Hand eczema

Are There Ethnic Differences in Hand Eczema? A Review

Hand eczema is a common disease with economic and social ramifications. This study undertakes a review of certain existing literature to provide insight into contributory factors which may result in the varying prevalence and severity of hand eczema among different ethnic groups, particularly to identify modifiable risk factors, as well as to ascertain knowledge gaps for future research direction. The existing literature suggests that factors including (a) genes, (b) differing skin physiology, (c) cultural practices, (d) dietary habits and associated food preparation, (e) climate, (f) predominant occupations, (g) socioeconomic factors, and (h) dissimilar laws and regulations may account for the disparity in the risk of hand eczema among different ethnicities. Given that endogenous factors cannot be avoided, but certain exogenous aspects can be modified, especially as the environment plays an important role in hand eczema flares, it is helpful from a practical perspective to focus on addressing the modifiable risk factors. These factors pertain to unique cultural practices, customs, and food preparation methods. Healthcare professionals should be well-acquainted with such factors to tailor the treatment approach for patients of different ethnicities accordingly because, with globalization, physicians face increasingly diverse patient populations such that cultural customs no longer remain limited to particular geographic regions.

A cross-sectional study to assess the role of dermoscopy in differentiating palmar psoriasis, chronic hand eczema, and eczema in psoriatico

Background:

Overlapping clinical features often make the differentiation between palmar psoriasis, hand eczema, and eczema in psoriatico a difficult task. In such cases, history and biopsy often aid in the diagnosis. Dermoscopy acts as a link between clinical dermatology and dermatopathology.

Aim:

To study the dermoscopic features in biopsy-proven cases of palmar psoriasis, hand eczema, and eczema in psoriatico.

Methods:

A 1-year cross-sectional study was conducted using a video dermatoscope, Dinolite premier AM4113ZT, on 60 patients having clinical diagnosis of either of palmar psoriasis, hand eczema, and eczema in psoriatico. Statistical analysis was performed using R i386 3.6.3 software.

Results:

Among 60 patients, 38 were psoriatics followed by 14 of eczema and 8 of eczema in psoriatico. On dermoscopy, characteristic features of psoriasis lesions were diffuse scaling in 76.3% (29/38), white scales in 60.5% (23/38), and dotted vessels in 76.3% (29/38) along with regular distribution of vessels in 71% (27/38); in hand eczema lesions, diffuse scaling in 78.5% (11/14), white and yellow scales in 57.1% (8/14), and dotted vessels in 78.5% (11/14) along with a patchy distribution of vessels in 57.1% (8/14); in eczema in psoriatico, diffuse scaling in 75% (6/8), white and yellow scales in 62.5% (5/8), and dotted vessels in 87.5% (7/8) along with regular distribution of vessels in 50% (4/8).

Conclusion:

The various patterns and combinations reflecting specific features give an insight into the cases of palmar psoriasis, hand eczema, and eczema in psoriatico on dermoscopy. However, a study with larger sample size is required to validate the findings of our study.

Limitations:

Inability to perform a patch test for eczema due to unavailability.

Clinical Pattern and Patch Test Profile of Hand Eczema in Hospital Employees in a Tertiary Care Hospital of North India

Introduction:

Health care workers form an important occupational group with a high risk of hand eczema. All health care professionals are exposed to a variety of allergens and irritants which can cause hand dermatitis, resulting in significant morbidity.

Aims and Objectives:

To assess the clinical profile of hand eczema in hospital employees, to perform patch test in relevant cases and to find out the most common sensitizers in them.

Materials and Methods:

This was a cross-sectional, hospital-based study in which the staff was screened for features of hand eczema and patch testing was done in the suspected cases of allergic contact dermatitis.

Results:

Out of 340 employees screened, 46 employees (13.5%) suffered from hand eczema. The most common type was wear and tear dermatitis accounting for 17 (36.9%) cases, followed by discoid eczema, pompholyx, focal palmar peeling, finger-tip eczema, hyperkeratotic eczema, ring eczema, and unspecified types. Patch testing was positive in 15 (32.6%) cases. The most common allergen was paraphenylene diamine, followed by fragrance mix, nitrofurazone, mercaptobenzothiazole, potassium bichromate, black rubber mix, and thiuram mix. A statistically significant association (0.001) was found with an underlying history of atopy.

Conclusion:

Hand eczema is a commonly encountered dermatological complaint in many hospital employees. Proper counseling, work, up, patch testing, and treatment can mitigate the symptoms in such employees.

A Comparison of the Effect of Topical Preparation of Sambucus ebulus L. and Hydrocortisone on Hand Eczema: A Double-Blind Randomized Controlled Trial

Objectives: Corticosteroids as the main treatment of hand eczema can cause major side effects. This study compared the effect of topical preparation of Sambucus ebulus L. leaves and hydrocortisone on the severity of hand eczema. Design: Ninety-four patients with hand eczema aging 18-60 years were recruited in two groups (S. ebulus vs. hydrocortisone). Interventions: The patients used topical medications twice a day and were followed for 4 weeks. The observations were made at the first visit, and also second and fourth weeks of the study. Outcome measures: The primary outcomes were changes in the severity of hand eczema (hand eczema severity index [HECSI]) and life quality (dermatology life quality index [DLQI]). Secondary outcomes were the rate of healing and the severity of itching. Results: Thirty-eight patients in hydrocortisone and 43 in S. ebulus fulfilled all phases of the follow-up. In both groups, the HECSI, itching scores decreased over time without any significant difference between the groups (p = 0.49, 0.57, respectively). The DLQI scores were significantly better in the S. ebulus group (p = 0.02) after 4 weeks of medication. There was no significant difference between the healing rates of the two groups (p = 0.33). Conclusions: Topical use of S. ebulus can be as effective as that of hydrocortisone when it comes to reducing the severity of hand eczema.

Efficacy of Pumpkin Ointment in Treatment of Chronic Hand Eczema: A Randomized, Active-Controlled, Double Blind Clinical Trial

Background

Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research.

Methods

This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment.

Results

Patients' DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed.

Conclusion

Although pumpkin ointment showed a better response in patients' DLQI in HE but it was less effective than betamethasone in decreasing HECSI.

Onset of occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic: Comparing a single surgical site with a COVID-19 intensive care unit

Background

As a result of the COVID‐19 outbreak, hygiene regulations have been revised and hand sanitation has been intensified.

Objective

To investigate the onset of hand eczema during the COVID‐19 pandemic in healthcare workers (HCWs) directly involved in intensive care of COVID‐19 patients and HCWs without direct contact with COVID‐19 patients. Hereby, we aim at increasing awareness about occupational hand eczema and preventive measures that can be adopted.

Method

A survey was distributed amongst 114 HCWs at a single surgical centre and at a COVID‐19 intensive care unit of the university hospital Ludwig Maximilian University Munich, Germany. Participants were questioned about the daily frequency of hand hygiene prior to and during the pandemic. Participants self‐reported the onset of hand eczema and associated symptoms.

Results

Our study revealed a significant increase in hand washing, disinfection, and use of hand cream across all participants (P‐value <.001), regardless of having direct contact with COVID‐19 patients. A high prevalence of symptoms associated with acute hand dermatitis of 90.4% was found across all HCWs, whereas hand eczema itself was underreported (14.9%).

Conclusion

The increase in hand sanitation during the COVID‐19 pandemic impairs the skin of the hands across all HCWs, independent of direct intensive care of affected patients.

Expression of retinoid receptors in hand eczema

BACKGROUND

Hand eczema is the most common occupational skin disease. The etiology is multifactorial. Systemic alitretinoin, a pan-retinoic receptor agonist, has proven efficacy in the treatment of recalcitrant chronic hand eczema; however, its precise mechanism of action in hand eczema is not fully understood.

AIMS

Assessment of the level of expression of retinoid receptors (RAR and RXR) in the skin of patients with hand eczema in an attempt to explain their possible role in the pathogenesis of the disease.

METHODS

Thirty patients with hand eczema and 30 age- and sex-matched healthy controls were included. Full clinical examination was done, and tissue levels of retinoic acid receptor (RAR) and retinoid x receptor (RXR) were measured by quantitative real-time PCR (qRT-PCR).

RESULTS

The levels of RAR and RXR expression were significantly downregulated in the patient group compared to the control group; (P < 0.001) for both. In addition, there was a statistically significant negative correlation between Osnabrück Hand Eczema Severity Index (OHSI) and the levels of RAR and RXR expression (P < 0.001).

CONCLUSION

Deficient retinoid receptor expression has a primary role in the pathogenesis, clinical phenotype, and severity of hand eczema and sheds light on the mechanism of action of retinoids in the treatment of chronic hand eczema.

Analysis of Hypersensitivity in Fragrance Series by Patch Testing

Introduction:

Allergic contact dermatitis (ACD) is an inflammatory disorder, which occurs as a result of repeated contact with an allergen. Fragrances are the products obtained naturally or produced synthetically. The purpose of this study is to detect the fragrance allergens producing ACD.

Materials and Methods:

This is an open-label prospective observational study. Patients of age above 18 years with history of using cosmetic products with dermatitis lesions over face, neck, axilla and hands were included. Patch testing was done with fragrance series by using the standard technique. The results were interpreted on day 2 and day 4 as recommended by International Contact Dermatitis Research Group criteria.

Results:

Totally 27 patients were included in this study. Of them, 12 were males and 15 were females; the mean age was 43 years. The mean duration of symptoms was 12.5 months. The most common site of involvement was hands. Housewives and office workers were the most commonly affected occupational groups. The most commonly used category of cosmetic product was talcum powders by 13 (48.1%) patients. In this study, 85.18% patients showed at least one fragrance antigen positivity. Fragrance mix II is the most frequent allergen in this study.

Discussion:

We conclude that the fragrance mix II is an important marker to find out fragrance allergy. Hand dermatitis is the most common presentation in patients with fragrance allergy. Perfumed talcum powders, soaps and perfumes are the leading sources of sensitization to fragrance allergens.

Comparative Analysis of Epidemiological Data as Well as Quality of Life in Patients having Hand Eczema vis-à-vis Foot Eczema

Context:

Eczema of hand or foot though not life-threatening, not only impacts daily activities and work productivity adversely, but also impairs interpersonal relationships.

Materials and Methods:

Cross-sectional study of 100 outpatients of hand and foot eczema at a tertiary care teaching institute. Epidemiological data was collated and quality of life (QoL) evaluated by dermatology life quality index (DLQI) score.

Results:

Forty seven had hand eczema, 45; foot eczema and 8; both. Peak incidence of hand eczema (38.2%) was in fourth decade and foot eczema (33.3%), fifth decade. Hand eczema was more frequent in females (32; 68%) and foot eczema in males (32; 71.1%). Hand eczema was more common among housewives (14; 29.7%) and foot eczema among manual labourers (26; 57.7%). A persistent course was seen in foot (44; 83%) whereas recurrent course in hand eczema (21; 38.1%). Aggravation on contact with irritants/allergens was associated more with hand (32; 58.1%) than with foot eczema (18; 33.9%). Association with atopy was not significant. Substance abuse was associated more with foot eczema (25; 47.1%). Impairment in QoL was significantly higher in hand eczema (mean DLQI, 16.33) as compared to foot eczema (12.83).

Conclusion:

Hand eczema prevalent among females showed a high rate of recurrence whereas foot eczema in males, has a persistent course. Atopy is not significantly associated. The impairment in QoL is much greater in hand eczema as compared to foot eczema. The studies on comparative analysis of hand vis-à-vis foot eczema do not appear to exist in literature whereas studies of QoL impairment on hand eczema are abound.

Comparative Study of Quality of Life and Obsessive-Compulsive Tendencies in Patients With Chronic Hand Eczema and Lichen Simplex Chronicus

BACKGROUND

Lichen simplex chronicus (LSC) and chronic hand eczema (CHE) are 2 common dermatological disorders that affect physical, social, and psychological aspects of life. The aim of this study was to compare quality of life and obsessive-compulsive tendencies between patients with LSC and patients with CHE.

MATERIALS AND METHODS

Sixty patients with LSC, 60 patients with CHE, and 60 healthy controls were included in the study. Quality of life was evaluated according to the Dermatology Life Quality Index (DLQI). Patients were also assessed for compulsive behavior with the Leyton Trait Scale.

RESULTS

Patients with LSC (13.00 [1.41]) had a statistically significant higher mean (SD) DLQI compared with patients with CHE (11.33 [1.53]). Patients with LSC (13.97 [2.14]) presented statistically significant higher levels of obsessive-compulsive personality traits than patients with CHE (12.48 [2.69]), whereas both groups also differed from the healthy controls (10.68 [3.87]). The DLQI was not correlated with the Leyton Trait Scale in either the patients with LSC (r = 0.10, P = 0.50, not significant [NS]) or in the CHE patients (r = 0.01, P = 0.92, NS).

CONCLUSIONS

Although both LSC and CHE are associated with impaired quality of life and obsessive-compulsive tendencies, significantly higher scores were recorded in patients with LSC.

Patch Test as a Diagnostic Tool in Hand Eczema

INTRODUCTION

Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country.

AIM

To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing.

MATERIALS AND METHODS

This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher's-exact test.

RESULTS

Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate.

CONCLUSION

Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.

Review of Medicinal Remedies on Hand Eczema Based on Iranian Traditional Medicine: A Narrative Review Article

BACKGROUND

Hand Eczema (HE) is a dermatological disorder with frequent relapses and multiple causes such as atopic, allergic and irritant contact dermatitis. The management is complex because of the wide range of different pathogenesis. Efficacy of some of available treatments is not well established and it can affect patients' quality of life significantly.

METHODS

Reports on HE such as diagnosis, pathophysiology, pharmacological and nonpharmacological therapy that described in medieval Iranian medicine, were gathered and analyzed from selected medical and pharmaceutical textbooks of Iranian Traditional Medicine (ITM). The search of databases such as PubMed, EMBASE/Excerpta Medica, Science direct, Scopus, Google scholar, Web of science, Sid, Iran medex, Irandoc, was performed to reconfirm the efficacy of ITM remedies in conventional medicine from 1980-Jan-1 to 2015-Dec-30.

RESULTS

According to their opinion, HE is highly associated with liver function. This disorder was categorized into two main types as wet and dry ones. Most Iranian textbook explained signs of HE, as excessive skin itching, redness, burning and dryness. Treatments recommended by Iranian scientists were lifestyle modification, dietary intervention and performing the rules of prevention as well as herbal therapy and special manipulations.

CONCLUSION

Iranian practitioners believed that, six essential principles, diet therapy and medicinal plants have high impact on treatment of HE. These remedies based on Iranian scholar's experiences might be useful for further studies to the management of HE.

Periungual Pyogenic Granuloma: The Importance of the Medical History

Pyogenic granuloma (PG) is a common, benign vascular proliferation that can arise on the skin or subcutaneous tissue. It is more frequent in the early decades of life, and the most common locations are the digits of both hands and feet. The most common cause of periungual PG is drug intake, but many other trigger factors have been described in the literature. Treatment should be chosen according to the cause. We describe 2 particular cases of periungual PG in which the clinical history has been fundamental. In the first case, there was an underlying hand eczema, and in the second case, a foreign body was present.

A Relationship between Physical Activities and Hand Dermatitis: An Epidemiology Study of the USA Population

Background:

Hand dermatitis is a common, chronic relapsing skin disease, resulting from a variety of causes including endogenous predisposition and environmental exposures to irritants and allergens. Physical activities have been reported to be beneficial for patients with hand dermatitis.

Objectives:

We aim to evaluate the association between self-reported physical activities and hand dermatitis using the 2003-2004 National Health and Nutrition Examination Survey (NHANES) database.

Methods:

Information regarding 2,688 participants aged 20 to 59 years from the 2003-2004 NHANES cycle were retrieved and analyzed. Diagnosis of hand dermatitis was based on standardized photographs of the hands read by two dermatologists. Physical activity during leisure time for the prior 30 days was assessed using standardized questionnaire. Based on the suggested MET scores provided for each response in the questionnaire section of the NHANES methodology, the MET scores for average level of physical activities, walking/bicycling, and performing tasks around home/yard for the past 30 days was calculated.

Results:

There were 42 (1.56%) diagnosed cases of active hand dermatitis among the 2,688 participants. Those who reported recent vigorous or moderate physical activities were less likely to have a diagnosis of active hand dermatitis (OR: 0.436, 95% CI: 0.200 to 0.947, P = 0.036 and OR: 0.489, 95% CI: 0.261 to 0.916, P = 0.025, respectively). This negative association remained statistically significant even after adjusting for age, gender, ethnic groups and atopic diathesis.

Conclusions:

Moderate and vigorous levels of physical activities appeared to be beneficial for hand dermatitis. Therefore, it is important to advise patients with active hand dermatitis to remain physically active. However, clinicians should also be cognizant of the fact that the heat and sweat generated from physical activities might also exacerbate the condition.