS Thirty-nine studies containing over 109.000 participants were included in the review. The prevalence of OCD varied between 2.2% and 30.1%. Main occupational risk factors for developing OCD among cleaners included wet work and irritants in cleaning products (bleach, chlorine, ammonia, multi-use-cleaning) and skin contact to metal. The most common contact allergies included rubber, biocides, nickel/cobalt, and perfumes. Other risk factors were inconsistent use of protective gloves and low educational level. Consequences associated with OCD included significant impairment in quality of life, tendency to have unscheduled absence from work, sick leave, increased rate of disability, and recognized degree of injury. Only one prevention study has been published investigating the effect of an educative course in skin-protective behavior in cleaners. The study reported a higher degree of knowledge of skin protection, a decrease in the severity of hand eczema, and a shift toward fewer daily hand washings at follow-up after 3 months. CONCLUSION Our study proves that OCD is common in cleaners, and the main risk factors included wet work, irritants, and contact allergies, as well as inconsistent use of protective gloves and low educational level. More focus and a greater number of studies are needed on skin protection in this population.
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Zalewski A, Szepietowski JC. Topical and systemic JAK inhibitors in hand eczema - a narrative review. Expert Rev Clin Immunol 2023; 19:365-373. [PMID: 36708316 DOI: 10.1080/1744666x.2023.2174526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Hand eczema is a chronic inflammatory skin disease characterized by significant prevalence and impact on patients' Quality of Life (QoL). Because of its complex and diverse clinical picture, HE management requires patient-specific treatment which may constitute a challenge. First described in the 1990s, Janus kinase inhibitors (JAK inhibitors) state a group of modern therapeuticals, which exhibit good bioavailability and are well tolerated by patients in both - topical and systemic - routes of administration. They are an immunomodulating small molecules, impacting JAKs' enzymatic activity. AREAS COVERED This review provides a summary of available data concerning JAK inhibitors' use in HE patients, regarding also clinical trials for the HE treatment. EXPERT OPINION Recent studies are introducing JAK inhibitors as an alternative for other topical and systemic therapies in HE patients. Treatment targeting specific immune pathways enables precise management and extends range of potential therapeutic options. Despite early promising results, future studies need to evaluate JAK inhibitors' safety, potential risks and benefits resulting from the treatment, as well as impact of the therapy on patients' QoL.
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Affiliation(s)
- Adam Zalewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368, Wroclaw, Poland
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9
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Elsner P, Schliemann S. Behandlung nach Stufenschema. DEUTSCHE DERMATOLOGIE 2023. [PMCID: PMC9848705 DOI: 10.1007/s15011-022-5700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Peter Elsner
- grid.275559.90000 0000 8517 6224Dermatologie und Allergologie, Universitätshautklinik Jena, Erfurter Str. 35, 07743 Jena, Deutschland
| | - Sibylle Schliemann
- grid.275559.90000 0000 8517 6224Dermatologie und Allergologie, Universitätshautklinik Jena, Erfurter Str. 35, 07743 Jena, Deutschland
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10
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Questionnaire-Based Study Evaluating the Hand Hygiene Practices and the Impact of Disinfection in the COVID-19 Pandemic on Hand Skin Conditions in Poland. J Clin Med 2022; 12:jcm12010195. [PMID: 36614996 PMCID: PMC9821516 DOI: 10.3390/jcm12010195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
During the COVID-19 pandemic, disinfection became an integral part of everybody's life in order to avoid spreading the coronavirus. In 2021, an original anonymous online survey was carried out. The questions concerned the usage of disinfectants. The study population included 56 subjects diagnosed by a physician with hand eczema (HE-derm group) and 114 subjects with no hand skin disease diagnosed by a specialist (non-derm). The HE and non-HE groups were distinguished. Nearly 80% of the HE group, and 10% of the non-HE group, experienced worsening of hand skin lesions caused by increased skin disinfection. HE-group respondents more often declared the occurrence of new hand skin symptoms, over 80% of the subjects of this group had more than 1 new symptom (compared to nearly 40% of the non-HE group). Exacerbations of the skin disease were more frequently observed by the HE group during the pandemic. There was a statistically significant decrease of the quality of life in the HE group compared to the non-HE group during the pandemic. The COVID-19 pandemic caused an increase in the prevalence of hand skin symptoms and deterioration of the skin condition. Education on appropriate disinfection techniques and skincare, as well as early dermatological intervention, might allow us to limit the development of hand skin diseases.
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11
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Guarneri F, Belloni Fortina A, Corazza M, Cristaudo A, Foti C, Parodi A, Pigatto P, Stingeni L, DE Pità O. Topical non-pharmacological treatment of eczema: an Italian consensus. Ital J Dermatol Venerol 2022; 157:402-413. [PMID: 36213968 DOI: 10.23736/s2784-8671.22.07283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.
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Affiliation(s)
- Fabrizio Guarneri
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Caterina Foti
- Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paolo Pigatto
- Unit of Dermatology, Department of Surgical and Odontoiatric Biomedical Sciences, Galeazzi IRCCS Orthopedic Institute, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ornella DE Pità
- Unit of Clinical Pathology, Inflammatory and Autoimmune Skin Diseases, Cristo Re Hospital, Rome, Italy
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12
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Cheng J, Facheris P, Ungar B, Guttman-Yassky E. Current emerging and investigational drugs for the treatment of chronic hand eczema. Expert Opin Investig Drugs 2022; 31:843-853. [PMID: 35658708 DOI: 10.1080/13543784.2022.2087059] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Chronic hand eczema (CHE) is a highly prevalent, burdensome condition associated with functional impairment. Currently, topical therapeutics are the mainstay of CHE management. However, many cases are refractory to existing topical therapeutics, and the few existing systemic options are often limited in efficacy and by their side effect profiles. AREAS COVERED : Following a brief overview of CHE pathogenesis and existing treatments, this review will outline the mechanisms and available data on emerging and investigational drugs currently being studied in clinical trials for the treatment of CHE. EXPERT OPINION : Immunomodulatory drugs such as topical and systemic JAK inhibitors and Th2-targeting antibodies such as dupilumab are currently under investigation for CHE treatment, with early promise. Management of CHE will likely move toward more targeted treatments through clinical trials and away from broad immunosuppressants such as cyclosporine and methotrexate, which have previously been investigated for CHE and have more side effects. In coming years, CHE patients may benefit from a wider range of both topical and systemic therapeutics that target immune pathways relevant to the various CHE subtypes.
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Affiliation(s)
- Julia Cheng
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paola Facheris
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Ungar
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. S1-Leitlinie Kontaktekzem. J Dtsch Dermatol Ges 2022; 20:711-734. [PMID: 35578429 DOI: 10.1111/ddg.14734_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster
| | - Vera Mahler
- Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Langen
| | | | | | | | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Johannes Geier
- Zentrale des IVDK, Universitätsmedizin Göttingen, Göttingen
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14
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. German S1 guideline: Contact dermatitis. J Dtsch Dermatol Ges 2022; 20:712-734. [DOI: 10.1111/ddg.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich Dickel
- Department of Dermatology Venereology and Allergology St. Josef Hospital University Medical Center of the Ruhr University Bochum Bochum Germany
| | - Andrea Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - Randolf Brehler
- Department of Dermatology University Hospital Münster Münster Germany
| | - Vera Mahler
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Hans F. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - Irena Neustädter
- Department of Pediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | | | - Thomas Werfel
- Department of Dermatology Allergology and Venereology Hannover Medical School Hannover Germany
| | - Margitta Worm
- Department of Dermatology Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Johannes Geier
- Center of IVDK University Medical Center Göttingen Göttingen Germany
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15
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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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16
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Jamil W, Svensson Å, Josefson A, Lindberg M, Von Kobyletzki L. Incidence Rate of Hand Eczema in Different Occupations: A Systematic Review and Meta-analysis. Acta Derm Venereol 2022; 102:adv00681. [PMID: 35098319 PMCID: PMC9631253 DOI: 10.2340/actadv.v102.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hand eczema is a chronic disease that results in economic and psychosocial burdens. The aim of this study was to systematically review and assess the magnitude of the association between exposure related to occupations and the incidence rate of hand eczema. A systematic search in PubMed, EMBASE, CINAHL and Cochrane databases, from inception to September 2017, of full-text observational studies reporting incident cases of hand eczema during employment, and a supplementary search in PubMed to September 2020, were conducted. Among 2,417 screened abstracts, 15 studies fulfilled the inclusion criteria. Incidence rates were reported per 100 person-years. Based on the Newcastle-Ottawa Scale, 9 studies were good quality, 2 fair quality, and 4 poor quality. Hairdressers had a high incidence of hand eczema of 21.4 (95% confidence interval [CI] 15.3–27.4), as did nurses, 16.9 (95% CI 11.2–22.7), and metal workers, 12.4 (95% CI 3.5–21.3). Hairdressers were predominantly women, and metal worker were predominantly men. Office occupations had an incidence rate of hand eczema of 4.9 (95% CI 1.2–9.6). The high risk of hand eczema for hairdressers, nurses, and metal workers, should be considered by healthcare policymakers. Even occupations with low irritant profile, such as office workers, were at risk of developing hand eczema, and more occupations should be investigated regarding the related risk of developing hand eczema.
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Affiliation(s)
| | | | | | | | - Laura Von Kobyletzki
- Department of Occupational and Environmental Dermatology, Malmö, Lund university,.
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17
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Voorberg AN, Romeijn GLE, de Bruin-Weller MS, Schuttelaar MLA. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis - 52 week results from the Dutch BioDay registry. Contact Dermatitis 2022; 87:185-191. [PMID: 35279856 PMCID: PMC9545501 DOI: 10.1111/cod.14104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
Background The hands are a common predilection site of atopic dermatitis (AD). Dupilumab is licensed for the treatment of AD but not for chronic hand eczema (CHE), while CHE is challenging to treat. Objectives To evaluate the long‐term effect of dupilumab on hand eczema (HE) in patients with AD from the BioDay Registry. Methods A prospective observational study of adult patients with HE, treated for AD with dupilumab. Patients with a HE severity of at least moderate at baseline were considered for analysis. Patients with other concomitantly systemic immunosuppressive treatments were excluded. Clinical effectiveness on HE severity, using the Hand Eczema Severity Index (HECSI) and photographic guide, and health‐related quality of life, using the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), were evaluated. Results A total of 72 patients were included. HECSI‐75 was achieved by 54/62 patients (87.1%) and HECSI‐90 by 39/72 (62.9%) at 52 weeks. Based on the photographic guide, 56/62 patients (90.3%) achieved the endpoint of ‘clear’ or ‘almost clear’. Mean QOLHEQ reduction was −63.5% (95% confidence interval −38.23 to −27.41). There was no difference in response between HE subtypes. Conclusions The results from this study hold promise for dupilumab to be a suitable treatment option for isolated CHE.
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Affiliation(s)
- Angelique N Voorberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Brands MJ, Loman L, Schuttelaar MLA. Exposure and work-related factors in subjects with hand eczema: data from a cross-sectional questionnaire within the Lifelines Cohort study. Contact Dermatitis 2022; 86:493-506. [PMID: 35122264 PMCID: PMC9314613 DOI: 10.1111/cod.14066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hand eczema (HE) is the most frequent occupational skin disease. However, studies on non-occupational wet exposure, occupations not considered as high-risk, and socioeconomic factors are scarce. OBJECTIVES To investigate the association between HE and occupational and non-occupational wet exposure and work-related factors in the Dutch general population. METHODS Within the Lifelines Cohort Study, participants with HE were identified by a digital add-on questionnaire, including questions regarding exposure. Data on work-related and socioeconomic factors were collected from baseline. RESULTS Overall, 57 046 participants (42.0%) were included. Occupational and non-occupational wet exposure were positive associated with HE in the past year (Odds Ratios (OR) 1.35 95% confidence interval (CI) [1.22-1.49] and OR 1.34 95% CI [1.17-1.53], respectively). Positive associations for high-risk occupations (OR 1.20 95% CI [1.06-1.36] for personal care workers in health services and OR 1.25 95% CI [1.06-1.48] for nursing and midwifery professionals), occupations not considered as high-risk (OR 1.19 95% CI [1.03-1.39 for legal, social and religious associate professionals) and higher levels of education were found (OR 1.17 95% CI [1.04-1.32] and OR 1.18 95% CI [1.04-1.34] for middle and high level, respectively). CONCLUSION Preventive strategies for HE should focus on avoidance of all exposure to wet, regardless of origin. In addition, job tasks instead of job title should be taken into account. As previous results on the association between HE and socioeconomic factors differ, future research should focus on a uniform definition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marjolein J Brands
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Loman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Worm M, Thyssen JP, Schliemann S, Bauer A, Shi VY, Ehst B, Tillmann S, Korn S, Resen K, Agner T. The pan-JAK inhibitor delgocitinib in a cream formulation demonstrates dose-response in chronic hand eczema in a 16-week randomised phase 2b trial. Br J Dermatol 2022; 187:42-51. [PMID: 35084738 DOI: 10.1111/bjd.21037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic hand eczema (CHE) is a burdensome disease, and new well-documented, safe, and efficacious treatments are warranted. In a recent CHE phase 2a trial, the pan-Janus kinase (JAK) inhibitor delgocitinib in an ointment formulation was found to be efficacious and well-tolerated. OBJECTIVES This trial assessed the dose-response, efficacy, and safety of delgocitinib cream in CHE. METHODS In this double-blind, phase 2b dose-ranging trial, adults with CHE and a recent history of inadequate response or contraindication to topical corticosteroids were randomised to delgocitinib cream 1, 3, 8, 20 mg/g or vehicle treatment twice daily for 16 weeks. Primary endpoint was Investigator's Global Assessment for CHE (IGA-CHE) treatment success (0 [clear] or 1 [almost clear] with a ≥2-point improvement from baseline to Week 16). Secondary endpoints were time to IGA-CHE treatment success and changes in Hand Eczema Severity Index (HECSI); other endpoints were itch and pain NRS scores, and Patient's Global Assessment (PaGA) at Week 16. RESULTS 258 patients were randomised 1:1:1:1:1 to delgocitinib cream 1, 3, 8, 20 mg/g or vehicle. A significant dose-response relationship was established for IGA-CHE (p<0.025). IGA-CHE treatment success at Week 16 was achieved in 21.2% (1 mg/g), 7.8% (3 mg/g), 36.5% (8 mg/g), 37.7% (20 mg/g), and 8.0% (vehicle) of patients. Delgocitinib 8 and 20 mg/g showed a treatment effect against vehicle (p<0.001). Similarly, there were improvements in HECSI, itch and pain NRS scores, and PaGA. Delgocitinib cream was well-tolerated with majority of adverse events being mild or moderate and considered unrelated to treatment. Most frequently reported adverse events were nasopharyngitis (17.3%-29.4% in delgocitinib groups vs 40% in vehicle group), eczema (5.8%-11.3% in delgocitinib groups vs 16.0% in vehicle group) and headache (3.8%-11.5% in delgocitinib groups vs 4.0% in vehicle group). CONCLUSIONS In this trial, delgocitinib cream showed a dose-response relationship in terms of efficacy and was well-tolerated.
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Affiliation(s)
- Margritta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Germany
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | | | - Andrea Bauer
- Department of Dermatology, University Allergy Center (UAC), University Hospital Carl Gustav Carus, Germany
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ben Ehst
- Oregon Medical Research Center, Portland, OR, USA
| | | | | | | | - Tove Agner
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Denmark
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20
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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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21
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Chandrashekar L, Sakkaravarthi V, Rajappa M. Prevalence and patterns of latex glove allergy among healthcare workers in a tertiary care center in South India - A cross-sectional study. Indian Dermatol Online J 2022; 13:475-479. [PMID: 36262582 PMCID: PMC9574155 DOI: 10.4103/idoj.idoj_58_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Objectives: Materials and Methods: Results: Conclusion:
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22
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Methkal A, Kuts L. REVEALING THE MOLECULAR-GENETIC AND CLINICAL PREDICTORS OF GLUCOCORTICOID RESISTANCE IN PATIENTS WITH HAND ECZEMA. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2076-2080. [PMID: 36256931 DOI: 10.36740/wlek202209105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To reveal the possible predictors of the glucocorticoid resistance in patients with hand eczema (HE) based on the demographic, clinical, and molecular-genetic data. PATIENTS AND METHODS Materials and methods: 143 patients with HE were included in the study. Demographic, clinical, biochemical (blood content of IgE, IL-17A, IL-2, 25(OH)D), and genetic (rs41423247 genotypes) data were obtained from all patients. RESULTS Results: After 2 weeks of treatment by glucocorticoids, all subjects were divided into "responder" and "non-responder" groups according to change of the Hand Eczema Severity Index (HECSI). Statistical analysis was done using SPSS (version 22.0.). Binary logistic regression was used to identify predictors of glucocorticoid resistance. P-value 0.05). The results of the multivariate regression showed that Bcl-1 G-allele (OR =3.83; P = 0.033), and severe eczema (OR = 2.52; P = 0.023) are linked with an elevated risk of glucocorticoid resistance in patients with hand eczema. CONCLUSION Conclusions: Insensitivity to glucocorticoids in HE patients is associated with NR3C1 gene Bcl-1 polymorphism, eczema severity and blood level of IL-17, IL-2, 25(OH)D. The final adjustment showed that minor C-allele of the Bcl-1 polymorphism and severe eczema are the strongest predictors of the glucocorticoid resistance.
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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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24
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Nørreslet LB, Lilje B, Ingham AC, Edslev SM, Clausen ML, Plum F, Andersen PS, Agner T. Skin Microbiome in Patients with Hand Eczema and Healthy Controls: A Three-week Prospective Study. Acta Derm Venereol 2021; 102:adv00633. [PMID: 34877605 PMCID: PMC9631265 DOI: 10.2340/actadv.v101.845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The pathogenesis of chronic hand eczema remains unclear. Insights into the skin microbiome in hand eczema and its potential relevance to disease severity may help to elucidate the underlying mechanisms of hand eczema. The aim of this study was to characterize the microbiome in patients with hand eczema and healthy controls. A 5-visit prospective study was conducted over a period of 3 weeks. At each visit, bacterial swabs were taken from the hands of patients with hand eczema and controls. The microbiome was examined using DNA extraction and 16S rRNA amplicon sequencing (V3–V4 regions). Fifty patients with hand eczema and 50 controls were included (follow-up rate=100%). The baseline bacterial α-diversity was reduced on the hands of patients with hand eczema compared with controls (effect size=–0.31; 95% confidence interval (95% CI) –0.50; –0.11; p = 0.003). The dysbiosis on the patients’ hands was stable over the study period, was associated with disease severity, and was characterized by reduced bacterial diversity and different bacterial community compositions.
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Affiliation(s)
- Line Brok Nørreslet
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.
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25
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Sloot MM, Loman L, Romeijn GLE, Rosenberg FM, Arents BWM, Schuttelaar MLA. Patients' perspectives on quality of care for chronic hand eczema: a qualitative study. Contact Dermatitis 2021; 86:204-212. [PMID: 34871458 PMCID: PMC9305235 DOI: 10.1111/cod.14020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
Background Hand eczema (HE) has a significant impact on patients’ quality of life and work‐related activities. However, little is known about the patients' perspectives on quality of care for HE. Objectives To evaluate the patient perspective of the HE care process in a tertiary referral center. Methods Qualitative, semi‐structured focus groups were carried out, recorded, transcribed, and analysed using an inductive‐deductive thematic approach. Results Fifteen patients participated in four focus groups. Time and attention, together with being listened to and understood by the health care professional, were the most important aspects of care for HE mentioned by participants. Other aspects of care that were regarded as important were that diagnoses, causes and follow‐up of HE were not always clear to the participant; more psychosocial support was needed, and that participants experienced frequent changes in doctors. Information provided by nurses was valuable, but more individualized advice was needed. Conclusions To better meet the needs of patients, more explanation should be given about the causes of HE and the final diagnosis. Besides focusing on the treatment, it is also important to focus on its impact on the patient and options for psychosocial and peer support should be discussed. Furthermore, the beneficial role of the specialized nurse as part of integrated care was emphasized.
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Affiliation(s)
- Manon M Sloot
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Loman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fieke M Rosenberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernd W M Arents
- Dutch Association of People with Atopic Dermatitis, Nijkerk, The Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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26
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Napolitano M, Potestio L, De Lucia M, Nocerino M, Fabbrocini G, Patruno C. Alitretinoin for the treatment of severe chronic eczema of the hands. Expert Opin Pharmacother 2021; 23:159-167. [PMID: 34789049 DOI: 10.1080/14656566.2021.1998457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Chronic hand eczema (CHE) is a frequent skin disorder affecting up to 10% of the population and strongly reduces Quality of Life (QoL). The first-line therapeutic strategies for the management of CHE include a change of lifestyle, an education program for the skin and the application of specific emollients. Topical corticosteroids or calcineurin inhibitors are the most used anti-inflammatory drugs. However, up to 65% of patients require systemic options. Alitretinoin, a retinoid structurally related to vitamin A, is the first systemic treatment approved in the European Union (EU) for severe CHE refractory to potent topical corticosteroids. AREAS COVERED This review summarizes the available data on the pharmacokinetics, pharmacodynamics, efficacy, and safety profile of oral alitretinoin for the treatment of CHE. EXPERT OPINION Alitretinoin can be considered as a valid therapeutic option for the treatment of CHE in patients not responding to ordinary treatments. Clinical trials and real-life experiences showed that it acts effectively on both objective and subjective clinical signs, resulting in a significant improvement in QoL of patients. As for other retinoids, caution should be taken in patients with certain chronic diseases (hepatopathies, kidney failure, hyperlipidemia, thyroid dysfunction) or childbearing potential women.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Mario De Lucia
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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27
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Lauerma A, Werner P, Wisgrill L, Fyhrquist N. New Key Players in Irritant Contact Dermatitis: Residential Skin Cells and Neutrophils Drive Inflammation. J Invest Dermatol 2021; 142:509-512. [PMID: 34749986 DOI: 10.1016/j.jid.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
The chemokine CCL2 is a potential biomarker for progression of inflammatory skin disease. In a new article of the Journal of Investigative Dermatology, Shibuya et al. (2021) use murine experimental models to show that CCL2‒CCR2‒dependent IL-1β secretion by local skin cells and skin-infiltrating neutrophils are key drivers of skin irritation.
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Affiliation(s)
- Antti Lauerma
- Department of Dermatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Paulina Werner
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lukas Wisgrill
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescence Medicine, Medical University of Vienna, Vienna, Austria
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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28
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Keng BMH, Gan WH, Tam YC, Oh CC. Personal protective equipment-related occupational dermatoses during COVID-19 among health care workers: A worldwide systematic review. JAAD Int 2021; 5:85-95. [PMID: 34485949 PMCID: PMC8407949 DOI: 10.1016/j.jdin.2021.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Occupational dermatoses caused by personal protective equipment (PPE) in the ongoing COVID-19 pandemic are emerging occupational health challenges that must be promptly and effectively addressed to ease burden on our health care workers. Objective A systematic review was conducted to determine common PPE-related dermatoses, affected body sites, and implicated occupational contactants. We further proposed solutions to mitigate this problem. Methods Online databases were searched for articles on PPE-related dermatoses in health care workers during the COVID-19 pandemic written in English and published from January 1, 2020, to January 30, 2021. Results Sixteen studies, including a total of 3958 participants, were included. The most common dermatoses were xerosis, pressure-related erythema, and contact dermatitis, mainly affecting the face and hands. The most widely implicated contactants were increased frequency of hand hygiene, gloves, N95 masks, and goggles. Proposed solutions were categorized as individual self-care, protection of the workforce, and long-term preventive measures. Conclusion Through measures such as regular basic skin care education, early access to specialty clinics via telemedicine, and designing of better-fit PPE, the challenges posed by PPE-related occupational dermatoses can be significantly reduced.
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Affiliation(s)
| | - Wee Hoe Gan
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yew Chong Tam
- Education Resource Centre, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Duke-NUS Medical School, Singapore, Singapore.,Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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29
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Voorberg AN, Niehues H, Oosterhaven JAF, Romeijn GLE, van Vlijmen-Willems IMJJ, van Erp PEJ, Ederveen THA, Zeeuwen PLJM, Schuttelaar MLA. Vesicular hand eczema transcriptome analysis provides insights into its pathophysiology. Exp Dermatol 2021; 30:1775-1786. [PMID: 34252224 PMCID: PMC8596617 DOI: 10.1111/exd.14428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022]
Abstract
Hand eczema is a common inflammatory skin condition of the hands whose pathogenesis is largely unknown. More insight and knowledge of the disease on a more fundamental level might lead to a better understanding of the biological processes involved, which could provide possible new treatment strategies. We aimed to profile the transcriptome of lesional palmar epidermal skin of patients suffering from vesicular hand eczema using RNA‐sequencing. RNA‐sequencing was performed to identify differentially expressed genes in lesional vs. non‐lesional palmar epidermal skin from a group of patients with vesicular hand eczema compared to healthy controls. Comprehensive real‐time quantitative PCR analyses and immunohistochemistry were used for validation of candidate genes and protein profiles for vesicular hand eczema. Overall, a significant and high expression of genes/proteins involved in keratinocyte host defense and inflammation was found in lesional skin. Furthermore, we detected several molecules, both up or downregulated in lesional skin, which are involved in epidermal differentiation. Immune signalling genes were found to be upregulated in lesional skin, albeit with relatively low expression levels. Non‐lesional patient skin showed no significant differences compared to healthy control skin. Lesional vesicular hand eczema skin shows a distinct expression profile compared to non‐lesional skin and healthy control skin. Notably, the overall results indicate a large overlap between vesicular hand eczema and earlier reported atopic dermatitis lesional transcriptome profiles, which suggests that treatments for atopic dermatitis could also be effective in (vesicular) hand eczema.
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Affiliation(s)
- Angelique N Voorberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanna Niehues
- Department of Dermatology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Jart A F Oosterhaven
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivonne M J J van Vlijmen-Willems
- Department of Dermatology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Piet E J van Erp
- Department of Dermatology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Thomas H A Ederveen
- Center for Molecular and Biomolecular Informatics, RIMLS, Radboudumc, Nijmegen, The Netherlands
| | - Patrick L J M Zeeuwen
- Department of Dermatology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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30
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Heichel T, Brans R, John SM, Nienhaus A, Nordheider K, Wilke A, Sonsmann FK. Acceptance of semipermeable glove liners compared to cotton glove liners in health care workers with work-related skin diseases: Results of a quasi-randomized trial under real workplace conditions. Contact Dermatitis 2021; 85:543-553. [PMID: 34232510 DOI: 10.1111/cod.13929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative. OBJECTIVES To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work-related skin diseases (WRSDs). METHODS One hundred sixty-one HCWs with WRSDs were asked to wear GLs in combination with occlusive gloves for 10 ±2 weeks under workplace conditions. A questionnaire was applied to compare acceptance and usability of the respective glove combinations and previously used protective gloves (PUGs). RESULTS A total of 120 data sets were available (SYM: n = 65, 77.4%; COT: n = 55, 71.4%). Both GLs provided a significantly lower sweating sensation, more pleasant climate, comfortable wearing experience, and moist or dry feeling on the skin compared to PUGs. SYM-GLs performed significantly better than COT-GLs regarding mobility of hands, sensitivity, and sense of touch. COT-GLs were significantly better than SYM-GLs in the categories fit, donning and doffing, and material contact. CONCLUSIONS Both GLs did not impair work performance, were applicable in various areas of health care activities, and were preferred over PUGs. Our results indicate that SYM-GLs are an alternative to COT-GLs and thus may contribute to current prevention strategies.
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Affiliation(s)
- Theres Heichel
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Service Research in Nursing, Institute for Health Service Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Flora K Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
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31
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Kim HJ, Bang CH, Kim HO, Lee DH, Ko JY, Park EJ, Son SW, Ro YS. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema. Ann Dermatol 2021; 33:351-360. [PMID: 34341637 PMCID: PMC8273322 DOI: 10.5021/ad.2021.33.4.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. Objective These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. Methods A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. Results Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. Conclusion These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Suk Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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32
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Bonnekoh H, Vera C, Abad‐Perez A, Radetzki S, Neuenschwander M, Specker E, Mahnke NA, Frischbutter S, Latz E, Nazaré M, Kries JV, Maurer M, Scheffel J, Krause K. Topical inflammasome inhibition with disulfiram prevents irritant contact dermatitis. Clin Transl Allergy 2021; 11:e12045. [PMID: 34322217 PMCID: PMC8297992 DOI: 10.1002/clt2.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The pathogenesis of contact dermatitis, a common inflammatory skin disease with limited treatment options, is held to be driven by inflammasome activation induced by allergens and irritants. We here aim to identify inflammasome-targeting treatment strategies for irritant contact dermatitis. METHODS A high content screen with 41,184 small molecules was performed using fluorescent Apoptosis associated speck-like protein containing a CARD (ASC) speck formation as a readout for inflammasome activation. Hit compounds were validated for inhibition of interleukin (IL)-1β secretion. Of these, the approved thiuramdisulfide derivative disulfiram was selected and tested in a patch test model of irritant contact dermatitis in 25 healthy volunteers. Topical application of disulfiram, mometasone or vehicle was followed by application of sodiumdodecylsulfate (SDS) for 24 h each. Eczema induction was quantified by mexameter and laser speckle imaging. Corneocyte sampling of lesional skin was performed to assess inflammasome-mediated cytokines IL-1β and IL-18. RESULTS Disulfiram induced a dose-dependent inhibition of ASC speck formation and IL-1β release in cellular assays in vitro. In vivo, treatment with disulfiram, but not with vehicle and less mometasone, inhibited SDS-induced eczema. This was demonstrated by significantly lower erythema and total perfusion values assessed by mexameter and laser speckle imaging for disulfiram compared to vehicle (p < 0.001) and/or mometasone (p < 0.001). Also, corneocyte IL-18 levels were significantly reduced after application of disulfiram compared to vehicle (p < 0.001). CONCLUSION We show that disulfiram is a dose-dependent inhibitor of inflammasome pathway activation in vitro and inhibitor of SDS-induced eczema in vivo. Topical application of disulfiram represents a potential treatment option for irritant contact dermatitis.
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Affiliation(s)
- Hanna Bonnekoh
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Carolina Vera
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Angela Abad‐Perez
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Silke Radetzki
- Department of Chemical BiologyLeibniz‐Forschungsinstitut für Molekulare Pharmakologie (FMP)BerlinGermany
| | - Martin Neuenschwander
- Department of Chemical BiologyLeibniz‐Forschungsinstitut für Molekulare Pharmakologie (FMP)BerlinGermany
| | - Edgar Specker
- Department of Chemical BiologyLeibniz‐Forschungsinstitut für Molekulare Pharmakologie (FMP)BerlinGermany
| | - Niklas Amadeus Mahnke
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Stefan Frischbutter
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Eicke Latz
- Institute of Innate ImmunityUniversity of BonnBonnGermany
- German Center of Neurodegenerative Diseases (DZNE)University of BonnBonnGermany
| | - Marc Nazaré
- Department of Chemical BiologyLeibniz‐Forschungsinstitut für Molekulare Pharmakologie (FMP)BerlinGermany
| | - Jens v. Kries
- Department of Chemical BiologyLeibniz‐Forschungsinstitut für Molekulare Pharmakologie (FMP)BerlinGermany
| | - Marcus Maurer
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Jörg Scheffel
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Karoline Krause
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Autoinflammation Reference Center Charité (ARC2)Charité – Universitätsmedizin BerlinBerlinGermany
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Techasatian L, Thaowandee W, Chaiyarit J, Uppala R, Sitthikarnkha P, Paibool W, Charoenwat B, Wongmast P, Laoaroon N, Suphakunpinyo C, Kiatchoosakun P, Kosalaraksa P. Hand Hygiene Habits and Prevalence of Hand Eczema During the COVID-19 Pandemic. J Prim Care Community Health 2021; 12:21501327211018013. [PMID: 34009056 PMCID: PMC8138294 DOI: 10.1177/21501327211018013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: This study aimed to explore the prevalence of and possible risk factors for
hand eczema with respect to the dissemination of information about new hand
hygiene habits to protect against ongoing COVID-19 cross-transmission. The
authors conducted a survey among health care workers (HCWs) and non-HCW
populations in Khon Kaen, Thailand. Results: A total of 805 participants participated. The prevalence of hand eczema in
the study population was 20.87%. There were several risk factors, including
working as a HCW, having a history of previous hand eczema, having
underlying atopic dermatitis, wearing gloves in everyday life, and washing
hands frequently (more than 10 times/day). Hand hygiene with alcohol-based
products was shown to be a risk factor for hand eczema, (OR (95% CI) 1.86
(1.03-3.35), P = .04). Conclusion: In terms of hand eczema prevention, we suggest that the use of alcohol-based
products should be discontinued if other handwashing methods are available.
The following factors increase the risk of hand eczema: being a HCW, having
previous hand eczema, and having underlying atopic dermatitis. Proper
strategies in terms of hand eczema prevention should be addressed,
especially in this group, since we need to continue performing hand hygiene
during the ongoing COVID-19 pandemic.
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34
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Herloch V, Elsner P. Die (neue) Berufskrankheit Nr. 5101: „Schwere oder wiederholt rückfällige Hauterkrankungen“. J Dtsch Dermatol Ges 2021; 19:720-742. [PMID: 33979060 DOI: 10.1111/ddg.14537_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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Obermeyer L, Skudlik C, John SM, Brans R. Treatment with alitretinoin in patients taking part in a tertiary individual prevention program for work-related skin diseases. Contact Dermatitis 2021; 85:446-453. [PMID: 33966276 DOI: 10.1111/cod.13883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients taking part in a tertiary individual prevention program (TIP) for work-related skin diseases frequently have chronic hand eczema (HE) for which alitretinoin is a treatment option. OBJECTIVE To investigate treatment with alitretinoin before and during the TIP and related factors. METHODS Data of 1614 patients taking part in the TIP between January 2015 and December 2019 were analyzed retrospectively. RESULTS Three hundred forty-eight patients (21.6%) reported treatment with alitretinoin prior to the TIP showing an increase over time, particularly in men. In 45 patients (2.8%), alitretinoin treatment was initiated during the TIP. Treatment with alitretinoin was significantly less common among female than male patients, both prior to (P < .001) and during the TIP (P = .015). Female patients who had received alitretinoin in the past were significantly older than the other female patients (P < .001). Among patients treated with alitretinoin prior to the TIP, women had a significantly higher disease severity at admission than men (P = .007). CONCLUSIONS About twenty percent of patients reported treatment with alitretinoin prior to the TIP. The data indicate that treatment of female TIP patients with alitretinoin is less frequent than among male patients and depends on age and disease severity.
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Affiliation(s)
- Lara Obermeyer
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Swen M John
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
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36
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Herloch V, Elsner P. The (new) occupational disease no. 5101: "Severe or recurrent skin diseases". J Dtsch Dermatol Ges 2021; 19:720-741. [PMID: 33938626 DOI: 10.1111/ddg.14537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
Occupational dermatoses are among the most common occupational diseases, with BK 5101 accounting for the largest proportion. Historically, the latter was also the most frequently reported group of occupational diseases within the working age population. More than 80,000 suspected cases of occupational diseases were notified in 2019, of which 19,883 related to BK 5101. In Germany, work-related hand eczema accounts for 90 % of all BK 5101 diseases, and consists mainly of contact eczema. Especially young people working in the hairdressing sector, health care, metal, food or construction industries belong to the high-risk group. Diagnosis, therapy and prevention of BK 5101 play an important role, since advanced skin diseases are usually accompanied by a poor prognosis and long periods of inability to work, which can have considerable socio-economic consequences. On January 1st , 2021, with the "Seventh Act amending the Fourth Book of the German Social Code (SGB) and other Laws", an amendment to the Occupational Diseases Law came into force, with which the obligation to cease work was abolished, thereby fulfilling a decades-long requirement for recognition of BK 5101. As of this year, only the "severe or repeated recurrences" of a skin disease remain as a criterion for the occurrence of an insured event, which will likely result in an increased number of notifications and acknowledged cases of occupational skin diseases.
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Affiliation(s)
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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37
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Nørreslet LB, Edslev SM, Clausen ML, Flachs EM, Ebbehøj NE, Andersen PS, Agner T. Hand eczema and temporal variation of Staphylococcus aureus clonal complexes: A prospective observational study. J Am Acad Dermatol 2021; 87:1006-1013. [PMID: 33878413 DOI: 10.1016/j.jaad.2021.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/18/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hand eczema (HE) is frequently associated with Staphylococcus aureus; however, its role in the pathogenesis of HE is poorly understood. OBJECTIVE To investigate the temporal variation in S aureus subtypes, ie, clonal complex (CC) types, on the hands and relate it to S aureus colonization in the nose and severity in a cohort of HE patients. METHODS S aureus from the hands and nose of 50 adult HE patients and 50 controls was prospectively identified at 5 visits over 3 weeks. RESULTS S aureus was identified on the hands of 23 (46%) patients at 2 or more visits and on the hands of 1 control once. Of the HE patients with S aureus colonization, 78% had the same S aureus CC type over time. Twenty-one patients had the same S aureus CC type on the hands and in the nose. Persistent colonization was strongly related to an increased disease severity. LIMITATIONS A relatively small S aureus culture-positive population. CONCLUSION The temporal stability of S aureus CC type and high occurrence of the identical subtypes on the hands and in the nose imply that S aureus colonization in patients with HE is of a more permanent nature. Taken together with the finding that persistent colonization and HE severity are clearly related, our results indicate that S aureus may contribute to the perpetuating course of HE.
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Affiliation(s)
- Line B Nørreslet
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Sofie M Edslev
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Maja-Lisa Clausen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Esben M Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Paal S Andersen
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Tove Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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38
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Erdem Y, Inal S, Sivaz O, Copur S, Boluk KN, Ugurer E, Kaya HE, Gulsunay IE, Sekerlisoy G, Vural O, Altunay IK, Aksu Çerman A, Özkaya E. How does working in pandemic units affect the risk of occupational hand eczema in healthcare workers during the coronavirus disease-2019 (COVID-19) pandemic: A comparative analysis with nonpandemic units. Contact Dermatitis 2021; 85:215-224. [PMID: 33797109 PMCID: PMC8251387 DOI: 10.1111/cod.13853] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hand eczema (HE) has increased among healthcare workers (HCWs) working in coronavirus disease-2019 (COVID-19) units, and was associated with increased hand hygiene practices. OBJECTIVES To compare the prevalence and clinical characteristics of HE, and hand hygiene practices in HCWs working in COVID-19 and non-COVID-19 units. METHODS A total of 244 HCWs working in COVID-19 (n = 118) and non-COVID-19 patient care units (n = 126) were examined by dermatologists with regard to demographic parameters and hand hygiene practices. The COVID-19 and non-COVID-19 groups were matched at a 1:1 ratio according to age, atopy, and generalized dry skin. RESULTS HE was more frequent in the COVID-19 group (48.3% vs 12.7%, P < .001), whereas working years (P < .05) and additional housework at home (P < .001) were longer in the non-COVID-19 group. After the development of HE, moisturizing creams were reported to be more frequently used in the COVID group (P < .001). Topical corticosteroids were used in a minority (40% in the COVID group and 26.7% in the non-COVID group). CONCLUSIONS HCWs in COVID-19 units developed HE more frequently. A majority increased the frequency of moisturizer use, instead of using topical corticosteroids, after the development of HE for the purpose of treating eczema. New approaches are needed for the prevention and management of HE in HCWs, especially by facilitating access to dermatologists.
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Affiliation(s)
- Yasemin Erdem
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Sena Inal
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Onur Sivaz
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Sevkiye Copur
- Istanbul Faculty of Medicine, Department of Dermatology and VenereologyIstanbul UniversityIstanbulTurkey
| | - Kubra N. Boluk
- Istanbul Faculty of Medicine, Department of Dermatology and VenereologyIstanbul UniversityIstanbulTurkey
| | - Ece Ugurer
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Hazel E. Kaya
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Ilayda E. Gulsunay
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Gul Sekerlisoy
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Osman Vural
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Ilknur K. Altunay
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Aslı Aksu Çerman
- Department of DermatologyHealth Science University, Şişli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Esen Özkaya
- Istanbul Faculty of Medicine, Department of Dermatology and VenereologyIstanbul UniversityIstanbulTurkey
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Kuwatsuka S, Kuwatsuka Y, Tomimura S, Takenaka M, Terasaka Y, Izumikawa K, Morinaga Y, Yanagihara K, Murota H. Impact of daily wearing of fabric gloves on the management of hand eczema: A pilot study in health-care workers. J Dermatol 2021; 48:645-650. [PMID: 33749004 DOI: 10.1111/1346-8138.15848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
Hand eczema is a major occupational disease, especially in medical workers, reducing their quality of life (QOL) and work productivity. Daily wearing of fabric gloves to prevent loss of moisture and lipids from the surface of the hands has been regarded as good in the management of hand eczema. However, limited evidence is available regarding the efficacy of moisturizing care with daily gloves on hand eczema. This pilot study was performed to evaluate the efficacy of moisturizing intervention with daily wearing of fabric gloves on skin barrier function, disease severity, and microbiome in health-care workers with hand eczema. Study 1: Nurses in the neonatal intensive care unit or growing care unit with and without hand eczema were recruited in the study. Subjects were instructed to apply moisturizer and wear two types of fabric gloves, common cotton gloves and moisturizing fabric gloves containing malate, for 4 weeks. Study 2: Physicians and health-care workers were recruited and instructed to wear a cotton glove on one hand at nighttime for 4 weeks. Disease severity, skin barrier function, QOL, and hand microbiome (Study 1) were evaluated. Study 1 found that daily wearing of both types of fabric gloves accompanied by use of topical moisturizers reduced the severity of hand eczema without changing the variation of microbiome. Study 2 found no apparent change between wearing and not wearing cotton gloves. In summary, topical moisturizer is of fundamental importance, and concomitant use of fabric gloves may merely enhance the efficacy of moisturizer in the management of hand eczema.
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Affiliation(s)
- Sayaka Kuwatsuka
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yutaka Kuwatsuka
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Saori Tomimura
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Motoi Takenaka
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoko Terasaka
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshitomo Morinaga
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Department of Microbiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsuori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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40
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Loman L, Uter W, Armario‐Hita JC, Ayala F, Balato A, Ballmer‐Weber BK, Bauer A, Bircher AJ, Buhl T, Czarnecka‐Operacz M, Dickel H, Fuchs T, Giménez Arnau A, John SM, Kränke B, Kręcisz B, Mahler V, Rustemeyer T, Sadowska‐Przytocka A, Sánchez‐Pérez J, Scherer Hofmeier K, Schliemann S, Simon D, Spiewak R, Spring P, Valiukevičienė S, Wagner N, Weisshaar E, Pesonen M, Schuttelaar MLA. European Surveillance System on Contact Allergies (ESSCA): Characteristics of patients patch tested and diagnosed with irritant contact dermatitis. Contact Dermatitis 2021; 85:186-197. [PMID: 33729576 PMCID: PMC8360089 DOI: 10.1111/cod.13833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. OBJECTIVES To describe the characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) database. METHODS Data collected by the ESSCA in consecutively patch-tested patients from January 2009 to December 2018 were analyzed. RESULTS Of the 68 072 patients, 8702 were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry cooks, and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. CONCLUSIONS The hands were mainly involved in OICD also in the subgroup of patients with contact dermatitis, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult-to-treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered.
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Affiliation(s)
- Laura Loman
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and EpidemiologyFriedrich‐Alexander‐University Erlangen/NürnbergErlangenGermany
| | - José C. Armario‐Hita
- Department of DermatologyUniversity Hospital of Puerto Real, University of CádizCádizSpain
| | - Fabio Ayala
- Department of DermatologyUniversity of Naples Federico IINaplesItaly
| | - Anna Balato
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Barbara K. Ballmer‐Weber
- Department of DermatologyUniversity Hospital ZürichZürichSwitzerland
- Department of DermatologyUniversity Hospital Zürich and Clinic of Dermatology and Allergology, Kantonsspital St GallenZürichSwitzerland
| | - Andrea Bauer
- Department of DermatologyUniversity Hospital Carl Gustav Carus, Technical University of DresdenDresdenGermany
| | - Andreas J. Bircher
- Department of DermatologyAllergy Unit, University Hospital BaselBaselSwitzerland
| | - Timo Buhl
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | - Ana Giménez Arnau
- Department of DermatologyHospital del Mar, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Swen M. John
- Department of Dermatology and Environmental MedicineInstitute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), University of Osnabrück, Lower Saxony Institute for Occupational Dermatology (NIB)OsnabrückGermany
| | - Birger Kränke
- Department of Dermatology and VenereologyMedical University of GrazGrazAustria
| | - Beata Kręcisz
- Faculty of Medicine and Health ScienceInstitute of Medical Science, Jan Kochanowski UniversityKielcePoland
- Department of DermatologyNofer Institute of Occupational MedicineŁódźPoland
| | - Vera Mahler
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
- Division of AllergologyPaul‐Ehrlich‐InstitutLangenGermany
| | - Thomas Rustemeyer
- Department of Dermatology‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | | | | | - Sibylle Schliemann
- Department of Dermatology and AllergologyUniversity Hospital JenaJenaGermany
| | - Dagmar Simon
- Department of DermatologyInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of PharmacyJagiellonian University Medical CollegeKrakowPoland
| | - Philip Spring
- Dermatologie et vénéréologie FMH, Center Médical d'EpalingesEpalingesSwitzerland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal DiseasesLithuanian University of Health SciencesKaunasLithuania
| | - Nicola Wagner
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Elke Weisshaar
- Department of Dermatology, Occupational DermatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Maria Pesonen
- Division Occupational MedicineFinnish Institute of Occupational HealthHelsinkiFinland
| | - Marie L. A. Schuttelaar
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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Jing M, Yu Q, Zhu B, Yuan F, Zhang J, Peng L, Lin W, Chen M. Topical 0.05% clobetasol cream in the treatment of chronic hand eczema: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24418. [PMID: 33725820 PMCID: PMC7969293 DOI: 10.1097/md.0000000000024418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic hand eczema (CHE) is a recurrent, frequently disabling skin condition that requires daily skin care to prevent transepidermal water loss, posing a significant burden of society and economy. In recent years, topical 0.05% clobetasol cream is widely used for the treatment of CHE for its efficacy, tolerability and safety. Whereas, no systematic review and meta-analysis has been updated up to now. Therefore, this work aims to assess the effectiveness and safety of topical 0.05% clobetasol cream in patients with CHE. METHODS Study on topical 0.05% clobetasol cream for CHE will be searched from their inception to December, 2020 with the language restrictions of English and Chinese in 8 databases (PubMed, Cochrane Library, Embase, the web of science, VIP, CNKI, CBM, and WAN FANG). According to the heterogeneity test, a fixed or random-effect model will be used to synthesize data. The primary outcome is the proportion of patients achieving more than 75% reduction in signs and symptoms according to the Hand Eczema Severity Index (HECSI). The secondary outcomes include: scored for 4 different characteristics of the lesions (redness, scaling, lichenification, and pruritus), QoL questionnaire, adverse events, and recurrence events. STATA 13.0 and Review Manager software 5.3 will be used for analysis and synthesis. Two or more reviewers will independently conduct the selection of studies, data extraction, and data analysis. RESULTS The results of the study expect to provide a high-quality, evidence-based recommendation on topical 0.05% clobetasol cream in the treatment of CHE for clinicians. CONCLUSION The study will provide scientific and useful evidence for better use of topical 0.05% clobetasol cream in treating CHE. ETHICS AND DISSEMINATION This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/SPHVZ.
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Abstract
BACKGROUND Since the outbreak of SARS-CoV-2, authorities have preached the importance of personal hygiene, including hand washing and disinfection. OBJECTIVE To evaluate changes in the frequency of hand washing and hand care, the onset of hand eczema (HE) and risk factors associated with HE since the outbreak of SARS-CoV-2 in Munich in January 2020. MATERIALS & METHODS All dermatologic outpatients at the university hospital between April 6 and April 19 were asked to complete a structured questionnaire. RESULTS Data of 512 patients with a median age of 49 years (243 females, 267 males) were analysed. The frequency of hand washing and hand disinfection increased after the outbreak of SARS-CoV-2 (p < 0.001, respectively). While symptoms associated with HE were reported by 29.9% (149/499) of patients, the actual diagnosis of HE was reported less frequently by 11.2% (53/473) with a median duration of 120 days. Frequent hand disinfection (p = 0.039), atopic dermatitis (p = 0.006) and young age (p = 0.0499) were identified as risk factors for symptoms of HE. Hand care was performed more frequently during the pandemic than before (p < 0.001). A high frequency of hand care during the pandemic was not significantly associated with symptoms of HE (p = 0.172), but was associated with self-recognition of HE symptoms (p = 0.002). CONCLUSION After the outbreak of SARS-CoV-2, the frequency of hand hygiene measures increased. A considerably high prevalence of HE symptoms was associated with frequent hand disinfection, atopic dermatitis and young age. Awareness of HE should be raised in order for preventive measures to be taken earlier.
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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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Silverberg JI, Warshaw EM, Maibach HI, DeKoven JG, Taylor JS, Atwater AR, Sasseville D, Zug KA, Reeder MJ, Fowler JF, Pratt MD, Fransway AF, Zirwas MJ, Belsito DV, Marks JG, DeLeo VA. Hand eczema in children referred for patch testing: North American Contact Dermatitis Group Data, 2000-2016. Br J Dermatol 2021; 185:185-194. [PMID: 33454963 DOI: 10.1111/bjd.19818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little is known about the aetiologies and relevant allergens in paediatric patients with hand eczema (HE). OBJECTIVES To characterize the aetiologies and determine the proportion of positive and currently relevant allergens in children/adolescents (age < 18 years) with HE referred for patch testing. METHODS A retrospective analysis (2000-2016) of North American Contact Dermatitis Group data was performed. RESULTS Of 1634 paediatric patients, 237 (14·5%) had involvement of the hands. Final physician diagnoses included allergic contact dermatitis (49·4%), atopic dermatitis (37·1%) and irritant contact dermatitis (16·9%). In multivariable logistic regression models, employment was the only association with increased odds of any HE or primary HE. Children with HE vs. those without HE had similar proportions of positive patch tests (56·1% vs. 61·7%; χ2 -test, P = 0·11). The five most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside and lanolin. In multivariable logistic regression models of the top 20 relevant allergens, HE was associated with significantly higher odds of currently relevant reactions to lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole and colophony. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel and methylchloroisothiazolinone/methylisothiazolinone. CONCLUSIONS Children with HE who were referred for patch testing had a high proportion of positive patch tests, which was similar to the proportion found in children without HE. Children with HE had a distinct and fairly narrow profile of currently relevant allergens.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, The Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN, USA.,Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - J G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - J S Taylor
- Department of Dermatology, Cleveland Clinic, OH, USA
| | - A R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - D Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, QC, Canada
| | - K A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - M J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J F Fowler
- Division of Dermatology, University of Louisville, KY, USA
| | - M D Pratt
- Division of Dermatology, University of Ottawa, ON, Canada
| | | | - M J Zirwas
- Department of Dermatology, Ohio State University, Columbus, OH, USA
| | - D V Belsito
- Department of Dermatology, Columbia University, New York, NY, USA
| | - J G Marks
- Department of Dermatology, Pennsylvania State University, State College, PA, USA
| | - V A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
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45
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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016. J Am Acad Dermatol 2020; 84:989-999. [PMID: 33259878 DOI: 10.1016/j.jaad.2020.11.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hand eczema (HE) is a heterogeneous and burdensome disorder. OBJECTIVE To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing. METHODS Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113). RESULTS Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ2, P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators. LIMITATIONS No data on HE phenotype. CONCLUSION HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE.
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Nabatanzi A, Mafuru M, Male M, Tian C, Zhang L, Wu T, Wu S, Huang C. <p>Feasibility Study for the Long-Term Management of Refractory Hyperkeratotic Eczema with Calcipotriol and Betamethasone Dipropionate (Daivobet<sup>®</sup>), Viaminate and Concomitant Conventional Therapies: A Retrospective Study</p>. Clin Cosmet Investig Dermatol 2020; 13:789-794. [PMID: 33149651 PMCID: PMC7605519 DOI: 10.2147/ccid.s276148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/26/2020] [Indexed: 11/23/2022]
Abstract
Background The available treatments for refractory hyperkeratotic eczema are inadequate with frustrating results. We, therefore, incorporated Calcipotriol and Betamethasone Dipropionate (Daivobet®), and Viaminate into the mainstay treatment to improve the clinical symptoms. The study aimed to evaluate the efficacy of Daivobet® and Viaminate as a potential treatment alternative for refractory hyperkeratotic eczema. Patients and Methods Between 2013 and 2015, 61 patients diagnosed with refractory hyperkeratotic eczema (RHE) who had shown inadequate response to conventional therapies were pooled from a single center. Besides, they were all treated with Daivobet®, Viaminate, and an occlusive dressing mixture containing 5% salicylic acid ointment and 25% zinc oxide paste following inadequate response to conventional therapies (corticosteroids plus 25% zinc oxide paste and 5% salicylic acid ointment). Investigators Global Assessment (IGA) and Patient-Oriented Eczema Measure (POEM) assessed baseline and outcome measures for the degree of hyperkeratinization (0-clear; 3-moderate; 4-severe). Results Of the 61 patients, 49 (80.3%) patients presented with moderate RHE and 12 (19.7%) with severe RHE. After 24 weeks of treatment, the period for loss of keratinization was significantly lower in patients with moderate RHE (3.9±1.9 weeks) than those with severe RHE (10.8±1.0 weeks) with a P-value <0.01. Furthermore, they required a significantly shorter total treatment duration (10.6 ± 4.3 weeks) than those with severe RHE (20.3±3.6 weeks) with a P-value of <0.01. However, there were no significant differences in post hoc analysis at week 36 with P-values of 0.46 and 1.00 for IGA and POEM, respectively. Conclusion Our results showed that the incorporation of Viaminate and Daivobet® into mainstay treatment was effective and safe for the long-term management of RHE.
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Affiliation(s)
- Amelia Nabatanzi
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Magesa Mafuru
- Department of Pharmacology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Musa Male
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Chunxia Tian
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Lingyun Zhang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ting Wu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shidi Wu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Changzheng Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Changzheng HuangDepartment of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of ChinaTel +86-13971176116Fax +86-27-85768188 Email
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Abstract
Background Assessment of chronic hand eczema (CHE) is complex and warrants standardization. Objective We sought to guide clinicians on the assessment of CHE. Methods An electronic questionnaire regarding the diagnosis and assessment of CHE was completed by councilors (n=45) of the International Eczema Council, an international group of clinicians and researchers with expertise in CHE. The survey consisted of 52 statements for consensus. Results Overall, nine statements (17.3%) had strong, twenty-three (44.2%) moderate, 12 (23.1%) low, and 8 (15.4%) very low levels of agreement. Five statements had considerable disagreement, including the value of conducting a skin biopsy (62.2% disagreement), investigating for possible type 1 reactions (60.0%), conducting a fungal culture (44.4%), finding no history of relevant allergens and/or irritants (31.1%) in most or all cases, and performing patch testing irrespective of lesion location and morphology (28.9%). Agreement was generally highest among respondents from Europe (28.6–77.8% agreement), followed by Asia (7.1%–35.7% agreement), North America (0%–35.5% agreement), and other (0%–13.3% agreement). Conclusions There were substantial differences of agreement, suggesting there are many knowledge and/or practice gaps with respect to CHE. Future research is needed to inform evidence-based and/or consensus guidelines for CHE.
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Nørreslet LB, Edslev SM, Andersen PS, Plum F, Holt J, Kjerulf A, Ebbehøj NE, Clausen ML, Flachs EM, Agner T. Colonization with Staphylococcus aureus in patients with hand eczema: Prevalence and association with severity, atopic dermatitis, subtype and nasal colonization. Contact Dermatitis 2020; 83:442-449. [PMID: 32720317 DOI: 10.1111/cod.13679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND While Staphylococcus aureus (S. aureus) colonization has been thoroughly studied in atopic dermatitis (AD), where S. aureus is related to flares and considered a trigger factor, S. aureus colonization in hand eczema (HE) has only been sparsely studied. OBJECTIVES To examine the 1-week prevalence of S. aureus colonization in HE patients, and its association with severity, HE subtype, AD, and nasal S. aureus colonization compared with healthy controls. METHODS In a case-control study of 50 adult HE patients and 50 healthy controls, bacterial swabs from lesional skin (patients only), non-lesional skin (dorsal hand), and the nasal cavity were sampled for culturing of S. aureus on days 1, 3, 5 and 8. Participants were characterized by demographics, AD, HE subtype, filaggrin gene mutation status, and HE severity. RESULTS Twenty-seven HE patients (54%) were colonized with S. aureus on the hand compared to one control (2%) (P < .01). Nasal S. aureus colonization was found in 72% of patients and 22% of controls (P < .01). For patients, S. aureus colonization on the hands was associated with an atopic HE subtype and HE severity (P = .01 and P < .01, respectively). CONCLUSIONS Both hand and nasal S. aureus colonization were highly prevalent among HE-patients and may have an impact on the persistence of HE.
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Affiliation(s)
- Line B Nørreslet
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sofie M Edslev
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | - Paal S Andersen
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | - Frederik Plum
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jette Holt
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institute, Copenhagen, Denmark
| | - Anne Kjerulf
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institute, Copenhagen, Denmark
| | - Niels E Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maja-Lisa Clausen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Esben M Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tove Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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50
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Rademaker M, Armour K, Baker C, Foley P, Gebauer K, Gupta M, Marshman G, O'Connor A, Rubel D, Sullivan J, Wong LC. Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. Australas J Dermatol 2020; 62:17-26. [PMID: 32776537 DOI: 10.1111/ajd.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Chronic hand/foot eczemas are common, but treatment is often challenging, with widespread dissatisfaction over current available options. Detailed history is important, particularly with regard to potential exposure to irritants and allergens. Patch testing should be regarded as a standard investigation. Individual treatment outcomes and targets, including systemic therapy, should be discussed early with patients, restoring function being the primary goal, with clearing the skin a secondary outcome. Each new treatment, where appropriate, should be considered additive or overlapping to any previous therapy. Management extends beyond mere pharmacological or physical treatment, and requires an encompassing approach including removal or avoidance of causative factors, behavioural changes and social support. To date, there is little evidence to guide sequences or combinations of therapies. Moderately symptomatic patients (e.g. DLQI ≥ 10) should be started on a potent/super-potent topical corticosteroid applied once or twice per day for 4 weeks, with tapering to twice weekly application. If response is inadequate, consider phototherapy, and then a 12-week trial of a retinoid (alitretinoin or acitretin). Second line systemic treatments include methotrexate, ciclosporin and azathioprine. For patients presenting with severe symptomatic disease (DLQI ≥ 15), consider predniso(lo)ne 0.5-1.0 mg/kg/day (or ciclosporin 3 - 5 mg/kg/day) for 4-6 weeks with tapering, and then treating as for moderate disease as above. In non-responders, botulinum toxin and/or iontophoresis, if associated with hyperhidrosis, may sometimes help. Some patients only respond to long-term systemic corticosteroids. The data on sequencing of newer agents, such as dupilumab or JAK inhibitors, are immature.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences, Hamilton, New Zealand
| | | | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia.,St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia.,St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia
| | - Gillian Marshman
- Flinders Medical Centre, Flinders University Medical School, Adelaide, South Australia, Australia
| | | | - Diana Rubel
- Woden Dermatology, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - John Sullivan
- The Sutherland Hospital, University of New South Wales, Caringbah, New South Wales, Australia
| | - Li-Chuen Wong
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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