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Thaitirarot S, Shuwisitkul D, Udompataikul M, Kamanamool N, Kanokrungsee S. The efficacy of a transdermal hydrogel patch containing betamethasone dipropionate for treatment of chronic hand eczema: A single-blind, randomized and controlled trial. Contact Dermatitis 2024; 90:153-160. [PMID: 37828631 DOI: 10.1111/cod.14438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/08/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Topical corticosteroids under occlusion have been used to enhance the treatment of eczema. However, no study has investigated the efficacy of a steroid-containing transdermal patch for the treatment of chronic hand eczema. METHODS We conducted a randomized, controlled, assessor-blinded trial to determine the efficacy of a transdermal patch containing betamethasone dipropionate compared to topical betamethasone dipropionate ointment in the treatment of mild to moderate chronic hand eczema. The patients were included and assigned to receive either the transdermal patch once daily at night or the ointment twice daily for a period of 8 weeks. The outcomes were assessed using the Hand Eczema Severity Index (HECSI), Physical Global Assessment (PGA) score, self-reported compliance, level of patient satisfaction, quality of life, and side effects. RESULTS Fifty-six patients completed this study. At 8 weeks, there was a significant reduction in the HECSI scores in both the transdermal patch and topical ointment groups compared to those measured at baseline (14.61 to 1.86, p < 0.001; 18.46 to 3.43, p < 0.001, respectively) without a statistically significant difference between the two groups. Similarly, the two groups did not show any significant difference in the PGA scores, quality of life and side effects. However, the transdermal patch group reported better compliance and a higher level of patient satisfaction than the topical ointment group. CONCLUSION The transdermal corticosteroid patch has proven to be a safe and effective treatment, comparable to topical corticosteroids, after 8 weeks of use. Its sustained-release properties, along with once-daily use, can improve patient satisfaction and promote greater adherence to the treatment. TRIAL REGISTRATION This study was registered with the Thai Clinical Trials Registry (www. CLINICALTRIALS in.th) under registration number TCTR20220413003.
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Affiliation(s)
- Sirinan Thaitirarot
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | | | - Montree Udompataikul
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Nanticha Kamanamool
- Department of Preventive and Social Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Silada Kanokrungsee
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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Sato T, Katayama C, Hayashida Y, Asanuma Y, Aoyama Y. Role of basal sweating in maintaining skin hydration in the finger: A long-standing paradox in dry skin resolved. Exp Dermatol 2022; 31:1891-1899. [PMID: 36054736 DOI: 10.1111/exd.14668] [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: 06/15/2022] [Revised: 08/04/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022]
Abstract
A long-standing paradox in dermatology is why skin dehydration in the fingers can be triggered by repeated water exposure despite the action of water to hydrate skin tissue. Potential clues might be provided by identifying a mechanism through which water is held in the skin of the fingers. We speculated that this mechanism would be impaired after repeated water exposure. Here, we investigated whether there might be glabrous skin-specific water-holding machinery and whether this machinery might be impaired in dry skin/hand eczema. We examined this by using an impression-mould technique, allowing for an accurate quantification of sweat gland/duct activity and optical coherence tomography. Unlike in hairy skin, sweat pores were rarely detected at the folds of the finger at baseline. Surprisingly, after water exposure, sweat pores at the folds opened and those at the ridges closed in healthy controls (HCs). Sweating in the dermal folds of the hands correlated with skin hydration, and decreased in dry skin/hand eczema, suggesting that its impairment may be one of the causes of dry skin. After repeated water exposure, basal sweating response at the folds was exhausted in patients with dry skin/hand eczema as well as HCs. This exhaustion was rescued by exposing individuals to high humidity. Basal sweating defects would be a target for dry skin/hand eczema. Maintaining basal sweating responses in the finger is the best preventive measures in achieving prevention of dry skin/hand eczema.
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Affiliation(s)
- Tetsuko Sato
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
| | - Chieko Katayama
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
| | - Yuki Hayashida
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
| | - Yumiko Asanuma
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
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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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Falay Gür T, Savaş Erdogan S, Doğan B. Investigation of the prevalence of hand eczema among healthcare professionals in Turkey: A cross-sectional study. J Cosmet Dermatol 2021; 21:1727-1735. [PMID: 34214218 DOI: 10.1111/jocd.14329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hand eczema is one of the common occupational dermatoses, having high prevalence among healthcare professionals (HCP). We found no epidemiological data in the literature concerning the prevalence of hand eczema among HCP in Turkey. AIMS The aim of the present study was to investigate the prevalence of hand eczema among HCP in Turkey and to determine the demographic characteristics and risk factors that cause eczema. METHODS A clinical assessment- and questionnaire-based cross-sectional study was conducted with 734 HCP working in a tertiary hospital. Demographic characteristics and personal and occupational risk factors were evaluated in terms of the development of hand eczema. RESULTS The survey response rate was 81.8%. The point prevalence of eczema was 27.6%, and the 12-month prevalence was 45.9%. Age, occupation, duration of work, atopic diseases, handwashing frequency, dry skin, moisturizing frequency, and presence and duration of glove use were important factors in the development of hand eczema. Powdered glove reaction was significantly higher in those with hand eczema (p = 0.0001). CONCLUSIONS The prevalence of hand eczema is high among HCP in Turkey. Combining self-reported questionnaires with clinical examination findings can provide a more accurate calculation of the prevalence of hand eczema. The availability of epidemiological data on hand eczema can provide guidelines for the prevention and treatment of this condition. Except for situations requiring absolute handwashing, disinfecting hands with alcohol-based lotions and applying a powder-free policy in all healthcare centers will reduce the prevalence of hand eczema among HCP.
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Affiliation(s)
- Tuğba Falay Gür
- Department of Dermatology, Health Science University, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Sevil Savaş Erdogan
- Department of Dermatology, Health Science University, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Bilal Doğan
- Department of Dermatology, Maltepe University Faculty of Medicine, Istanbul, Turkey
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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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Dietz JB, Menné T, Meyer HW, Viskum S, Flyvholm MA, Ahrensbøll-Friis U, John SM, Johansen JD. Degree of employment, sick leave, and costs following notification of occupational contact dermatitis-A register-based study. Contact Dermatitis 2020; 84:224-235. [PMID: 33058169 DOI: 10.1111/cod.13719] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Occupational contact dermatitis (OCD) is the most commonly recognized occupational disease in Denmark. OBJECTIVES To examine the impact of recognized OCD on degree of employment, sick leave, unemployment, and job change. METHODS Data on all recognized individuals with OCD notified in Denmark between 2010 and 2015 (n = 8940) were linked to information on social transfer payments in the years before and after notification. The number of weeks on unemployment benefits or sick leave and the degree of employment during the 2 years prior to notification was compared with the 2 years following notification. RESULTS The degree of employment decreased on average 8.9 work-hours/month, corresponding to an average annual loss of income per worker of approximately €1570. The average number of weeks that workers were receiving unemployment benefits and paid long-term sick leave rose by 2.5 and 3.4 weeks, respectively, corresponding to an average additional annual cost per worker of approximately €420 and €770, respectively. Longer case-processing time was significantly associated with lower degree of employment and higher levels of unemployment and sick leave. CONCLUSIONS OCD has a significant negative impact on employment and economics, thus highlighting the need for a national, strategic action plan for effective prevention of OCD.
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Affiliation(s)
- Jojo B Dietz
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Torkil Menné
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Harald W Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sven Viskum
- Unit of Social Medicine, Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark
| | - Mari-Ann Flyvholm
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Ulrik Ahrensbøll-Friis
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Swen M John
- Department of Dermatology, Environmental Health and Health Theory, University of Osnabrück and Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
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Sonne M, Agner T, Nørreslet LB, Lund TT. The Efficacy to Prevent Irritant Hand Eczema: an Overview of the Interventional Procedures. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00270-y] [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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Relationship between Hand Eczema Severity and Occupational Stress: A Cross-Sectional Study. Dermatol Res Pract 2019; 2019:8301896. [PMID: 31687011 PMCID: PMC6800949 DOI: 10.1155/2019/8301896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/02/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background Stress has been recently implicated as a contributing factor of hand eczema (HE) severity. However, published data are both rare and contradictory justifying the need of further research. The purpose of this study was to evaluate the relation between stress and HE severity. Methods This is a cross-sectional study enrolling all patients who have been attending the Dermato-allergology unit of Farhat Hached University Hospital of Sousse over a period of one year. The HE severity was assessed by the Osnabrück Hand Eczema Severity Index (OHSI). The stress level was assessed by the Perceived Stress Scale-10 (PSS-10) in its validated Arabic version. Results During the study period, 109 participants meeting the inclusion criteria were identified. The mean age was 40 ± 9.9 years with a sex-ratio of 0.8. Severe eczema was found in 76 participants (69.7%). A high level of perceived stress was found in 18.3% of cases. A statistically significant association was noted between HE severity and the high level of perceived stress (p=0.039, OR = 4.46, 95% CI [0.96–20.59]) and the number of dependent children ≥3 (p=0.0039, OR = 1.92, 95% CI [0.51–7.22]). Leisure activity was found to be a protective factor against HE severity (p=0.031, OR = 0.27, 95% CI [0.09–0.80]). Conclusion Although the link between the severity of eczema and atopy, wet work, and contact with irritants and allergens is well known, the relation remains questionable for other factors including stress.
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Oosterhaven JAF, Schuttelaar MLA. Responsiveness and interpretability of the Hand Eczema Severity Index. Br J Dermatol 2019; 182:932-939. [PMID: 31260086 PMCID: PMC7186841 DOI: 10.1111/bjd.18295] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Abstract
Background The Hand Eczema Severity Index (HECSI) is used to measure the severity of hand eczema. It is unclear what HECSI scores mean and what is the minimally important change (MIC). Furthermore, its responsiveness has not been studied. Objectives To study the responsiveness and interpretability of the HECSI. Methods This was a prospective study covering two time points: baseline and after 4–12 weeks. Responsiveness was assessed using a criterion approach, with at least one‐step improvement on the ‘Photographic guide for severity of hand eczema’ as the anchor for important improvement. Interpretability of single scores was determined by defining severity bands based on agreement with the anchor. For change scores, the smallest detectable change (SDC) was calculated in patients indicating no change and the MIC was obtained in patients indicating that they had changed using three methods: mean cutoff, receiver operating characteristic (ROC) curve and 95% limit. Results In total, 294 patients participated (160 male, mean age 44·9 years). HECSI scores improved or deteriorated in parallel with the anchor. The area under the ROC curve was 0·86 (95% confidence interval 0·81–0·91). The final severity band for single scores had a κ‐coefficient of agreement of 0·694: clear, 0; almost clear, 1–16; moderate, 17–37; severe, 38–116; very severe, ≥ 117. The SDC in 93 unchanged patients was 40·3 points. The obtained MIC values were all smaller than the SDC. Conclusions The HECSI has good responsiveness. This study gives meaning to HECSI scores, which can be applied to clinical decision making and the design of clinical trials. We recommend that an improvement of 41 points on the HECSI is regarded as the minimally measurable true change. What's already known about this topic? The Hand Eczema Severity Index (HECSI) is one of the most widely used measurement instruments to measure the severity of hand eczema. The HECSI has good reliability, but its responsiveness and interpretability have not been studied.
What does this study add? This study shows good responsiveness of the HECSI. A severity grading for single scores is proposed. The smallest detectable change and minimally important change for improvement are determined.
What are the clinical implications of this work? The obtained values help to interpret HECSI scores in daily practice and clinical studies, and may facilitate researchers in the calculation of sample sizes for clinical trials.
https://www.bjdonline.com/article/ Linked Comment:https://doi.org/10.1111/bjd.18544 https://doi.org/10.1111/bjd.18911 available online
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Affiliation(s)
- J A F Oosterhaven
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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10
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Hald M, Thyssen JP, Zachariae C, Røpke MA, Carstensen JM, Schultz N, Johansen JD. Multispectral imaging of hand eczema. Contact Dermatitis 2019; 81:438-445. [PMID: 31389010 DOI: 10.1111/cod.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer-dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema. OBJECTIVE To investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features. METHODS Patients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument. RESULTS Areas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging-based severity assessment and PGA was found. The imaging-based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging-based algorithm was not capable of differentiating hand eczema patients from controls. CONCLUSIONS Multispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful.
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Affiliation(s)
- Marianne Hald
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Mads A Røpke
- Department of Clinical Pharmacology, LEO Pharma A/S, Ballerup, Denmark
| | | | | | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Olesen CM, Agner T, Ebbehøj NE, Carøe TK. Factors influencing prognosis for occupational hand eczema: new trends. Br J Dermatol 2019; 181:1280-1286. [PMID: 30851194 DOI: 10.1111/bjd.17870] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Variables traditionally reported to influence the prognosis of occupational hand eczema (OHE) are atopic dermatitis (AD) and contact sensitization. However, recent studies indicate that lifestyle factors may be of major importance. OBJECTIVES To identify factors influencing the prognosis in a cohort of patients with recognized OHE. METHODS In this register-based cohort study, individuals with hand eczema recognized as occupational disease in the period January 2010-December 2011 were identified using files from Labor Market Insurance Denmark and included in the study. At baseline, information on sex, age, occupation, wet work, AD and contact sensitization was collected. In 2015 participants received a questionnaire with questions about lifestyle factors, current occupation and healing of OHE. RESULTS In total, 2703 patients received the questionnaire; 1491 responded to the question about healing of OHE and were included in the study. Altogether, 19·3% of patients reported complete healing at follow-up. Current tobacco smoking and a high level of stress were factors inversely associated with healing of hand eczema (P < 0·001 and P = 0·030, respectively), while a high level of exercise was significantly related to healing of eczema (P = 0·011). Change of profession was a favourable prognostic factor, while age, sex, AD, contact sensitization and education did not significantly influence prognosis. CONCLUSIONS Traditionally important risk factors such as AD and contact sensitization had no marked influence on prognosis, while lifestyle factors were of major importance. Our findings indicate that risk factors may vary over time, allowing for new perspectives on prevention. What's already known about this topic? Occupational hand eczema has a relapsing course and a poor overall prognosis. Atopic dermatitis and contact sensitization have previously been reported as risk factors for a poor prognosis. What does this study add? The results indicate that lifestyle factors are of importance for the prognosis of occupational hand eczema. Traditionally reported risk factors such as atopic dermatitis and contact sensitization do not currently influence prognosis.
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Affiliation(s)
- C M Olesen
- Departments of Dermatology, Bispebjerg University Hospital, Copenhagen, 2400, Denmark
| | - T Agner
- Departments of Dermatology, Bispebjerg University Hospital, Copenhagen, 2400, Denmark
| | - N E Ebbehøj
- Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, 2400, Denmark
| | - T K Carøe
- Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, 2400, Denmark
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Christoffers WA, Coenraads P, Svensson Å, Diepgen TL, Dickinson‐Blok JL, Xia J, Williams HC. Interventions for hand eczema. Cochrane Database Syst Rev 2019; 4:CD004055. [PMID: 31025714 PMCID: PMC6484375 DOI: 10.1002/14651858.cd004055.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hand eczema is an inflammation of the skin of the hands that tends to run a chronic, relapsing course. This common condition is often associated with itch, social stigma, and impairment in employment. Many different interventions of unknown effectiveness are used to treat hand eczema. OBJECTIVES To assess the effects of topical and systemic interventions for hand eczema in adults and children. SEARCH METHODS We searched the following up to April 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, AMED, LILACS, GREAT, and four trials registries. We checked the reference lists of included studies for further references to relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared interventions for hand eczema, regardless of hand eczema type and other affected sites, versus no treatment, placebo, vehicle, or active treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes were participant- and investigator-rated good/excellent control of symptoms, and adverse events. MAIN RESULTS We included 60 RCTs, conducted in secondary care (5469 participants with mild to severe chronic hand eczema). Most participants were over 18 years old. The duration of treatment was short, generally up to four months. Only 24 studies included a follow-up period. Clinical heterogeneity in treatments and outcome measures was evident. Few studies performed head-to-head comparisons of different interventions. Risk of bias varied considerably, with only five studies at low risk in all domains. Twenty-two studies were industry-funded.Eighteen trials studied topical corticosteroids or calcineurin inhibitors; 10 studies, phototherapy; three studies, systemic immunosuppressives; and five studies, oral retinoids. Most studies compared an active intervention against no treatment, variants of the same medication, or placebo (or vehicle). Below, we present results from the main comparisons.Corticosteroid creams/ointments: when assessed 15 days after the start of treatment, clobetasol propionate 0.05% foam probably improves participant-rated control of symptoms compared to vehicle (risk ratio (RR) 2.32, 95% confidence interval (CI) 1.38 to 3.91; number needed to treat for an additional beneficial outcome (NNTB) 3, 95% CI 2 to 8; 1 study, 125 participants); the effect of clobetasol compared to vehicle for investigator-rated improvement is less clear (RR 1.43, 95% CI 0.86 to 2.40). More participants had at least one adverse event with clobetasol (11/62 versus 5/63; RR 2.24, 95% CI 0.82 to 6.06), including application site burning/pruritus. This evidence was rated as moderate certainty.When assessed 36 weeks after the start of treatment, mometasone furoate cream used thrice weekly may slightly improve investigator-rated symptom control compared to twice weekly (RR 1.23, 95% CI 0.94 to 1.61; 1 study, 72 participants) after remission is reached. Participant-rated symptoms were not measured. Some mild atrophy was reported in both groups (RR 1.76, 95% CI 0.45 to 6.83; 5/35 versus 3/37). This evidence was rated as low certainty.Irradiation with ultraviolet (UV) light: local combination ultraviolet light therapy (PUVA) may lead to improvement in investigator-rated symptom control when compared to local narrow-band UVB after 12 weeks of treatment (RR 0.50, 95% CI 0.22 to 1.16; 1 study, 60 participants). However, the 95% CI indicates that PUVA might make little or no difference. Participant-rated symptoms were not measured. Adverse events (mainly erythema) were reported by 9/30 participants in the narrow-band UVB group versus none in the PUVA group. This evidence was rated as moderate certainty.Topical calcineurin inhibitors: tacrolimus 0.1% over two weeks probably improves investigator-rated symptom control measured after three weeks compared to vehicle (14/14 tacrolimus versus 0/14 vehicle; 1 study). Participant-rated symptoms were not measured. Four of 14 people in the tacrolimus group versus zero in the vehicle group had well-tolerated application site burning/itching.A within-participant study in 16 participants compared 0.1% tacrolimus to 0.1% mometasone furoate but did not measure investigator- or participant-rated symptoms. Both treatments were well tolerated when assessed at two weeks during four weeks of treatment.Evidence from these studies was rated as moderate certainty.Oral interventions: oral cyclosporin 3 mg/kg/d probably slightly improves investigator-rated (RR 1.88, 95% CI 0.88 to 3.99; 1 study, 34 participants) or participant-rated (RR 1.25, 95% CI 0.69 to 2.27) control of symptoms compared to topical betamethasone dipropionate 0.05% after six weeks of treatment. The risk of adverse events such as dizziness was similar between groups (up to 36 weeks; RR 1.22, 95% CI 0.80 to 1.86, n = 55; 15/27 betamethasone versus 19/28 cyclosporin). The evidence was rated as moderate certainty.Alitretinoin 10 mg improves investigator-rated symptom control compared with placebo (RR 1.58, 95% CI 1.20 to 2.07; NNTB 11, 95% CI 6.3 to 26.5; 2 studies, n = 781) and alitretinoin 30 mg also improves this outcome compared with placebo (RR 2.75, 95% CI 2.20 to 3.43; NNTB 4, 95% CI 3 to 5; 2 studies, n = 1210). Similar results were found for participant-rated symptom control: alitretinoin 10 mg RR 1.73 (95% CI 1.25 to 2.40) and 30 mg RR 2.75 (95% CI 2.18 to 3.48). Evidence was rated as high certainty. The number of adverse events (including headache) probably did not differ between alitretinoin 10 mg and placebo (RR 1.01, 95% CI 0.66 to 1.55; 1 study, n = 158; moderate-certainty evidence), but the risk of headache increased with alitretinoin 30 mg (RR 3.43, 95% CI 2.45 to 4.81; 2 studies, n = 1210; high-certainty evidence). Outcomes were assessed between 48 and 72 weeks. AUTHORS' CONCLUSIONS Most findings were from single studies with low precision, so they should be interpreted with caution. Topical corticosteroids and UV phototherapy were two of the major standard treatments, but evidence is insufficient to support one specific treatment over another. The effect of topical calcineurin inhibitors is not certain. Alitretinoin is more effective than placebo in controlling symptoms, but advantages over other treatments need evaluating.Well-designed and well-reported, long-term (more than three months), head-to-head studies comparing different treatments are needed. Consensus is required regarding the definition of hand eczema and its subtypes, and a standard severity scale should be established.The main limitation was heterogeneity between studies. Small sample size impacted our ability to detect differences between treatments.
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Affiliation(s)
- Wietske Andrea Christoffers
- University Medical Center Groningen, University of GroningenDepartment of DermatologyHanzeplein 1GroningenNetherlands9700RB
| | - Pieter‐Jan Coenraads
- University Medical Center Groningen, University of GroningenDepartment of DermatologyHanzeplein 1GroningenNetherlands9700RB
| | - Åke Svensson
- Skåne University HospitalDepartment of DermatologyMalmöSwedenS 205 02
| | - Thomas L Diepgen
- Heidelberg University HospitalDepartment of Clinical Social MedicineThibautstrasse 3HeidelbergGermany69115
| | | | - Jun Xia
- The University of Nottingham NingboNottingham China Health Institute199 Taikang E RdYinzhou QuNingboZhejiang ShengChina315000
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Soltanipoor M, Kezic S, Sluiter JK, de Wit F, Bosma AL, van Asperen R, Rustemeyer T. Effectiveness of a skin care programme for the prevention of contact dermatitis in healthcare workers (the Healthy Hands Project): A single-centre, cluster randomized controlled trial. Contact Dermatitis 2019; 80:365-373. [PMID: 30652317 PMCID: PMC6593800 DOI: 10.1111/cod.13214] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are at risk of developing hand dermatitis (HD). Guidelines recommend moisturizers to prevent HD, but in practice their effectiveness has been poorly investigated. OBJECTIVES To assess whether an intervention aimed at improving skin care leads to a reduction in HD severity. METHODS In this 1-year randomized controlled trial, 9 wards (285 HCWs) were allocated to an intervention group (IG), and 10 wards (216 HCWs) were allocated to the control group (CG). The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCWs. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (HECSI) score (ΔHECSI) and change in natural moisturizing factor (NMF) level (ΔNMF). RESULTS At 12 months, the rates of loss to follow-up were 41% and 39% in the IG and the CG, respectively. The HECSI score was reduced in the IG by -6.2 points (95%CI: -7.7 to -4.7) and in the CG by -4.2 points (95%CI: -6.0 to -2.4). There was no significant difference in ΔHECSI or ΔNMF between the groups. Relative improvement in the HECSI score was significantly higher in the IG than in the CG (56% vs 44%). In a subgroup of HCWs with mild HD, the IG showed a larger HECSI score decrease than the CG (P < 0.001). CONCLUSION Although there was no significant effect on the primary outcomes, the intervention showed overall positive effects on the HECSI score.
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Affiliation(s)
- Maryam Soltanipoor
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith K Sluiter
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fleur de Wit
- Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC (Meibergdreef), Amsterdam, The Netherlands
| | - Ruth van Asperen
- Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
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Parsons V, Williams HC, English J, Llewellyn J, Ntani G, Madan I. The development of a protocol for diagnosing hand dermatitis from photographic images. Contact Dermatitis 2018; 79:270-275. [DOI: 10.1111/cod.13053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/25/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Vaughan Parsons
- Clinical Trials Unit; King's College London & Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - Hywel C. Williams
- Centre of Evidenced Based Dermatology; University of Nottingham; Nottingham UK
| | - John English
- Department of Dermatology; Nottingham University Hospitals NHS Foundation Trust; Nottingham UK
| | - Joanne Llewellyn
- Centre of Evidenced Based Dermatology; University of Nottingham; Nottingham UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton UK
| | - Ira Madan
- School of Medicine; Occupational Health Service, Guy's and St Thomas’ NHS Foundation Trust & King's College London; UK
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15
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Cazzaniga S, Ballmer-Weber BK, Gräni N, Spring P, Bircher A, Anliker M, Sonntag AK, Piletta P, Huber C, Diepgen TL, Apfelbacher C, Naldi L, Borradori L, Simon D. Chronic hand eczema: A prospective analysis of the Swiss CARPE registry focusing on factors associated with clinical and quality of life improvement. Contact Dermatitis 2018; 79:136-148. [DOI: 10.1111/cod.13041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Simone Cazzaniga
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
- Centro Studio, Italian Group for Epidemiological Research in Dermatology (GISED); Bergamo Italy
- Graduate School for Cellular and Biomedical Sciences; University of Bern; Bern Switzerland
| | - Barbara K. Ballmer-Weber
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
- Faculty of Medicine; University of Zurich; Zurich Switzerland
- Allergy Unit, Clinic of Dermatology and Allergology; Cantonal Hospital St Gallen; St. Gallen Switzerland
| | - Nora Gräni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - Philippe Spring
- Department of Dermatology; University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - Andreas Bircher
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - Mark Anliker
- Clinic of Dermatology and Allergology; Cantonal Hospital St Gallen; St Gallen Switzerland
- Hautärzte am Graben; Winterthur Switzerland
| | | | - Pierre Piletta
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Caroline Huber
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
- Dermatology Office; Versoix Switzerland
| | - Thomas L. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital, Ruprecht Karls University; Heidelberg Germany
| | - Christian Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - Luigi Naldi
- Centro Studio, Italian Group for Epidemiological Research in Dermatology (GISED); Bergamo Italy
- Department of Dermatology; San Bortolo Hospital; Vicenza Italy
| | - Luca Borradori
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
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Abstract
Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.
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Affiliation(s)
- Justine Fenner
- Department of Dermatology, Mt Sinai West, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Nanette B Silverberg
- Department of Dermatology, Mt Sinai West, Icahn School of Medicine at Mt Sinai, New York, NY.
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Carøe T, Ebbehøj N, Bonde J, Vejlstrup S, Agner T. Job change facilitates healing in a cohort of patients with occupational hand eczema. Br J Dermatol 2018; 179:80-87. [DOI: 10.1111/bjd.16095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- T.K. Carøe
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - N.E. Ebbehøj
- Department of Occupational and Environmental Medicine; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - J.P.E. Bonde
- Department of Occupational and Environmental Medicine; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - S.G. Vejlstrup
- Department of Occupational and Environmental Medicine; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - T. Agner
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
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18
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Nørreslet LB, Agner T, Sørensen JA, Ebbehøj NE, Bonde JP, Fisker MH. Impact of hand eczema on quality of life: metropolitan versus non-metropolitan areas. Contact Dermatitis 2018; 78:348-354. [DOI: 10.1111/cod.12962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Line B. Nørreslet
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
| | - Tove Agner
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
| | - Jennifer A. Sørensen
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
- Department of Occupational and Environmental Medicine; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
| | - Niels E. Ebbehøj
- Department of Occupational and Environmental Medicine; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
| | - Jens P. Bonde
- Department of Occupational and Environmental Medicine; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
| | - Maja H. Fisker
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
- Department of Occupational and Environmental Medicine; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen Denmark
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19
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Lund TT, Agner T. Hand Eczema: Treatment Options. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Sørensen JA, Fisker MH, Agner T, Clemmensen KKB, Ebbehøj NE. Associations between lifestyle factors and hand eczema severity: are tobacco smoking, obesity and stress significantly linked to eczema severity? Contact Dermatitis 2016; 76:138-145. [DOI: 10.1111/cod.12674] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Jennifer A. Sørensen
- Department of Occupational and Environmental Medicine; Bispebjerg University Hospital; 2400 Copenhagen Denmark
- Department of Dermatology; Bispebjerg University Hospital; 2400 Copenhagen Denmark
| | - Maja H. Fisker
- Department of Occupational and Environmental Medicine; Bispebjerg University Hospital; 2400 Copenhagen Denmark
| | - Tove Agner
- Department of Dermatology; Bispebjerg University Hospital; 2400 Copenhagen Denmark
| | - Kim K. B. Clemmensen
- Department of Dermatology; Bispebjerg University Hospital; 2400 Copenhagen Denmark
| | - Niels E. Ebbehøj
- Department of Occupational and Environmental Medicine; Bispebjerg University Hospital; 2400 Copenhagen Denmark
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21
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Cazzaniga S, Ballmer-Weber B, Gräni N, Spring P, Bircher A, Anliker M, Sonntag A, Piletta P, Huber C, Borradori L, Diepgen T, Apfelbacher C, Simon D. Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study. J Eur Acad Dermatol Venereol 2015; 30:628-37. [DOI: 10.1111/jdv.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Cazzaniga
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
- Centro Studi GISED; Bergamo Italy
| | - B.K. Ballmer-Weber
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - N. Gräni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - P. Spring
- Department of Dermatology; University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - A. Bircher
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - M. Anliker
- Department of Dermatology; Cantonal Hospital St. Gallen; St. Gallen Switzerland
| | - A.K. Sonntag
- Department of Dermatology; Cantonal Hospital Aarau; Aarau Switzerland
| | - P. Piletta
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - C. Huber
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - L. Borradori
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
| | - T. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital; Ruprecht Karls University; Heidelberg Germany
| | - C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
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22
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Petersen A, Johansen J, Hald M. Hand eczema - prognosis and consequences: a 7-year follow-up study. Br J Dermatol 2014; 171:1428-33. [DOI: 10.1111/bjd.13371] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A.H. Petersen
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
| | - M. Hald
- Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
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23
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24
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Corti MA, Stirnimann R, Borradori L, Simon D. Effects of Systematic Patient Education in Skin Care and Protection in a Hand Eczema Clinic. Dermatology 2014; 228:220-4. [DOI: 10.1159/000357523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/21/2013] [Indexed: 11/19/2022] Open
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Mollerup A, Veien NK, Johansen JD. Effectiveness of the Healthy Skin Clinic - a randomized clinical trial of nurse-led patient counselling in hand eczema. Contact Dermatitis 2014; 71:202-14. [DOI: 10.1111/cod.12243] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/06/2014] [Accepted: 03/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Annette Mollerup
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
| | - Niels K. Veien
- The Dermatology Clinic; Fyrkildevej 7 9220 Aalborg Øst Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
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26
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Mollerup A, Veien NK, Johansen JD. An analysis of gender differences in patients with hand eczema - everyday exposures, severity, and consequences. Contact Dermatitis 2014; 71:21-30. [DOI: 10.1111/cod.12206] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/11/2013] [Accepted: 01/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Annette Mollerup
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
| | | | - Jeanne Duus Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
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27
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Thyssen JP, Menné T, Johansen JD. Hexavalent chromium in leather is now regulated in European Union member states to limit chromium allergy and dermatitis. Contact Dermatitis 2013; 70:1-2. [DOI: 10.1111/cod.12182] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 11/28/2022]
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28
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Lindberg M, Bingefors K, Meding B, Berg M. Hand eczema and health-related quality of life; a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the hand eczema extent score (HEES). Contact Dermatitis 2013; 69:138-43. [DOI: 10.1111/cod.12067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kerstin Bingefors
- Department of Pharmacy; Uppsala University; SE-751 05; Uppsala; Sweden
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Thyssen J. Atopic dermatitis, filaggrin mutations and irritant contact dermatitis. Br J Dermatol 2013; 168:233-4. [DOI: 10.1111/bjd.12155] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ibler KS, Jemec GBE, Diepgen TL, Gluud C, Lindschou Hansen J, Winkel P, Thomsen SF, Agner T. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. BMJ 2012; 345:e7822. [PMID: 23236031 PMCID: PMC3520547 DOI: 10.1136/bmj.e7822] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. DESIGN Randomised, observer blinded parallel group superiority clinical trial. SETTING Three hospitals in Denmark. PARTICIPANTS 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. INTERVENTIONS Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. MAIN OUTCOME MEASURES The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. RESULTS Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. CONCLUSION A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. TRIAL REGISTRATION ClinicalTrials.gov NCT01012453.
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Affiliation(s)
- Kristina Sophie Ibler
- Department of Dermatology, Roskilde Hospital, Health Science Faculty, Køgevej 7-13, 4000 Roskilde, Denmark.
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Abstract
Hand eczema is an inflammation of the skin; the cause is often multifactorial. Initial management includes avoiding causative irritants or allergens (e.g., by wearing impermeable gloves) and applying emollients and potent topical glucocorticoids.
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Affiliation(s)
- Pieter-Jan Coenraads
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Mollerup A, Veien NK, Johansen JD. Chronic hand eczema--self-management and prognosis: a study protocol for a randomised clinical trial. BMC DERMATOLOGY 2012; 12:6. [PMID: 22691871 PMCID: PMC3492110 DOI: 10.1186/1471-5945-12-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 02/08/2023]
Abstract
Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.
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Affiliation(s)
- Annette Mollerup
- National Allergy Research Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
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Ibler KS, Jemec GBE, Flyvholm MA, Diepgen TL, Jensen A, Agner T. Hand eczema: prevalence and risk factors of hand eczema in a population of 2274 healthcare workers. Contact Dermatitis 2012; 67:200-7. [DOI: 10.1111/j.1600-0536.2012.02105.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jamil WN, Erikssohn I, Lindberg M. How well is the outcome of patch testing remembered by the patients? A 10-year follow-up of testing with the Swedish baseline series at the Department of Dermatology in Örebro, Sweden. Contact Dermatitis 2012; 66:215-20. [DOI: 10.1111/j.1600-0536.2011.02039.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Menné T, Johansen JD, Sommerlund M, Veien NK. Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema. Contact Dermatitis 2011; 65:3-12. [PMID: 21658053 DOI: 10.1111/j.1600-0536.2011.01915.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Classification of hand eczema has traditionally been based both on aetiology and clinical appearance. For 20% of cases, the aetiology is unknown. OBJECTIVES To suggest a classification based on well-defined aetiology as well as on predefined clinical patterns and on the dynamics of hand eczema. METHODS Literature studies and discussions among members of the Danish Contact Dermatitis Group. RESULTS Criteria are given for the aetiological diagnoses of allergic contact dermatitis of the hands, irritant contact dermatitis of the hands, protein contact dermatitis of the hands, atopic hand eczema and aetiologically unclassifiable hand eczema. Six different clinical patterns are described and illustrated. Suggestions for general treatment principles are given. CONCLUSION Operational guidelines for the diagnosis and treatment of hand eczema are described.
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Affiliation(s)
- Torkil Menné
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, DK-2900 Hellerup, Denmark
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Carlsson A, Gånemo A, Anderson C, Meding B, Stenberg B, Svensson Å. Scoring of hand eczema: good agreement between patients and dermatological staff. Br J Dermatol 2011; 165:123-8. [DOI: 10.1111/j.1365-2133.2011.10312.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bregnhøj A, Søsted H, Menné T, Johansen JD. Validation of self-reporting of hand eczema among Danish hairdressing apprentices. Contact Dermatitis 2011; 65:146-50. [DOI: 10.1111/j.1600-0536.2011.01908.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lan CCE, Tu HP, Lee CH, Wu CS, Ko YC, Yu HS, Lu YW, Li WC, Chen GS. Hand dermatitis among university hospital nursing staff with or without atopic eczema: assessment of risk factors. Contact Dermatitis 2010; 64:73-9. [DOI: 10.1111/j.1600-0536.2010.01813.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mälkönen T, Alanko K, Jolanki R, Luukkonen R, Aalto-Korte K, Lauerma A, Susitaival P. Long-term follow-up study of occupational hand eczema. Br J Dermatol 2010; 163:999-1006. [DOI: 10.1111/j.1365-2133.2010.09987.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mise au point sur l’eczéma chronique des mains. Ann Dermatol Venereol 2010; 137:315-27. [DOI: 10.1016/j.annder.2010.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 02/25/2010] [Indexed: 11/30/2022]
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Baumeister T, Weistenhöfer W, Drexler H, Kütting B. Spoilt for choice - evaluation of two different scoring systems for early hand eczema in teledermatological examinations. Contact Dermatitis 2010; 62:241-7. [DOI: 10.1111/j.1600-0536.2010.01703.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hald M, Agner T, Blands J, Johansen J. Delay in medical attention to hand eczema: a follow-up study. Br J Dermatol 2009; 161:1294-300. [DOI: 10.1111/j.1365-2133.2009.09402.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Weistenhöfer W, Baumeister T, Drexler H, Kütting B. An overview of skin scores used for quantifying hand eczema: a critical update according to the criteria of evidence-based medicine. Br J Dermatol 2009; 162:239-50. [DOI: 10.1111/j.1365-2133.2009.09463.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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