Clinical severity and prognosis of hand eczema

TY - JOUR

T1 - Clinical severity and prognosis of hand eczema

AU - Hald, M

AU - Agner, T

AU - Blands, J

AU - Veien, N K

AU - Laurberg, G

AU - Avnstorp, C

AU - Menné, T

AU - Kaaber, K

AU - Kristensen, B

AU - Kristensen, O

AU - Andersen, K E

AU - Paulsen, E

AU - Thormann, J

AU - Sommerlund, M

AU - Nielsen, N H

AU - Johansen, J D

N1 - Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Eczema; Female; Follow-Up Studies; Hand Dermatoses; Humans; Male; Middle Aged; Photography; Prognosis; Prospective Studies; Questionnaires; Regression Analysis; Severity of Illness Index; Young Adult

PY - 2009

Y1 - 2009

N2 - 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 > or = 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.

AB - 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 > or = 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.

U2 - 10.1111/j.1365-2133.2009.09139.x

DO - 10.1111/j.1365-2133.2009.09139.x

M3 - Journal article

C2 - 19416249

SN - 0007-0963

VL - 160

SP - 1229

EP - 1236

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 6

ER -