title: Diagnosing chronic hand eczema by an algorithm: a tool for classification in clinical practice.
abstract: BACKGROUND
  Diagnostic classification of chronic hand eczema (CHE) represents a major clinical and taxonomic challenge because of its wide aetiological and clinical heterogeneity.
  
  
  OBJECTIVE
  To develop an algorithm for the diagnosis and classification of CHE.
  
  
  METHODS
  Well-defined aetiological, clinical and morphological criteria of CHE were arranged graphically in a diagnostic hierarchy, and validated in 137 German patients with hand eczema.
  
  
  RESULTS
  The algorithm distinguished chronic hand eczema due to contact allergy, irritant damage or a combination of the two, each either with or without atopy, and also atopic hand eczema and idiopathic hand eczema lacking obvious causative factors. Foot involvement helped to distinguish idiopathic from irritant hand eczema. Each subtype could occur either with a hyperkeratotic-rhagadiform, dyshidrotic or mixed morphology, but certain hand eczema subtypes had clear morphological preferences.
  
  
  CONCLUSIONS
  By providing a more precise clinical definition this diagnostic algorithm could improve the classification and taxonomy of hand eczema subtypes, facilitating more rational treatment decisions and allowing better treatment outcome analysis.
authors.affiliation: Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany. sonja.molin@med.uni-muenchen.de
authors.forename: S
authors.initials: S
authors.lastname: Molin
authors.forename: T L
authors.initials: TL
authors.lastname: Diepgen
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.forename: J C
authors.initials: JC
authors.lastname: Prinz
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002908:Chronic Disease; D003876:Dermatitis, Atopic / Q000175:diagnosis; D003877:Dermatitis, Contact / Q000175:diagnosis; D004485:Eczema / Q000145:classification* / Q000209:etiology; D005260:Female; D006229:Hand Dermatoses / Q000145:classification* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult