Abstract

Hand eczema is a complex disease with many players involved

Hand eczema is a common disease that affects younger age groups in particular, and women more often than men.

It is often work-related. And it is the most frequent disease among recognised occupational diseases in Denmark.

Hand eczema has a significantly negative impact on health-related quality of life, and causes sickness absence, job change and even early retirement. The disease is a major economic burden both to the individual and society. Even though hand eczema is a very common disease, multiple aspects of the disease still remain unknown.

Etiology of the disease is important when trying to optimize treatment and prevention. Contact allergy accounts for 20-25% of all hand eczema cases, while the larger group is due to irritant exposures. Wet work is here the major culprit, known to cause and aggravate hand eczema. A minor group of hand eczema is classified as endogenous, and probably related to genetic factors.

Since hand eczema is a complex disease with many players involved, research within the area also needs to include a broad specter of research methods and studies. At Bispebjerg Hospital research projects have in particular focused on occupational hand eczema, in joint studies between Department of Dermatology and Department of Environmental and Occupational Medicine.

Since hand eczema often turns into a chronic disease, prevention is an important area. The Bispebjerg research group has contributed to development of evidence-based skin care programmes for hand eczema patients, and the effectiveness of these was evaluated in a recent PhD study. Results from a randomized controlled intervention study emphasized the importance of differently designed skin care programmes and patient education, depending on occupation and educational level. Patients´ knowledge about skin care in relation to hand eczema has also been investigated, and risk groups with need for special attention have been identified.

Hand eczema may often affect work ability, and sometimes job change may be necessary. However, until now data on job change, and whether this will improve the eczema has been few. In a recent PhD-study a cohort of patients with occupational hand eczema was followed for 5 years. At follow-up around 30% had changed profession, and around 20% were outside the labour market. Those who had changed profession had significant improvement in eczema as compared to those who had not changed. However, when focusing on health-related quality of life, those who had stayed in the same profession had significantly better quality of life than those who changed. These results are important when advising patients with hand eczema regarding their professional life, and the results also illustrate the complexity of the disease. Furthermore, the results clearly show the socioeconomic importance of the disease.

Regarding prognosis for hand eczema it has been known for years that previous or current atopic dermatitis may contribute to a worse prognosis, as may contact allergy. Interesting, new research from the Bispebjerg research group has shown that also life style factors influence the prognosis. Tobacco smoking is particularly related to a bad prognosis, but also lack of physical activity and mental stress seems to be associated with bad prognosis

Knowing that wet work is an important culprit regarding development of hand eczema, a tool is needed to assess the extent of wet work exposure in different professions. This is important when counselling patients regarding job change, and when workers compensation is assessed. In an ongoing PhD-project a Job Exposure Matrice (JEM) evaluating the degree of wet work exposure in a large number of categories of jobs has been developed.

Future research comprises the role of bacteria and microbiome in hand eczema, which still remains to be assessed. It is known that 50-70% of patients with hand eczema are colonized with Staphylococcus aureus on the hand, but whether the bacteria are the chicken or the egg is unknown. It is not very well understood why hand eczema may often become a chronic disease, however the colonization with pathogen bacteria may be one out of more explanations for this.

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