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Clinical severity and prognosis of hand eczema

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Abstract:

Summary Background 

Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. Objectives 

In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. Methods 

Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. Results 

At baseline, 60·3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36·1% at follow-up. The mean HECSI value decreased from 19·9 points at baseline to 11·2 points at follow-up (P <0·001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P <0·001), atopic dermatitis (P =0·01) and ≥ 1 positive patch test (P <0·001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P =0·04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P =0·02) and a poor prognosis (P =0·04). Conclusions 

Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Keywords: Hand Eczema Severity Index; follow-up; hand eczema; photographic guide; prognosis

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-2133.2009.09139.x

Affiliations: 1: Department of Dermatology, Gentofte University Hospital, Niels Andersens vej 65, 2900 Hellerup, Denmark 2: National Board of Health, Ribe, Denmark 3: The Dermatology Clinic, Vesterbro 99, 9000 Aalborg, Denmark 4: The Dermatology Clinic, Roskildevej 264, 2610 Rødovre, Denmark 5: The Dermatology Clinic, Bredgade 30, 7400 Herning, Denmark 6: The Dermatology Clinic, Bredgade 50, 4400 Kalundborg, Denmark 7: Department of Dermatology, Odense University Hospital, 5000 Odense C, Denmark 8: The Dermatology Clinic, Skovgade 23 C, 7100 Vejle, Denmark 9: Department of Dermatology, Marselisborg University Hospital, 8000 Aarhus C, Denmark 10: The Dermatology Clinic, Bindeledet 15, 2880 Bagsværd, Denmark

Publication date: June 1, 2009

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