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Mense SA, Maher S, Chovatiya R. A Practical Approach to Chronic Hand Eczema. Dermatol Ther (Heidelb) 2025; 15:1953-1971. [PMID: 40382744 DOI: 10.1007/s13555-025-01433-y] [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: 04/04/2025] [Accepted: 04/22/2025] [Indexed: 05/20/2025] Open
Abstract
Chronic hand eczema (CHE) is a multifactorial condition with significant physical, psychological, and socioeconomic burdens. Its complex pathogenesis often does not align with clinical presentation, leading to overlapping etiologic subtypes, including allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), and atopic hand eczema (AHE). While patch testing remains the gold standard for confirming ACD, its clinical utility can be limited owing to frequent subtype overlap, impracticality of allergen avoidance, and practical considerations relating to the process and availability of patch testing itself. This review provides a practical, clinician-oriented framework for managing CHE, emphasizing the importance of clinical judgment in deciding when patch testing is indicated versus when prompt treatment should take priority. We explore the role of patch testing in CHE within the context of real-world practice, incorporating global perspectives where they inform practical clinical decision-making. With the emergence of targeted therapies addressing CHE immunopathogenesis, balancing traditional diagnostic approaches with early, effective treatment is increasingly necessary. A streamlined, patient-centered strategy balancing diagnostic thoroughness with timely interventions may aid clinicians in optimizing outcomes in this complex disease.
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Affiliation(s)
| | - Sawyeh Maher
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Raj Chovatiya
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA.
- Center for Medical Dermatology + Immunology Research, 3000 N Halsted St., Suite 301, Chicago, IL, 60657, USA.
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Ferrari C, Somma G, Giovinazzo V, Iarossi M, Treglia M, Pallocci M, Di Giampaolo L, Magrini A, Coppeta L. The Influence of Occupational Factors on Contact Dermatitis in Symptomatic Healthcare Workers: A Patch Test Study. Diseases 2025; 13:77. [PMID: 40136617 PMCID: PMC11941524 DOI: 10.3390/diseases13030077] [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: 02/20/2025] [Accepted: 03/07/2025] [Indexed: 03/27/2025] Open
Abstract
Healthcare workers (HCWs) are frequently exposed to a variety of chemical agents, which can result in the development of allergic or irritant contact dermatitis. The present study aimed to assess the prevalence of skin sensitization among HCWs who presented with symptoms of contact dermatitis, considering both occupational and non-occupational risk factors. The study population comprised 127 HCWs who attended routine occupational health surveillance at the Tor Vergata Teaching Hospital in Rome between November 2023 and May 2024. A structured dermatitis questionnaire and patch testing were administered to the participants. Demographic and lifestyle data, including information on occupation, night shift work, smoking habits, and body mass index (BMI), were collected. Patch test positivity was observed in 31.5% of participants, with the most common clinical presentation being erythematous-desquamative allergic contact dermatitis. A significantly higher likelihood of patch test positivity was observed among nurses (57.1%), particularly for nickel sensitization, compared to other occupational groups. A trend towards an association between night shift work and skin sensitization was observed, although this did not reach statistical significance. No significant associations were found for ages over 35 years, sex, or BMI. These findings highlight the elevated risk of contact sensitization among nurses, emphasizing the need for targeted interventions, including exposure reduction strategies and protective measures, to mitigate occupational skin hazards in healthcare settings.
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Affiliation(s)
- Cristiana Ferrari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
- PhD. Program in Social, Occupational and Medico-Legal Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giuseppina Somma
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
| | - Viola Giovinazzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
| | - Margherita Iarossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
| | - Michele Treglia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
| | - Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
| | - Luca Di Giampaolo
- Department of Occupational Medicine, University of Chieti “G. D’Annunzio”, 66013 Chieti, Italy;
| | - Andrea Magrini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
| | - Luca Coppeta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (G.S.); (V.G.); (M.I.); (M.T.); (M.P.); (A.M.); (L.C.)
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Abstract
Hand eczema is a highly prevalent skin disease and one of the most common work-related disorders. In up to two-thirds of individuals affected by hand eczema, the disease becomes chronic and results in substantial personal and occupational disability. Manifestations of chronic hand eczema vary in severity and appearance over time, and people with eczema typically experience itch, pain, and a burning sensation. The pathophysiology of chronic hand eczema is multifactorial. Major risk factors are current or past atopic dermatitis and excessive or prolonged exposure to irritants or allergens. Based on the suspected main causes, chronic hand eczema is commonly classified into irritant, allergic, and atopic hand eczema. Diagnosis and assessment can be complex, and management is often challenging. Strategies include structured education, avoidance of trigger factors, primary to tertiary prevention, topical anti-inflammatory treatment with glucocorticosteroids, calcineurin inhibitors, or januskinase inhibitors, phototherapy, systemic retinoids, and off-label use of immunosuppressive drugs. Topical and systemic immunomodulatory therapies approved for atopic dermatitis could be used in severe atopic hand eczema and some of them are under clinical development for chronic hand eczema. Additional research is needed to better understand chronic hand eczema subtypes and underlying mechanisms, and the comparative effectiveness and safety of therapies. This Review combines established knowledge with ongoing changes in our understanding of the disease and their implications for prevention, management, and future research.
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Affiliation(s)
- Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Natalija Novak
- Center for Skin Diseases, Clinic for Dermatology and Allergy, Bonn, Germany.
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Qu Z, Jiang Q, Wang B, Yao C, Jiang R, Chen K, Zhou Y, Chen L, Hu F. A cross-sectional study of clinical characteristics and risk factors for hand eczema in the general Chinese population. Sci Rep 2024; 14:29733. [PMID: 39613886 PMCID: PMC11607383 DOI: 10.1038/s41598-024-81610-9] [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: 07/18/2024] [Accepted: 11/14/2024] [Indexed: 12/01/2024] Open
Abstract
In the general population, there is limited evidence for the associations between hand eczema (HE) and lifestyle factors, and between the severity of HE and quality of life. This study aimed to estimate the risk factors for the incidence of HE in the general population and the risk factors for the severity of HE. A cross-sectional questionnaire was administered to 121 HE patients in a hospital from December 2018 to December 2019 in Wuhan. The severity of HE was significantly associated with working with wet hands more than 5 h per day and chapped skin. Sixty-seven patients have positive patch test results. Working with wet hands for more than 5 h per day and chapped skin were the most common and significant risk factors for HE. Working hours with wet hands per day was an independent risk factor for the hand eczema severity index and dermatology life quality index, and there was a significant positive correlation between chapped skin and the severity of hand eczema and higher transepidermal water loss (TEWL). The results also revealed a significant positive correlation between the severity of HE and the impact on quality of life and the severity of TEWL. Prolonged wet hand work can lead to a higher rate of severe hand eczema in the general population. HE can be relieved by reducing the wet hand working time and hand moisturizing.
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Affiliation(s)
- Zilu Qu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Hubei Province and Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qian Jiang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Hubei Province and Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bei Wang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, 430000, China
| | - Cong Yao
- Health Care Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Ruili Jiang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kai Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Hubei Province and Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital, Wuhan, 430022, China
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu Zhou
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China.
- Hubei Province and Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital, Wuhan, 430022, China.
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Feng Hu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China.
- Hubei Province and Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital, Wuhan, 430022, China.
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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