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Weisshaar E. Chronic Hand Eczema. Am J Clin Dermatol 2024:10.1007/s40257-024-00890-z. [PMID: 39300011 DOI: 10.1007/s40257-024-00890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2024] [Indexed: 09/22/2024]
Abstract
Chronic hand eczema (CHE) is a complex, challenging, and frequently multifactorial skin disease of the hands. It is very common in the general population, especially in certain professions. When hand eczema (HE) persists for longer than 3 months or has a minimum of two relapses per year after initial manifestation with complete clearance, it is considered chronic. In this case, health-related quality of life and the patient's working life are often impaired. CHE can be considered as an umbrella term because it covers different clinical pictures and etiologies. To date, there is no definite and unique HE classification. Treatment starts with identifying the individual HE etiology paralleled by symptomatic therapy (local and/or systemic and/or ultraviolet phototherapy). Sustainable management of HE requires the identification and avoidance of its triggering factors, from the professional and private environment. This includes ruling out allergic contact dermatitis if any HE persists for more than 3 months despite adequate therapy. Randomized controlled trials investigating the efficacy in HE are lacking for several treatment modalities. Patient education measures of skin protection and prevention complete the multimodal treatment.
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Affiliation(s)
- Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.
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2
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Bauer A, Brans R, Brehler R, Büttner M, Dickel H, Elsner P, Fartasch M, Herzog C, John SM, Köllner A, Maul JT, Merk H, Molin S, Nast A, Nikolakis GD, Schliemann S, Skudlik C, Weisshaar E, Werfel T, Zidane M, Worm M. S2k-Leitlinie Diagnostik, Prävention und Therapie des Handekzems: S2k guideline diagnosis, prevention and therapy of hand eczema. J Dtsch Dermatol Ges 2023; 21:1054-1076. [PMID: 37700403 DOI: 10.1111/ddg.15179_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie S2k‐Leitlinie „Diagnostik, Prävention und Therapie des Handekzems (HE)“ gibt auf der Grundlage eines evidenz‐ und konsensbasierten Ansatzes konkrete Handlungsanweisungen und Empfehlungen für die Diagnostik, Prävention und Therapie des HE. Die Leitlinie wurde auf der Grundlage der deutschen Leitlinie „Management von Handekzemen“ aus dem Jahr 2009 und der aktuellen Leitlinie der European Society of Contact Dermatitis (ESCD) „Guidelines for diagnosis, prevention and treatment of hand eczema“ aus dem Jahr 2022 erstellt. Allgemeines Ziel der Leitlinie ist es, Dermatologen und Allergologen in der Praxis und Klinik eine akzeptierte, evidenzbasierte Entscheidungshilfe für die Auswahl sowie Durchführung einer geeigneten und suffizienten Therapie für Patienten mit Handekzemen zur Verfügung zu stellen. Die Leitlinie basiert auf zwei Cochrane‐Reviews zu therapeutischen und präventiven Interventionen beim HE. Die übrigen Kapitel wurden überwiegend basierend auf nicht systematischen Literaturrecherchen durch die Expertengruppe erarbeitet und konsentiert. Die Expertenkommission bestand aus Mitgliedern von allergologischen und berufsdermatologischen Fachgesellschaften und Arbeitsgruppen, einer Patientenvertretung und Methodikern. Im Rahmen einer Konsensuskonferenz am 15.09.2022 wurden die Vorschläge für die Empfehlungen und Kernaussagen unter Verwendung eines nominalen Gruppenprozesses konsentiert. Der strukturierte Konsensfindungsprozess wurde professionell moderiert. Die vorliegende Leitlinie hat eine Gültigkeit bis zum 22.02.2028.
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Affiliation(s)
- Andrea Bauer
- Klinik für Dermatologie und Poliklinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Richard Brans
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für Interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Randolf Brehler
- Allergologie, Berufsdermatologie und Umweltmedizin an der Hautklinik, Universitätsklinikum Münster, Münster, Deutschland
| | | | - Heinrich Dickel
- Bochum Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Peter Elsner
- Privatpraxis für Dermatologie und Allergologie, SRH Krankenhaus Gera, Gera, Deutschland
| | - Manigé Fartasch
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Institut der Ruhr-Universität Bochum, Bochum, Deutschland
| | - Claudia Herzog
- Universitätskrebszentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Swen-Malte John
- Fachbereich Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für interdisziplinäre dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Arno Köllner
- Dermatologische Gemeinschaftspraxis, Duisburg, Deutschland
| | | | - Hans Merk
- Professor für Dermatologie und Allergologie, ehemaliger Direktor der Hautklinik, RWTH Aachen, Deutschland
| | - Sonja Molin
- Abteilung für Dermatologie, Fachbereich Medizin, Queen's University, Kingston, Kanada
| | - Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Evidenzbasierte Medizin (dEBM), Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Georgios D Nikolakis
- Klinik für Dermatologie, Venerologie, Allergologie und Immunologie, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | | | - Christoph Skudlik
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für Interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Elke Weisshaar
- Berufsdermatologie, Abteilung Dermatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thomas Werfel
- Klinik für Dermatologie und Allergologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Miriam Zidane
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Evidenzbasierte Medizin (dEBM), Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
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3
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Bauer A, Brans R, Brehler R, Büttner M, Dickel H, Elsner P, Fartasch M, Herzog C, John SM, Köllner A, Maul JT, Merk H, Molin S, Nast A, Nikolakis GD, Schliemann S, Skudlik C, Weisshaar E, Werfel T, Zidane M, Worm M. S2k guideline diagnosis, prevention, and therapy of hand eczema. J Dtsch Dermatol Ges 2023; 21:1054-1074. [PMID: 37700424 DOI: 10.1111/ddg.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.
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Affiliation(s)
- Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Randolf Brehler
- Department of Allergy, Occupational Dermatology and Environmental Medicine, University Hospital Münster, Münster, Germany
| | | | - Heinrich Dickel
- Bochum Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Peter Elsner
- Privat practice for dermatology and allergology, SRH Hospital Gera, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University Bochum, Bochum, Germany
| | - Claudia Herzog
- University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Swen-Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Sonja Molin
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, Canada
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georgios D Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | | | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Suzuki NM, Hafner MDFS, Lazzarini R, Duarte IAG, Veasey JV. Patch tests and hand eczema: retrospective study in 173 patients and literature review. An Bras Dermatol 2023; 98:339-346. [PMID: 36870887 PMCID: PMC10173083 DOI: 10.1016/j.abd.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease. OBJECTIVES To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology. METHODS A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020. RESULTS A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%). STUDY LIMITATIONS The number of treated cases and socioeconomic profile was limited to a vulnerable population group. CONCLUSION HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix.
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Affiliation(s)
- Nathalie Mie Suzuki
- Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil.
| | | | - Rosana Lazzarini
- Dermatology Clinic, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Guarneri F, Belloni Fortina A, Corazza M, Cristaudo A, Foti C, Parodi A, Pigatto P, Stingeni L, DE Pità O. Topical non-pharmacological treatment of eczema: an Italian consensus. Ital J Dermatol Venerol 2022; 157:402-413. [PMID: 36213968 DOI: 10.23736/s2784-8671.22.07283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.
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Affiliation(s)
- Fabrizio Guarneri
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Caterina Foti
- Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paolo Pigatto
- Unit of Dermatology, Department of Surgical and Odontoiatric Biomedical Sciences, Galeazzi IRCCS Orthopedic Institute, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ornella DE Pità
- Unit of Clinical Pathology, Inflammatory and Autoimmune Skin Diseases, Cristo Re Hospital, Rome, Italy
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6
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Is Patch Test Necessary in Children to Solve the Clinical Conundrum of Foot Eczema. Dermatitis 2022; 33:349-354. [PMID: 34999604 DOI: 10.1097/der.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Foot eczema in children is a commonly encountered condition but is associated with diverse etiology, thereby posing a diagnostic challenge. These include atopic eczema, juvenile plantar dermatoses, irritant contact dermatitis, and allergic contact dermatitis. Because of the diverse etiology, it is often difficult to distinguish between the conditions clinically, thereby warranting patch testing for the correct diagnosis. OBJECTIVES The study was conducted to determine the frequency of positive patch tests among children with foot eczema and to compare them with children with and without atopy. METHODS This was a prospective observational study done on 86 children aged 4 to 17 years presenting with foot eczema in whom patch testing was done using Indian standard series and footwear series and patients' own footwear. RESULTS The clinical diagnosis of foot eczema in our study was allergic contact dermatitis (37%), followed by atopic eczema (30%), juvenile plantar dermatoses (17%), and lichen simplex chronicus (15%). Patch test positivity was present in 36% of the cases with clinical relevance in 65% of the cases. The common allergens were rubber allergens and disperse dyes. Of the children who were patch tested, highest patch test positivity rates were seen in allergic contact dermatitis (50%) and juvenile plantar dermatoses (53%). No significant differences were observed with regard to patch test positivity or relevance between children with and without atopy. CONCLUSIONS The diagnosis of foot eczema in children cannot be made on clinical grounds alone, and patch testing should be recommended in children with any morphological pattern of foot eczema irrespective of presence or absence of atopy, especially in those with long-standing and recalcitrant disease with frequent exacerbations.
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7
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Thyssen JP, Schuttelaar MLA, Alfonso JH, Andersen KE, Angelova-Fischer I, Arents BWM, Bauer A, Brans R, Cannavo A, Christoffers WA, Crépy MN, Elsner P, Fartasch M, Larese Filon F, Giménez-Arnau AM, Gonçalo M, Guzmán-Perera MG, Hamann CR, Hoetzenecker W, Johansen JD, John SM, Kunkeler ACM, Ljubojevic Hadzavdic S, Molin S, Nixon R, Oosterhaven JAF, Rustemeyer T, Serra-Baldrich E, Shah M, Simon D, Skudlik C, Spiewak R, Valiukevičienė S, Voorberg AN, Weisshaar E, Agner T. Guidelines for diagnosis, prevention and treatment of hand eczema. Contact Dermatitis 2021; 86:357-378. [PMID: 34971008 DOI: 10.1111/cod.14035] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Jacob P Thyssen
- Dep. Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jose H Alfonso
- Dep. of Dermatology, Oslo University Hospital, Oslo, Norway.,Dep. of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Klaus E Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Irena Angelova-Fischer
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Alicia Cannavo
- Contact Dermatitis and Occupational Dermatoses, Hospital de Clínicas "José de San Martín", Buenos Aires University, Argentina
| | | | - Marie-Noelle Crépy
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, Paris, France.,Department of Dermatology, University Hospital of Centre of Paris, Cochin Hospital, AP-HP, Paris, France
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine (IPA) of the German Social Accident Insurance, Department of Clinical and Experimental Occupational Dermatology, Ruhr University Bochum, Bochum, Germany
| | | | - Ana M Giménez-Arnau
- Department of Dermatology, Hopsital del Mar, IMIM , Universitat Autònoma de Barcelona
| | - Margarida Gonçalo
- Clinic of Dermatology - University Hospital and Faculty of Medicine, University of Coimbra, Portugal
| | | | - Carsten R Hamann
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital and Kepler University Linz, Linz, Austria
| | - Jeanne Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Amalia C M Kunkeler
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Sonja Molin
- Division of Dermatology, Queen's University, Kingston, Canada
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Jart A F Oosterhaven
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Mili Shah
- Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Angelique N Voorberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tove Agner
- Dep. Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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8
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Napolitano M, Potestio L, De Lucia M, Nocerino M, Fabbrocini G, Patruno C. Alitretinoin for the treatment of severe chronic eczema of the hands. Expert Opin Pharmacother 2021; 23:159-167. [PMID: 34789049 DOI: 10.1080/14656566.2021.1998457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Chronic hand eczema (CHE) is a frequent skin disorder affecting up to 10% of the population and strongly reduces Quality of Life (QoL). The first-line therapeutic strategies for the management of CHE include a change of lifestyle, an education program for the skin and the application of specific emollients. Topical corticosteroids or calcineurin inhibitors are the most used anti-inflammatory drugs. However, up to 65% of patients require systemic options. Alitretinoin, a retinoid structurally related to vitamin A, is the first systemic treatment approved in the European Union (EU) for severe CHE refractory to potent topical corticosteroids. AREAS COVERED This review summarizes the available data on the pharmacokinetics, pharmacodynamics, efficacy, and safety profile of oral alitretinoin for the treatment of CHE. EXPERT OPINION Alitretinoin can be considered as a valid therapeutic option for the treatment of CHE in patients not responding to ordinary treatments. Clinical trials and real-life experiences showed that it acts effectively on both objective and subjective clinical signs, resulting in a significant improvement in QoL of patients. As for other retinoids, caution should be taken in patients with certain chronic diseases (hepatopathies, kidney failure, hyperlipidemia, thyroid dysfunction) or childbearing potential women.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Mario De Lucia
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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9
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Napolitano M, Di Guida A, Nocerino M, Fabbrocini G, Patruno C. The emerging role of dupilumab in dermatological indications. Expert Opin Biol Ther 2021; 21:1461-1471. [PMID: 33769900 DOI: 10.1080/14712598.2021.1907341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Dupilumab represents a breakthrough in the management of atopic dermatitis (AD), thanks to its powerful T-helper (Th)2-mediated immunity modulating activity. It can reduce the atopic skin molecular signature and induce a significant decrease in the clinical signs and symptoms of AD patients. AREAS COVERED Th2 activation has been confirmed or suspected in skin diseases other than AD, and several reports about the treatment with dupilumab in these conditions have been published. In order to review the new indications of dupilumab in dermatology, we performed a search on PubMed, Embase, Cochrane Skin databases, and clinicaltrials.gov. EXPERT OPINION The analysis of available literature suggests that dupilumab may have a large application in dermatology, besides AD. Clinical trials are underway on some widespread disease (i.e. chronic urticaria, bullous pemphigoid, alopecia areata, or allergic contact dermatitis). The data are still partial, but they seem to indicate that dupilumab is efficacious and safe. On the other hand, the dupilumab use in some rare skin diseases remains only hypothetical or linked to few case reports. Dupilumab could have a prominent position in the therapeutic algorithm of chronic skin diseases that significantly affect the quality of life of patients, require long-term treatment, or lacking effective therapies.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Jing M, Yu Q, Zhu B, Yuan F, Zhang J, Peng L, Lin W, Chen M. Topical 0.05% clobetasol cream in the treatment of chronic hand eczema: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24418. [PMID: 33725820 PMCID: PMC7969293 DOI: 10.1097/md.0000000000024418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic hand eczema (CHE) is a recurrent, frequently disabling skin condition that requires daily skin care to prevent transepidermal water loss, posing a significant burden of society and economy. In recent years, topical 0.05% clobetasol cream is widely used for the treatment of CHE for its efficacy, tolerability and safety. Whereas, no systematic review and meta-analysis has been updated up to now. Therefore, this work aims to assess the effectiveness and safety of topical 0.05% clobetasol cream in patients with CHE. METHODS Study on topical 0.05% clobetasol cream for CHE will be searched from their inception to December, 2020 with the language restrictions of English and Chinese in 8 databases (PubMed, Cochrane Library, Embase, the web of science, VIP, CNKI, CBM, and WAN FANG). According to the heterogeneity test, a fixed or random-effect model will be used to synthesize data. The primary outcome is the proportion of patients achieving more than 75% reduction in signs and symptoms according to the Hand Eczema Severity Index (HECSI). The secondary outcomes include: scored for 4 different characteristics of the lesions (redness, scaling, lichenification, and pruritus), QoL questionnaire, adverse events, and recurrence events. STATA 13.0 and Review Manager software 5.3 will be used for analysis and synthesis. Two or more reviewers will independently conduct the selection of studies, data extraction, and data analysis. RESULTS The results of the study expect to provide a high-quality, evidence-based recommendation on topical 0.05% clobetasol cream in the treatment of CHE for clinicians. CONCLUSION The study will provide scientific and useful evidence for better use of topical 0.05% clobetasol cream in treating CHE. ETHICS AND DISSEMINATION This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/SPHVZ.
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11
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Ulrich NH, Thyssen JP, Mizutani H, Nixon RL. Hand Eczema: Causative Factors, Diagnosis, Personal and Societal Consequences. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Dubin C, Del Duca E, Guttman-Yassky E. Drugs for the Treatment of Chronic Hand Eczema: Successes and Key Challenges. Ther Clin Risk Manag 2020; 16:1319-1332. [PMID: 33408476 PMCID: PMC7780849 DOI: 10.2147/tcrm.s292504] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic hand eczema (CHE) is a common and burdensome inflammatory skin condition seen in up to 10% of the population, more often in high-risk occupational workers. Topical therapeutics comprise the standard of care, but up to 65% of cases do not resolve after treatment, and moderate-to-severe cases are often resistant to topical therapeutics and require systemic options instead. To date, there are no systemic therapeutics approved to treat CHE in the United States, but several drugs are under investigation as potential treatments for CHE. The primary focus of this review is on the novel therapeutics, topical and systemic, that are under investigation in recently completed or currently ongoing trials. This review also briefly outlines the existing treatments utilized for CHE, often with limited success or extensive adverse effects. CHE represents a major challenge for physicians and patients alike, and efforts to improve the minimally invasive diagnostic tools and treatment paradigms are ongoing. In the near future, CHE patients may benefit from new topical and systemic therapeutics that specifically target abnormally expressed immune markers.
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Affiliation(s)
- Celina Dubin
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ester Del Duca
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Dermatology, University of Magna Graecia, Catanzaro, Italy
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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13
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Nabatanzi A, Mafuru M, Male M, Tian C, Zhang L, Wu T, Wu S, Huang C. <p>Feasibility Study for the Long-Term Management of Refractory Hyperkeratotic Eczema with Calcipotriol and Betamethasone Dipropionate (Daivobet<sup>®</sup>), Viaminate and Concomitant Conventional Therapies: A Retrospective Study</p>. Clin Cosmet Investig Dermatol 2020; 13:789-794. [PMID: 33149651 PMCID: PMC7605519 DOI: 10.2147/ccid.s276148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/26/2020] [Indexed: 11/23/2022]
Abstract
Background The available treatments for refractory hyperkeratotic eczema are inadequate with frustrating results. We, therefore, incorporated Calcipotriol and Betamethasone Dipropionate (Daivobet®), and Viaminate into the mainstay treatment to improve the clinical symptoms. The study aimed to evaluate the efficacy of Daivobet® and Viaminate as a potential treatment alternative for refractory hyperkeratotic eczema. Patients and Methods Between 2013 and 2015, 61 patients diagnosed with refractory hyperkeratotic eczema (RHE) who had shown inadequate response to conventional therapies were pooled from a single center. Besides, they were all treated with Daivobet®, Viaminate, and an occlusive dressing mixture containing 5% salicylic acid ointment and 25% zinc oxide paste following inadequate response to conventional therapies (corticosteroids plus 25% zinc oxide paste and 5% salicylic acid ointment). Investigators Global Assessment (IGA) and Patient-Oriented Eczema Measure (POEM) assessed baseline and outcome measures for the degree of hyperkeratinization (0-clear; 3-moderate; 4-severe). Results Of the 61 patients, 49 (80.3%) patients presented with moderate RHE and 12 (19.7%) with severe RHE. After 24 weeks of treatment, the period for loss of keratinization was significantly lower in patients with moderate RHE (3.9±1.9 weeks) than those with severe RHE (10.8±1.0 weeks) with a P-value <0.01. Furthermore, they required a significantly shorter total treatment duration (10.6 ± 4.3 weeks) than those with severe RHE (20.3±3.6 weeks) with a P-value of <0.01. However, there were no significant differences in post hoc analysis at week 36 with P-values of 0.46 and 1.00 for IGA and POEM, respectively. Conclusion Our results showed that the incorporation of Viaminate and Daivobet® into mainstay treatment was effective and safe for the long-term management of RHE.
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Affiliation(s)
- Amelia Nabatanzi
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Magesa Mafuru
- Department of Pharmacology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Musa Male
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Chunxia Tian
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Lingyun Zhang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ting Wu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shidi Wu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Changzheng Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Changzheng HuangDepartment of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of ChinaTel +86-13971176116Fax +86-27-85768188 Email
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Abstract
Background Assessment of chronic hand eczema (CHE) is complex and warrants standardization. Objective We sought to guide clinicians on the assessment of CHE. Methods An electronic questionnaire regarding the diagnosis and assessment of CHE was completed by councilors (n=45) of the International Eczema Council, an international group of clinicians and researchers with expertise in CHE. The survey consisted of 52 statements for consensus. Results Overall, nine statements (17.3%) had strong, twenty-three (44.2%) moderate, 12 (23.1%) low, and 8 (15.4%) very low levels of agreement. Five statements had considerable disagreement, including the value of conducting a skin biopsy (62.2% disagreement), investigating for possible type 1 reactions (60.0%), conducting a fungal culture (44.4%), finding no history of relevant allergens and/or irritants (31.1%) in most or all cases, and performing patch testing irrespective of lesion location and morphology (28.9%). Agreement was generally highest among respondents from Europe (28.6–77.8% agreement), followed by Asia (7.1%–35.7% agreement), North America (0%–35.5% agreement), and other (0%–13.3% agreement). Conclusions There were substantial differences of agreement, suggesting there are many knowledge and/or practice gaps with respect to CHE. Future research is needed to inform evidence-based and/or consensus guidelines for CHE.
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15
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Rademaker M, Armour K, Baker C, Foley P, Gebauer K, Gupta M, Marshman G, O'Connor A, Rubel D, Sullivan J, Wong LC. Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. Australas J Dermatol 2020; 62:17-26. [PMID: 32776537 DOI: 10.1111/ajd.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Chronic hand/foot eczemas are common, but treatment is often challenging, with widespread dissatisfaction over current available options. Detailed history is important, particularly with regard to potential exposure to irritants and allergens. Patch testing should be regarded as a standard investigation. Individual treatment outcomes and targets, including systemic therapy, should be discussed early with patients, restoring function being the primary goal, with clearing the skin a secondary outcome. Each new treatment, where appropriate, should be considered additive or overlapping to any previous therapy. Management extends beyond mere pharmacological or physical treatment, and requires an encompassing approach including removal or avoidance of causative factors, behavioural changes and social support. To date, there is little evidence to guide sequences or combinations of therapies. Moderately symptomatic patients (e.g. DLQI ≥ 10) should be started on a potent/super-potent topical corticosteroid applied once or twice per day for 4 weeks, with tapering to twice weekly application. If response is inadequate, consider phototherapy, and then a 12-week trial of a retinoid (alitretinoin or acitretin). Second line systemic treatments include methotrexate, ciclosporin and azathioprine. For patients presenting with severe symptomatic disease (DLQI ≥ 15), consider predniso(lo)ne 0.5-1.0 mg/kg/day (or ciclosporin 3 - 5 mg/kg/day) for 4-6 weeks with tapering, and then treating as for moderate disease as above. In non-responders, botulinum toxin and/or iontophoresis, if associated with hyperhidrosis, may sometimes help. Some patients only respond to long-term systemic corticosteroids. The data on sequencing of newer agents, such as dupilumab or JAK inhibitors, are immature.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences, Hamilton, New Zealand
| | | | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia.,St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia.,St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia
| | - Gillian Marshman
- Flinders Medical Centre, Flinders University Medical School, Adelaide, South Australia, Australia
| | | | - Diana Rubel
- Woden Dermatology, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - John Sullivan
- The Sutherland Hospital, University of New South Wales, Caringbah, New South Wales, Australia
| | - Li-Chuen Wong
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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16
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Barati Sedeh F, Ebbehøj NE, Agner T, Carøe TK. Systemic therapy and the use of complementary and alternative medicine in patients with recognized occupational hand eczema in Denmark: A cross‐sectional questionnaire‐based study. Contact Dermatitis 2020; 82:272-278. [DOI: 10.1111/cod.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/22/2022]
Affiliation(s)
| | - Niels E. Ebbehøj
- Department of Occupational and Environmental MedicineBispebjerg University Hospital Copenhagen Denmark
| | - Tove Agner
- Department of DermatologyBispebjerg University Hospital Copenhagen Denmark
| | - Tanja K. Carøe
- Department of Occupational and Environmental MedicineBispebjerg University Hospital Copenhagen Denmark
- National Research Centre for the Working Environment Copenhagen Denmark
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17
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Ulrich NH, Thyssen JP, Mizutani H, Nixon RL. Hand Eczema: Causative Factors, Diagnosis, Personal and Societal Consequences. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_61-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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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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19
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Tauber M, Bérard E, Lourari S, Questel E, Redoules D, Paul C, Simon M. Latent class analysis categorizes chronic hand eczema patients according to skin barrier impairment. J Eur Acad Dermatol Venereol 2019; 34:1529-1535. [DOI: 10.1111/jdv.16083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- M. Tauber
- Dermatology and Allergology Department Larrey Hospital Toulouse University Toulouse France
- U1056 UDEAR Purpan Hospital INSERM‐University Paul Sabatier Toulouse France
| | - E. Bérard
- Department of Epidemiology, Health Economics and Public Health UMR1027 INSERM‐ Toulouse University Toulouse University Hospital (CHU) Toulouse France
| | - S. Lourari
- Dermatology and Allergology Department Larrey Hospital Toulouse University Toulouse France
| | - E. Questel
- Pierre Fabre Dermo‐Cosmétique Toulouse France
| | - D. Redoules
- Pierre Fabre Dermo‐Cosmétique Toulouse France
| | - C. Paul
- Dermatology and Allergology Department Larrey Hospital Toulouse University Toulouse France
- U1056 UDEAR Purpan Hospital INSERM‐University Paul Sabatier Toulouse France
| | - M. Simon
- U1056 UDEAR Purpan Hospital INSERM‐University Paul Sabatier Toulouse France
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21
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Handa S, Khullar G, Pal A, Kamboj P, De D. Filaggrin gene mutations in hand eczema patients in the Indian subcontinent: A prospective case‐control study. Contact Dermatitis 2019; 80:359-364. [DOI: 10.1111/cod.13233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Sanjeev Handa
- Department of Dermatology, Venereology, and LeprologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Geeti Khullar
- Department of Dermatology, Venereology, and LeprologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Arnab Pal
- Department of BiochemistryPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Parul Kamboj
- Department of BiochemistryPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Dipankar De
- Department of Dermatology, Venereology, and LeprologyPostgraduate Institute of Medical Education and Research Chandigarh India
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22
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Ulrich NH, Thyssen JP, Mizutani H, Nixon RL. Hand Eczema. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_61-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Antipruritic Effects of Botulinum Neurotoxins. Toxins (Basel) 2018; 10:toxins10040143. [PMID: 29596343 PMCID: PMC5923309 DOI: 10.3390/toxins10040143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 12/20/2022] Open
Abstract
This review explores current evidence to demonstrate that botulinum neurotoxins (BoNTs) exert antipruritic effects. Both experimental and clinical conditions in which botulinum neurotoxins have been applied for pruritus relief will be presented and significant findings will be highlighted. Potential mechanisms underlying antipruritic effects will also be discussed and ongoing challenges and unmet needs will be addressed.
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24
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van der Heiden J, Agner T, Rustemeyer T, Clemmensen KKB. Hyperkeratotic hand eczema compared to other subgroups of hand eczema - a retrospective study with a follow-up questionnaire. Contact Dermatitis 2018; 78:216-222. [PMID: 29314088 DOI: 10.1111/cod.12945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Only a few clinical trials on hand eczema have included further classification into subtypes, and there is a need for studies evaluating the present classifications. OBJECTIVES To examine differences in demographic factors, lifestyle factors and severity between subgroups of hand eczema patients, with a focus on hyperkeratotic hand eczema. METHODS This was a retrospective study including hand eczema patients referred to the outpatient dermatological clinic, Bispebjerg Hospital, between January 2013 and July 2014. The study comprises information on subdiagnoses, treatment and foot eczema from patient files, as well as a follow-up questionnaire. RESULTS A total of 120 patients were included, 10 of whom were diagnosed with hyperkeratotic hand eczema. A significantly higher proportion of the patients with hyperkeratotic hand eczema were male (p = 0.002) and received systemic or ultraviolet (UV) treatment (p = 0.026). The frequency of tobacco smoking was significantly higher in patients with hyperkeratotic hand eczema (p = 0.016), as well as in the other subgroups combined (p = 0.049), than in the background population. CONCLUSIONS Studies evaluating the subdiagnoses of hand eczema are needed, to further validate the classification system, and to provide more detailed information about demographic factors, severity and possible risk factors for different subgroups of hand eczema.
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Affiliation(s)
- Janique van der Heiden
- Department of Dermatology, Bispebjerg University Hospital, 2400, Copenhagen, Denmark.,Department of Dermatology, VU University Medical Centre, 1081, Amsterdam, The Netherlands
| | - Tove Agner
- Department of Dermatology, Bispebjerg University Hospital, 2400, Copenhagen, Denmark
| | - Thomas Rustemeyer
- Department of Dermatology, VU University Medical Centre, 1081, Amsterdam, The Netherlands
| | - Kim K B Clemmensen
- Department of Dermatology, Bispebjerg University Hospital, 2400, Copenhagen, Denmark
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Cazzaniga S, Apfelbacher C, Diepgen T, Ofenloch R, Weisshaar E, Molin S, Bauer A, Mahler V, Elsner P, Schmitt J, Ballmer‐Weber B, Spring P, Naldi L, Borradori L, Simon D. Patterns of chronic hand eczema: a semantic map analysis of the
CARPE
registry data. Br J Dermatol 2017; 178:229-237. [DOI: 10.1111/bjd.15660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. Cazzaniga
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
- Centro Studi GISED Bergamo Italy
| | - C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
| | - T. Diepgen
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - R.F. Ofenloch
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - E. Weisshaar
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - S. Molin
- Department of Dermatology and Allergy Ludwig Maximilian University Munich Germany
| | - A. Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - V. Mahler
- Department of Dermatology University Hospital of Erlangen Friedrich Alexander University Erlangen‐Nuremberg Erlangen Germany
| | - P. Elsner
- Department of Dermatology and Dermatological Allergy Friedrich Schiller University Jena Jena Germany
| | - J. Schmitt
- Centre for Evidence‐based Healthcare Medical Faculty Carl Gustav Carus Technical University Dresden Dresden Germany
| | - B.K. Ballmer‐Weber
- Allergy Unit Department of Dermatology University Hospital Zürich Zurich Switzerland
| | - P. Spring
- Department of Dermatology University Hospital of Lausanne CHUV Lausanne Switzerland
| | - L. Naldi
- Centro Studi GISED Bergamo Italy
- Department of Dermatology Papa Giovanni XXIII Hospital Bergamo Italy
| | - L. Borradori
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - D. Simon
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
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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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Agner T, Aalto-Korte K, Andersen KE, Foti C, Gimenéz-Arnau A, Goncalo M, Goossens A, Le Coz C, Diepgen TL. Factors associated with combined hand and foot eczema. J Eur Acad Dermatol Venereol 2016; 31:828-832. [PMID: 27768241 DOI: 10.1111/jdv.14016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND As for hand eczema, the aetiology of foot eczema is multifactorial and not very well understood. The aim of the present study was to identify factors associated with foot eczema in a cohort of hand eczema patients being classified into different subgroups. METHODS Associations between foot and hand eczema were studied in a cross-sectional design in a cohort of hand eczema patients. Consecutive patients were recruited from nine different European Centres during the period October 2011-September 2012. Data on demographic factors, presence of foot eczema, hand eczema duration and severity, and whether the hand eczema was work-related or not were available, as well as patch-test results. RESULTS Of a total of 427 hand eczema patients identified, information on foot eczema was available in 419 patients who were included in the present study. A total of 125 patients (29.8%) had concomitant foot and hand eczema. It was found more often in association with hyperkeratotic hand eczema (P = 0.007) and was less often associated with irritant hand eczema (P < 0.001). However, foot eczema was nevertheless found in 18% of patient with irritant hand eczema and in 25% of patients with occupational hand eczema. Combined foot and hand eczema was associated with more severe and long-standing hand eczema (P < 0.001 and P = 0.004, respectively). Contact allergy was found in 51.8% with no difference between patients with combined foot and hand eczema and patients with hand eczema only. CONCLUSION Occurrence of combined foot and hand eczema is a common finding and not restricted to endogenous hand eczema.
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Affiliation(s)
- T Agner
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - K Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - K E Andersen
- Department of Dermatology and Allergy Centre, Centre for Innovative Medical Technology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - A Gimenéz-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - M Goncalo
- Clinic of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Goossens
- Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
| | - C Le Coz
- Cabinet de Dermatologie, Strasbourg, France
| | - T L Diepgen
- Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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28
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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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Tamrazova OB, Novoseltsev MV. Hand microbial eczemas. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-1-85-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article concerns with the case dermatitis of hands. It analyses the modern classifications of hand dermatitis, epidemiological aspects, initiating agents, clinical treatment and therapeutical principals. The special focus is put on microbal eczemas and chronical allergodermathosis of hands. Among the pathogenetical factors of development and maintaining of dermatological inflammation the problem of microbacterial infection of skin is emphasized. The effectiveness and safety of external therapy of patients with microbal and chronical hand eczemas is proven and established while using the multicomponental medication Triderm.
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Shroff A, Malajian D, Czarnowicki T, Rose S, Bernstein DM, Singer GK, Lebwohl MG, Hadi S, Guttman-Yassky E. Use of 308 nm excimer laser for the treatment of chronic hand and foot eczema. Int J Dermatol 2016; 55:e447-53. [PMID: 26917041 DOI: 10.1111/ijd.13205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic hand and foot eczema (CHFE), a prevalent debilitating disorder affecting approximately 15% of the population, presents a socioeconomic and psychosocial burden for patients and often follows a chronic course, refractory to conventional therapies. Thus, a large need exists for more effective therapeutics; the excimer laser (308 nm) is effective for some inflammatory skin diseases, but its efficacy has not been evaluated for CHFE. METHODS The study is a retrospective chart review conducted on 30 patients with recalcitrant CHFE (19 with hand involvement, four with foot involvement, and seven with both) treated twice weekly with excimer laser (308 nm) single wavelength ultraviolet (UV)B radiation between January 2013 and December 2014. RESULTS Improvements in clinical scores included a 69% reduction in average physician's global assessment (PGA) scores (from 2.77 at baseline to 0.87 after treatment, P < 0.0001) with a parallel reduction in average modified total lesion/symptom scores of 70% (from 10.2 to 3.1, P < 0.0001). Only mild sunburn-like reactions were observed. CONCLUSION This report evaluates excimer laser for patients with refractory CHFE and shows excellent and sustained efficacy for this treatment. Compared to other UV therapies, excimer laser offers lower cumulative doses of UV radiation by targeting specific areas. This effective treatment should be considered alone or in combination with other established or newer therapies.
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Affiliation(s)
- Anjali Shroff
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dana Malajian
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA.,College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Tali Czarnowicki
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Sharon Rose
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel M Bernstein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giselle K Singer
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhail Hadi
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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31
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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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32
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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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33
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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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34
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Wiszniewska M, Walusiak-Skorupa J. Recent Trends in Occupational Contact Dermatitis. Curr Allergy Asthma Rep 2015; 15:43. [PMID: 26143395 DOI: 10.1007/s11882-015-0543-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Occupational contact dermatitis (OCD) remains prevalent among workers and impacts quality of life and workability. The purpose of this review is to summarize the recent advances in occupational contact dermatitis as well as potential hazardous agents in the workplaces causing OCD. The review covers new developments in the epidemiology, etiology, diagnosis, and management of occupational contact dermatitis. This article also provides updated information on the prevalence of work-related skin symptoms and on new contact allergens among working population. It is emphasized that in the context of prevention of OCD, special attention should be focused on the identified high-risk occupational groups, especially healthcare workers and hairdressers starting with the apprentices. Current approaches include working out the standards and guidelines to improve the education, knowledge, diagnosis, and management of OCD based on a multidisciplinary team of medical specialists and an employer.
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Affiliation(s)
- Marta Wiszniewska
- Department of Occupational Diseases and Clinical Toxicology, Nofer Institute of Occupational Medicine, 8 Teresy St., 91-348, Lodz, Poland,
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35
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Agner T, Aalto-Korte K, Andersen K, Foti C, Gimenéz-Arnau A, Goncalo M, Goossens A, Le Coz C, Diepgen T. Classification of hand eczema. J Eur Acad Dermatol Venereol 2015; 29:2417-22. [DOI: 10.1111/jdv.13308] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- T. Agner
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen Copenhagen Denmark
| | - K. Aalto-Korte
- Occupational Medicine; Finnish Institute of Occupational Health; Helsinki Finland
| | - K.E. Andersen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - C. Foti
- Unit of Dermatology; Department of Biomedical Science and Human Oncology; University of Bari; Bari Italy
| | - A. Gimenéz-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d′Investigations Mediques; Universitat Autònoma; Barcelona Spain
| | - M. Goncalo
- Department of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - A. Goossens
- Department of Dermatology; University Hospital; K. U. Leuven; Leuven Belgium
| | - C. Le Coz
- Cabinet de Dermatologie and Laboratoire de Dermatochimie; Strasbourg France
| | - T.L. Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology; University Hospital; Heidelberg Germany
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36
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37
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Antonov D, Schliemann S, Elsner P. Hand dermatitis: a review of clinical features, prevention and treatment. Am J Clin Dermatol 2015; 16:257-270. [PMID: 25920436 DOI: 10.1007/s40257-015-0130-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hand dermatitis is a socially significant health problem. This review provides a discussion on the clinical features and patterns as well as the differential diagnosis of hand dermatitis, because these are essential for proper diagnosis in clinical practice. The morphology, however, is poorly related to the etiology in chronic cases. In all cases of chronic hand dermatitis, a full diagnostic examination should be undertaken and the etiology should be clarified and addressed in the treatment concept, instead of just moving directly from a morphological diagnosis to therapy. Preventive measures should be included in the treatment concept according to etiology. A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others.
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38
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de León FJ, Berbegal L, Silvestre JF. Management of Chronic Hand Eczema. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:533-44. [PMID: 26005193 DOI: 10.1016/j.ad.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema.
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Affiliation(s)
- F J de León
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
| | - L Berbegal
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
| | - J F Silvestre
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
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39
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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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40
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Jungersted JM, Høgh JK, Hellgren LI, Wilkinson S, Jemec GBE, Agner T. Hand eczema and stratum corneum ceramides. Clin Exp Dermatol 2014; 40:243-6. [DOI: 10.1111/ced.12502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 01/26/2023]
Affiliation(s)
- J. M. Jungersted
- Department of Dermatology; Roskilde Hospital; Roskilde Denmark
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - J. K. Høgh
- Center of Biological Sequence Analysis; Technical University of Denmark; Kongens Lyngby Denmark
| | - L. I. Hellgren
- Center of Biological Sequence Analysis; Technical University of Denmark; Kongens Lyngby Denmark
| | - S. Wilkinson
- Medical Toxicology Centre; Institute for Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
| | - G. B. E. Jemec
- Department of Dermatology; Roskilde Hospital; Roskilde Denmark
| | - T. Agner
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
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41
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Molin S, Ruzicka T, Herzinger T. Smoking is associated with combined allergic and irritant hand eczema, contact allergies and hyperhidrosis. J Eur Acad Dermatol Venereol 2014; 29:2483-6. [DOI: 10.1111/jdv.12846] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/13/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S. Molin
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | - T. Ruzicka
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | - T. Herzinger
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
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42
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Bernier C, Gélot P. [Skin tests in chronic hand dermatitis]. Ann Dermatol Venereol 2014; 141 Suppl 1:S117-26. [PMID: 24953621 DOI: 10.1016/s0151-9638(14)70149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic hand dermatitis is often multifactorial but allergic causes are frequent and can complicate atopic dermatitis or irritant dermatitis. The management of patients affected by hand dermatitis includes detailed interrogation and a complete examination of the skin. Allergologic tests must be systematically realized if examination is suggestive of contact dermatitis or protein contact dermatitis, if an occupational origin is suspected but also in all patients in which treatment is ineffective. Skin tests include patch tests with the European standard series, specialized or additional series if necessary. Skin tests may also include personal items used by patients on a daily basis. If protein contact dermatitis is suspected skin tests include prick tests. Only complete and definitive eviction of allergens can allow a complete and definitive cure of chronic hand dermatitis.
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Affiliation(s)
- C Bernier
- Service de dermatologie, CHU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - P Gélot
- Service de dermatologie, CHU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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43
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Gelot P, Avenel-Audran M, Balica S, Bensefa L, Crépy MN, Debons M, Ammari H, Milpied B, Raison N, Vigan M, Weibel N, Stalder JF, Bernier C. Éducation thérapeutique du patient dans l’eczéma chronique des mains. Ann Dermatol Venereol 2014; 141 Suppl 1:S127-42. [DOI: 10.1016/s0151-9638(14)70150-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Weisshaar E, Kallen U, Weiß M. "The itching hand"- important differential diagnoses and treatment. J Dtsch Dermatol Ges 2012; 11:31-42. [PMID: 23176572 DOI: 10.1111/j.1610-0387.2012.08002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Skin diseases affecting the hands receive particular individual attention and constitute a considerable emotional burden. Many dermatoses also present with itching of the hands. Itch is often underestimated when it occurs in a comparably limited body area such as the hands. The high occupational significance of the hands in many professions must, nevertheless, be stressed. One of the most frequent diagnoses in itching of the hands is eczema. In the differential diagnosis, less common diseases such as neurological and systemic diseases and adverse drug reactions must also be taken into consideration. Itching of the hands can also be accompanied by other sensations, such as burning, stinging and pain. A thorough history regarding sensations and dysesthesias already allows for a diagnostic classification of the disease in some cases. Itching of the hands requires a careful and thorough diagnostic approach. This forms the basis of a specific and successful therapy which may be adapted stepwise, depending on the underlying cause, and also may require, in addition to causal therapy, symptomatic antipruritic therapy. Therapy should follow the current guidelines for chronic pruritus and hand eczema. This article reviews over the differential diagnosis and therapy of "itching hands".
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Affiliation(s)
- Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Germany.
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45
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Abstract
Hand eczema is an inflammation of the skin; the cause is often multifactorial. Initial management includes avoiding causative irritants or allergens (e.g., by wearing impermeable gloves) and applying emollients and potent topical glucocorticoids.
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Affiliation(s)
- Pieter-Jan Coenraads
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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