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Borg E, Munro D, Thoning H. The management of Chronic Hand Eczema: A retrospective patient record review. Contact Dermatitis 2024; 90:365-371. [PMID: 38164049 DOI: 10.1111/cod.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Chronic Hand Eczema (CHE) is a heterogeneous fluctuating inflammatory disease that represents a significant burden. Effective treatment options for moderate to severe CHE are limited. OBJECTIVES To assess how patients with moderate to severe CHE are treated in clinical practice. METHODS A retrospective, physician-led patient record review assessed the demographic, clinical and treatment characteristics of patients aged ≥18 years with CHE across seven countries. Each participating physician was requested to review records for their three most recent patients with moderate to severe CHE treated with a topical or systemic therapy. RESULTS A total of 264 physicians, of whom 88.6% were dermatologists and 70.1% were predominantly or partly hospital-based, reviewed the records of 792 patients. Signs were present on hands only in 56.4% of patients and the mean time on current treatment was 16.7 months. Overall, 62.9% of patients received systemic therapy and almost one-quarter (23.4%) were treated with a biologic; 28.6% of patients were only treated with topical corticosteroids and/or topical calcineurin inhibitors. CONCLUSION In patients with moderate to severe CHE, most received systemic therapy with one-quarter on biologic therapy. However, given that many of these treatments have limited evidence of efficacy in CHE, there is a need for studies specifically in patients with CHE as well as new therapeutic options.
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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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3
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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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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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5
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Woo YR, Han Y, Lee JH, Lee YB, Kim JE, Kim M, Park CJ, Lee JH, Cho SH. Real‐world prevalence and burden of genital eczema in atopic dermatitis: A multicenter questionnaire‐based study. J Dermatol 2021; 48:625-632. [DOI: 10.1111/1346-8138.15817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Yu Ri Woo
- Department of Dermatology Incheon St. Mary’s Hospital The Catholic University of Korea Incheon Korea
- Eczema Research Association of Catholic Medical Center Seoul Korea
| | - Yujin Han
- Department of Dermatology Incheon St. Mary’s Hospital The Catholic University of Korea Incheon Korea
| | - Ji Hae Lee
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology St. Vincent’s Hospital College of Medicine The Catholic University of Korea Gyeonggi‐do Korea
| | - Young Bok Lee
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology Uijeongbu St. Mary’s Hospital College of Medicine The Catholic University of Korea Gyeonggi‐do Korea
| | - Jung Eun Kim
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology Eunpyung St Mary’s Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Miri Kim
- Department of Dermatology Yeouido St. Mary’s Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Chul Jong Park
- Department of Dermatology Bucheon St. Mary’s Hospital College of Medicine The Catholic University of Korea Gyeonggi‐do Korea
| | - Ji Hyun Lee
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology Seoul St. Mary’s Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Sang Hyun Cho
- Department of Dermatology Incheon St. Mary’s Hospital The Catholic University of Korea Incheon Korea
- Eczema Research Association of Catholic Medical Center Seoul Korea
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6
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Andrees V, John SM, Nienhaus A, Skudlik C, Brans R, Augustin M, Krensel M. Economic evaluation of a tertiary prevention program for occupational skin diseases in Germany. Contact Dermatitis 2020; 82:361-369. [DOI: 10.1111/cod.13506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health TheoryUniversity of Osnabrück Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück Osnabrück Germany
| | - Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health TheoryUniversity of Osnabrück Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück Osnabrück Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health TheoryUniversity of Osnabrück Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück Osnabrück Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Magdalene Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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Agner T, Elsner P. Hand eczema: epidemiology, prognosis and prevention. J Eur Acad Dermatol Venereol 2019; 34 Suppl 1:4-12. [DOI: 10.1111/jdv.16061] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/06/2019] [Indexed: 12/27/2022]
Affiliation(s)
- T. Agner
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - P. Elsner
- Department of Dermatology University Hospital Jena Jena Germany
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Tauber M, Lourari S, Bérard E, Questel E, Redoules D, Giordano-Labadie F, Simon M, Carle P. Positive change in hand care habits using therapeutic patient education in chronic hand eczema. Contact Dermatitis 2019; 82:10-17. [PMID: 31461531 DOI: 10.1111/cod.13390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. OBJECTIVE To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life, and work productivity. METHODS A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index), and WPAI (Work Productivity and Activity Impairment). RESULTS Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program, hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams, and following specific treatments and recommendations for CHE improved significantly in the 58 patients who completed the study and were associated with a significant improvement in the mTLSS, DLQI, and WPAI scores. CONCLUSIONS TPE helps patients change their hand care behaviours and adopt skin protection measures, and may improve CHE severity, quality of life, and work productivity.
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Affiliation(s)
- Marie Tauber
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | - Siham Lourari
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital (CHU), Toulouse, France
| | | | | | | | - Michel Simon
- UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | - Paul Carle
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
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10
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Kreis K, Aumann-Suslin I, Lüdeke A, Wegewitz U, Zeidler J, Graf von der Schulenburg JM. Costs of isocyanate-related occupational diseases: A systematic review. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:446-466. [PMID: 31100044 DOI: 10.1080/15459624.2019.1609005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although isocyanates are increasingly used in manufacturing and workplace exposure to isocyanates is widely recognized as one of the most frequent causes for occupational lung and skin diseases, little is known about the economic burden on the affected individual and the society. This study provides an overview on costs of occupational diseases related to isocyanates. We performed a systematic literature search of studies in the electronic databases of the German Institute of Medical Documentation and Information, and the Canadian Centre for Occupational Health and Safety. We extracted the key characteristics of the studies and performed a study quality assessment. We identified eight studies on the costs of illness, of which five focused on occupational lung diseases and three on occupational skin diseases. Further, eight studies calculated loss of income/compensation payments. Out of the 16 identified articles, only two reported costs directly attributable to isocyanate-induced diseases (asthma). Studies were hardly comparable because they differed substantially in their methodological approaches. Moreover, the quality assessment of the studies revealed substantial limitations. While a wide range of isocyanate-related costs was identified, consequences of isocyanate-related occupational diseases were considerable in terms of societal costs and loss of income. In most studies, indirect costs were the main cost driver. There is a need for high-quality cost of illness studies on isocyanate-induced diseases stratified by degree of severity and sex. Such studies provide valuable information to develop preventive strategies and set priorities for measures to lower the burden of professional health risks.
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Affiliation(s)
- Kristine Kreis
- a Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Ines Aumann-Suslin
- a Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Andreas Lüdeke
- b Federal Institute for Occupational Safety and Health (BAuA) , Dortmund , Germany
| | - Uta Wegewitz
- c Federal Institute for Occupational Safety and Health (BAuA) , Berlin , Germany
| | - Jan Zeidler
- a Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
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Küster D, Haufe E, Rethberg C, Bauer A, Seidler A, Schmitt J. Health utilities for controlled and uncontrolled chronic hand eczema in healthcare employees. Contact Dermatitis 2017; 78:18-27. [DOI: 10.1111/cod.12863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Denise Küster
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Eva Haufe
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Constanze Rethberg
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Andrea Bauer
- Clinic and Policlinic for Dermatology; Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Andreas Seidler
- Institute and Outpatient clinic of Occupational and Social Medicine; Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
| | - Jochen Schmitt
- Centre of Evidence-Based Healthcare; University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden; 01307 Dresden Germany
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12
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Weistenhöfer W, Uter W, Drexler H. Protection during production: Problems due to prevention? Nail and skin condition after prolonged wearing of occlusive gloves. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:396-404. [PMID: 28696905 DOI: 10.1080/10937404.2017.1304741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Wearing of occlusive gloves during the whole working shift is considered a risk factor for developing hand eczema, similar to wet work. Moreover, the increased hydration due to glove occlusion may lead to brittle nails. Two hundred and seventy clean room workers, wearing occlusive gloves for prolonged periods, and 135 administrative employees not using gloves were investigated. This included a dermatological examination of the nails and the hands, using the Hand Eczema ScoRe for Occupational Screening (HEROS), measurement of transepidermal water loss (TEWL), and a standardized interview. Of the clean room workers, 39%, mainly women, reported nail problems, mostly brittle nails with onychoschisis. Skin score values showed no significant differences between HEROS values of both groups. TEWL values of exposed subjects were similar to TEWL values of controls 40 min after taking off the occlusive gloves. In a multiple linear regression analysis, male gender and duration of employment in the clean room were associated with a significant increase in TEWL values. The effect of occlusion on TEWL seems to be predominantly transient and not be indicative of a damaged skin barrier. This study confirmed the results of a previous investigation showing no serious adverse effect of wearing of occlusive gloves on skin condition without exposure to additional hazardous substances. However, occlusion leads to softened nails prone to mechanical injury. Therefore, specific prevention instructions are required to pay attention to this side effect of occlusion.
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Affiliation(s)
- Wobbeke Weistenhöfer
- a Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine , Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Wolfgang Uter
- b Department of Medical Informatics , Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Hans Drexler
- a Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine , Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
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Augustin M, Thaçi D, Kamps A. Der Einfluss von Alitretinoin auf die Lebensqualität bei Patienten mit schwerem chronischen Handekzem: FUGETTA - Beobachtungsstudie unter Praxisbedingungen. J Dtsch Dermatol Ges 2016; 14:1261-1272. [PMID: 27992125 DOI: 10.1111/ddg.12870_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
HINTERGRUND UND ZIELE Alitretinoin ist die einzige zugelassene Behandlung für schweres chronisches Handekzem (CHE), das refraktär gegenüber potenten topischen Corticosteroiden ist. Bei dieser Studie (FUGETTA) wurde die Wirksamkeit von leitliniengerecht angewendetem oralem Alitretinoin sowie dessen Einfluss auf die Lebensqualität (LQ) bei Patienten mit schwerem refraktärem CHE beurteilt. PATIENTEN UND METHODEN Multizentrische, offene, nichtinterventionelle Beobachtungsstudie, durchgeführt in Deutschland. Die Patienten wurden nach Ermessen ihres behandelnden Arztes mit Alitretinoin 10 mg oder 30 mg einmal täglich über maximal 24 Wochen behandelt. Die Wirksamkeit wurde anhand des Physician Global Assessment (PGA) und des Dermatology Life Quality Index (DLQI) bewertet. Zudem wurden unerwünschte Ereignisse (UE) erfasst. ERGEBNISSE Die Studienpopulation bestand aus 658 Patienten (30 mg: n = 581; 10 mg: n = 77). Bei Beobachtungsbeginn litten die meisten Patienten (83 %) gemäß PGA an einem schweren CHE. Bei Beobachtungsende war das Handekzem bei 48 % der Patienten gemäß PGA vollständig oder fast vollständig abgeheilt (30 mg: 49 %; 10 mg: 43 %). Die mittlere Verbesserung des DLQI-Scores in Woche 24 betrug 58 % (30 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,4 [8,04]) und 70 % (10 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,8 [7,29]). Die Gesamtinzidenz von NW war niedrig und in den beiden Gruppen ähnlich. SCHLUSSFOLGERUNGEN Alitretinoin führte zu einer schnellen, deutlichen Verbesserung der LQ bei Patienten mit schwerem CHE.
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Affiliation(s)
| | - Diamant Thaçi
- Zentrum für Entzündungsmedizin, Universität zu Lübeck, Deutschland
| | - Anja Kamps
- Stiefel, ein GSK-Unternehmen, München, Deutschland
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14
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Augustin M, Thaçi D, Kamps A. Impact on quality of life of alitretinoin in severe chronic hand eczema: FUGETTA real-world study. J Dtsch Dermatol Ges 2016; 14:1261-1270. [DOI: 10.1111/ddg.12870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine; University of Luebeck; Germany
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Thaçi D, Augustin M, Westermayer B, Kamps A, Hennig M. Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real-world observational study. J DERMATOL TREAT 2016; 27:577-583. [DOI: 10.1080/09546634.2016.1227422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Hand Dermatitis: Utilizing Subtype Classification to Direct Intervention. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0090-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Politiek K, Oosterhaven JAF, Vermeulen KM, Schuttelaar MLA. Systematic review of cost-of-illness studies in hand eczema. Contact Dermatitis 2016; 75:67-76. [DOI: 10.1111/cod.12590] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Klaziena Politiek
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
| | - Jart A. F. Oosterhaven
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
| | - Marie-Louise A. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB Groningen The Netherlands
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Mahler V. Hand dermatitis - differential diagnoses, diagnostics, and treatment options. J Dtsch Dermatol Ges 2015; 14:7-26; quiz 27-8. [DOI: 10.1111/ddg.12922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Vera Mahler
- Department of Dermatology; University Hospital Erlangen; Erlangen Germany
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19
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Mahler V. Handekzeme - Differenzialdiagnosen, Diagnostik und Therapien. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.150_12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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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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21
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Fartasch M, Diepgen TL, Drexler H, Elsner P, John SM, Schliemann S. S1-Leitlinie „Berufliche Hautmittel: Hautschutz, Hautpflege und Hautreinigung“ (ICD 10: L23, L24) - Kurzversion. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12617_suppl] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Manigé Fartasch
- Abteilung klinische & experimentelle Berufsdermatologie, Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung; Institut der Ruhr-Universität Bochum (IPA)
| | - Thomas L. Diepgen
- Abteilung Klinische Sozialmedizin, Berufs- und Umweltdermatologie; Ruprecht- Karls-Universität Heidelberg
| | - Hans Drexler
- Institut & Poliklinik für Arbeits-, Sozial- & Umweltmedizin; Universität Erlangen- Nürnberg
| | | | - Swen Malte John
- Fachgebiet Dermatologie; Umweltmedizin, Gesundheitstheorie, Universität Osnabrück
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22
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Fartasch M, Diepgen TL, Drexler H, Elsner P, John SM, Schliemann S. S1 guideline on occupational skin products: protective creams, skin cleansers, skin care products (ICD 10: L23, L24) - short version. J Dtsch Dermatol Ges 2015; 13:594-606. [DOI: 10.1111/ddg.12617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Manigé Fartasch
- Department of Clinical and Experimental Occupational Dermatology; Institute for Prevention and Occupational Medicine of the German Occupational Accident Insurance, Institute of the Ruhr University Bochum (IPA); Germany
| | - Thomas L. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; Ruprecht Karls University Heidelberg; Germany
| | - Hans Drexler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine; University of Erlangen-Nuremberg; Germany
| | - Peter Elsner
- Department of Dermatology; University Hospital Jena; Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine; Health Theory, University of Osnabrueck; Germany
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23
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Jankowska-Konsur A, Reich A, Szepietowski JC. Systemic antihistamines--a common outside the guidelines therapeutic strategy in hand eczema management. J Eur Acad Dermatol Venereol 2015; 30:67-71. [PMID: 25731585 DOI: 10.1111/jdv.13060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hand eczema (HE) is the most common skin disease affecting hands. Although the current treatment guidelines do not recommend use of systemic antihistamines as routine therapy, they seem to be widely used by physicians handling with this problem. OBJECTIVE The aim of the study was to investigate the attitude to prescribe systemic antihistamines in HE. MATERIAL AND METHODS A 10-item questionnaire was distributed among physicians participating in regional dermatological conferences. 127 valid questionnaires were analysed. RESULTS A total of 127 physicians participated in the survey. 124 (97.6%) responders prescribe antihistamines in HE and 16 (12.6%) subjects declared routine use of oral antihistamines in the HE management. Significantly more dermatologists than other specialists used antihistamines in the treatment of HE accompanying atopic dermatitis (77.8% vs. 54.5%, P < 0.01) and dermatologists significantly more commonly used antihistamines in HE due to their anti-inflammatory properties (40.3% vs. 20.0%, P = 0.02). Regarding the type of eczema, antihistamines were prescribed most frequently in acute allergic HE (n = 92, 72.4%) and in HE accompanying atopic dermatitis (n = 86, 67.7%). CONCLUSIONS Despite the lack of the large, randomized, controlled studies on the effectiveness of the systemic antihistamines in the treatment of HE, this type of therapy seems to be prevalently used among the physicians.
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Affiliation(s)
- A Jankowska-Konsur
- Department of Dermatology, Allergology and Venereology, University of Medicine, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, Allergology and Venereology, University of Medicine, Wroclaw, Poland
| | - J C Szepietowski
- Department of Dermatology, Allergology and Venereology, University of Medicine, Wroclaw, Poland
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Weistenhöfer W, Wacker M, Bernet F, Uter W, Drexler H. Occlusive gloves and skin conditions: is there a problem? Results of a cross-sectional study in a semiconductor company. Br J Dermatol 2015; 172:1058-65. [PMID: 25319754 DOI: 10.1111/bjd.13481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although there is poor scientific evidence that working with occlusive gloves is as damaging as wet work, prolonged glove occlusion is considered to be a risk factor for developing hand eczema similar to wet work. OBJECTIVES To assess the effects of wearing occlusive gloves during the whole working day, without exposure to any additional hazardous substances, on skin condition and skin barrier function. METHODS We investigated 323 employees of a semiconductor production company in Germany: 177 clean-room workers wearing occlusive gloves during the whole shift (exposed group) and 146 employees working in administration (control group). A standardized interview was performed, the skin condition of both hands was studied using the quantitative skin score HEROS, and transepidermal water loss (TEWL) and stratum corneum hydration were measured. RESULTS There was no significant difference in skin condition between the two subgroups. Values for TEWL and corneometry were significantly higher in exposed participants (P < 0·05). However, the TEWL values were similar to control values if participants took off the occlusive gloves at least 30 min before the measurement. Hence, the effect of occlusion on skin barrier function seems to be transient. CONCLUSIONS Prolonged wearing of occlusive gloves with clean hands and without exposure to additional hazardous substances does not seem to affect the skin negatively.
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Affiliation(s)
- W Weistenhöfer
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, D-91054, Erlangen, Germany
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25
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Molin S, Merl J, Dietrich KA, Regauer M, Flaig M, Letulé V, Saucke T, Herzinger T, Ruzicka T, Hauck SM. The hand eczema proteome: imbalance of epidermal barrier proteins. Br J Dermatol 2015; 172:994-1001. [PMID: 25244099 DOI: 10.1111/bjd.13418] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic hand eczema (CHE) is a common skin disease with a high socioeconomic impact. While some light has been shed on the genetic factors that predispose individuals to the disease, little is known about its actual pathogenesis. OBJECTIVES We aimed to carry out a systematic and comprehensive analysis of the differential protein expression in CHE using modern mass spectrometry. METHODS We performed liquid chromatography with tandem mass spectrometry analyses and label-free quantification to analyse the proteomic profile of palmar skin from 12 individuals (six patients with hand eczema and six healthy volunteers). Immunohistochemistry of the palmar skin from seven different patients with hand eczema and seven different healthy volunteers was performed in a second step. RESULTS With this method we were able to identify 185 candidate proteins with a significantly different abundance in the hand eczema samples. Among them we found several barrier proteins: filaggrin (FLG), FLG-2 and hornerin were all downregulated in the hand eczema samples, as were the desquamation-related enzymes kallikrein-related peptidase (KLK)5 and KLK7 and cystatin E/M. The antimicrobial peptides S100A7 and S100A8/A9 and the small proline-rich protein 2B and S100A11 were upregulated in the diseased skin. Immunohistochemistry confirmed these findings. CONCLUSIONS Our results corroborate the assumption that skin barrier dysfunction plays an essential role in the pathogenesis of CHE.
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Affiliation(s)
- S Molin
- Department of Dermatology and Allergy, Ludwig Maximilian University, D-80337, Munich, Germany; Research Unit Protein Science, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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26
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Scalone L, Cortesi P, Mantovani L, Belisari A, Ayala F, Fortina A, Bonamonte D, Borroni G, Cannavò S, Guarneri F, Cristaudo A, De Pità O, Gallo R, Girolomoni G, Gola M, Lisi P, Pigatto P, Satta R, Giannetti A. Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy. Br J Dermatol 2014; 172:187-95. [DOI: 10.1111/bjd.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Scalone
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - P.A. Cortesi
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - L.G. Mantovani
- CHARTA Foundation; Milan Italy
- Faculty of Pharmacy; University of Naples Federico II; Naples Italy
| | | | - F. Ayala
- Department of Dermatology; University of Naples Federico II; Naples Italy
| | - A.B. Fortina
- Pediatric Dermatology Unit; Department of Medicine; University of Padova; Padova Italy
| | - D. Bonamonte
- Department of Biomedical Science and Human Oncology; Unit of Dermatology; University of Bari ‘Aldo Moro’; Bari Italy
| | - G. Borroni
- Clinical-Surgical, Diagnostic and Pediatric Science; Dermatology Unit; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S.P. Cannavò
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - F. Guarneri
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - A. Cristaudo
- Department of Allergological and Occupational Dermatology; San Gallicano Dermatologic Institute, IRCCS; Rome Italy
| | - O. De Pità
- Laboratory of Immunology; Istituto Dermopatico dell'Immacolata (IDI)-IRCCS; Rome Italy
| | - R. Gallo
- Section of Dermatology; DISSAL - Department of Health Sciences; University of Genoa; Genoa Italy
| | - G. Girolomoni
- Department of Medicine; Section of Dermatology and Venereology; University of Verona; Verona Italy
| | - M. Gola
- Allergological and Occupational Dermatology Unit; Department of Critical Care Medicine and Surgery; University of Florence; Florence Italy
| | - P. Lisi
- Department of Medical and Surgical Specialities and Public Health; Section of Clinical, Allergological and Venereological Dermatology; University of Perugia; Perugia Italy
| | - P.D. Pigatto
- Department of Biomedical Science for Health IRCCS Galeazzi Hospital; University of Milan; Milan Italy
| | - R. Satta
- Institute of Dermatology; University of Sassari; Sassari Italy
| | - A. Giannetti
- Division of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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Diepgen TL, Scheidt R, Weisshaar E, John SM, Hieke K. Cost of illness from occupational hand eczema in Germany. Contact Dermatitis 2014; 69:99-106. [PMID: 23869729 DOI: 10.1111/cod.12038] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is little knowledge about the costs of occupational hand eczema. OBJECTIVES To estimate the societal costs of patients with occupational hand eczema in Germany. METHODS Resource use during the past year, disease severity and quality of life [Dermatology Life Quality Index (DLQI)] were gathered for patients with occupational hand eczema before they entered a special rehabilitation programme. Costs were calculated from the societal perspective. The analysis focused on all patients and the severity groups no signs/mild (group A) and moderate to severe (group B). RESULTS One hundred and fifty-one patients were analysed, with a mean age of 44.9~years and a mean DLQI score of 10.9; 64.9% were male. Sickness absence was recorded for 62.9% of all patients (76.4~days on average in the last 12~months). Annual societal costs were €8799 per patient. Indirect costs represented 70% of total costs. Quality of life (DLQI) was statistically different across both severity groups (group A, 7.9; group B, 12.9), but direct treatment costs were not (€2705 versus €2610, respectively). There was a trend towards higher indirect costs in patients in severity group B (group A, €5120; group B, €6796). CONCLUSION The annual societal costs of patients with occupational hand eczema in this study are high, and similar to those for severe psoriasis and atopic dermatitis.
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Affiliation(s)
- Thomas L Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, 69115 Heidelberg, Germany.
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Agner T, Jungersted JM, Coenraads PJ, Diepgen T. Comparison of four methods for assessment of severity of hand eczema. Contact Dermatitis 2014; 69:107-11. [PMID: 23869730 DOI: 10.1111/cod.12039] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several instruments for the assessment of the severity of hand eczema and health-related quality of life (HR-QoL) related to hand eczema have been developed. OBJECTIVES The aim of the present study was to evaluate the correlation between frequently used methods. METHODS Consecutive patients with current hand eczema from three different centres participated in the study. Severity of hand eczema was assessed with the Hand Eczema Severity Index (HECSI), the Physician Global Assessment (PGA), the Clinical Photo Guide, and the Dermatology Life Quality Index (DLQI). RESULTS One hundred and nineteen patients with hand eczema were included in the study. All six pairwise correlation coefficients between the tested methods were highly statistically significant. Correlation was highest between the HECSI and the PGA (r = 0.82), and weakest, although still statistically significant, between the DLQI and the other three severity scores (r between 0.30 and 0.45). Age and frequency of eruptions did not influence the correlations. With respect to sex, there was a tendency for correlation between methods to be higher for men than for women. CONCLUSION We found an overall positive correlation between the four severity assessments applied. As the weakest correlation was found between the DLQI and the other methods, it is suggested that measurement of HR-QoL should be included for assessment of the severity and consequences of hand eczema, but the finding also indicates that a disease-specific tool for evaluation of HR-QoL in hand eczema patients is needed.
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Affiliation(s)
- Tove Agner
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400 Copenhagen, Denmark.
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Macan J, Rimac D, Kežić S, Varnai VM. Occupational and non-occupational allergic contact dermatitis: a follow-up study. Dermatology 2013; 227:321-9. [PMID: 24193097 DOI: 10.1159/000354763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to obtain insight into the clinical course and prognosis of allergic contact dermatitis (ACD), including potential effects of genetic and environmental factors. METHODS Eighty-two patients with previously defined ACD acquired occupationally (OACD) or non-occupationally (NOACD) were patch retested and evaluated for the presence of persistent eczema, atopy and filaggrin mutations. RESULTS The crude risk for the persistence of a positive patch test (PT) reaction was 6.3 times higher (95% CI 3.63-11.0) for PT reactions assessed as '+++' compared to '++' reactions at the first PT. Among the categories of OACD, NOACD, age, gender, atopy, and the number of positive PT reactions at the first and second PT, only OACD (OR 10.0, 95% CI 1.95-51.2) and number of positive PT reactions at retesting (OR 3.85, 95% CI 1.57-9.44) were found to be predictors of persistent eczema. CONCLUSIONS Occupationally acquired contact allergy was emphasized as the most important factor in predicting poor prognosis of ACD.
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Affiliation(s)
- Jelena Macan
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
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30
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Cortesi PA, Scalone L, Belisari A, Bonamonte D, Cannavò SP, Cristaudo A, De Pità O, Gallo R, Giannetti A, Gola M, Pigatto PD, Mantovani LG. Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids. Contact Dermatitis 2013; 70:158-68. [PMID: 24102212 DOI: 10.1111/cod.12130] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/26/2013] [Accepted: 06/30/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is known about the socio-economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids. OBJECTIVES To estimate the socio-economic burden of severe chronic hand eczema refractory to potent topical corticosteroids, and to establish an algorithm for the estimation of the health-related quality of life EuroQol five-dimensional (EQ-5D) utility index from the Dermatology Life Quality Index (DLQI) summary score. METHODS A multicentre cost of illness study was conducted, adopting the societal perspective. Adult patients with severe and refractory chronic hand eczema were enrolled. Direct (e.g. drug treatment and travel) and indirect (i.e. loss of productivity) mean costs/patient-month were estimated. Health-related quality of life was assessed with the EQ-5D and DLQI questionnaires. An ordinary least square regression model was used to investigate relationships between health-related quality of life scores. RESULTS One hundred and four valid patients (mean age 44.5 years, 39.4% male) participated. Overall mean costs were €418.3/patient-month: loss of productivity contributed 43.7%, followed by hospitalization (16.1%) and travel (10.3%). Health-related quality of life scores were, on average, 0.50 (EQ-5D utility) and 11.3 (DLQI). Utility and DLQI summary were significantly related to each other. CONCLUSIONS Wellbeing and loss of productivity are the most important consequences in these patients. Appropriate treatment is necessary to improve patient health and productivity, which will contribute to reducing societal costs.
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Affiliation(s)
- Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20052, Monza, Italy; CHARTA Foundation, 20122 Milano, Italy
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Gola M, D’Erme AM, Milanesi N, Marmugi L. Effects of Alitretinoin on Quality of Life of Patients Having Chronic Hand Eczema. Dermatitis 2013; 24:166-9. [DOI: 10.1097/der.0b013e3182987773] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ibler KS, Jemec GBE, Agner T. Exposures related to hand eczema: a study of healthcare workers. Contact Dermatitis 2012; 66:247-53. [PMID: 22486567 DOI: 10.1111/j.1600-0536.2011.02027.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand eczema is common in healthcare workers, owing to intensive exposure to wet work and skin irritants. Targeted interventions and vocational guidance based on documented exposures and risk factors are needed. OBJECTIVES The aims of the study were to investigate the relationship between exposures (domestic and at work) and prevalence and severity of hand eczema. METHODS Self-administered questionnaires were sent to 3181 healthcare workers in Denmark. RESULTS Two thousand two hundred and sixty-nine (71%) workers responded to the questionnaire. Frequent hand washing was significantly related to the presence of hand eczema. Having children < 4 years old in the household was also related to the presence of hand eczema. A lower prevalence of hand eczema was found among those using moisturizers at work, and a higher prevalence was found among those using moisturizers at home. CONCLUSIONS Although healthcare workers are recommended to use disinfectants when the hands are not visibly dirty, hand washing is still significantly related to hand eczema. Frequent hand washing may be a question of behavioural habits, and a focus for future guidance should be on changing hand washing habits. Attention should also be paid to healthcare workers with small children at home. The preventive effect of moisturizers used during working hours should be tested in future follow-up studies.
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Affiliation(s)
- Kristina S Ibler
- Department of Dermatology, Roskilde University Hospital, 4000 Roskilde, Denmark.
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