Clinical severity and prognosis of hand eczema.
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.


OBJECTIVE
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.
National Allergy Research Centre, Gentofte University Hospital, Hellerup, Denmark. marhal02@geh.regionh.dk
M
M
Hald
T
T
Agner
J
J
Blands
N K
NK
Veien
G
G
Laurberg
C
C
Avnstorp
T
T
Menné
K
K
Kaaber
B
B
Kristensen
O
O
Kristensen
K E
KE
Andersen
E
E
Paulsen
J
J
Thormann
M
M
Sommerlund
N H
NH
Nielsen
J D
JD
Johansen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004485:Eczema / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006229:Hand Dermatoses / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult