title: Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial.
abstract: OBJECTIVE
  To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema.
  
  
  METHODS
  Randomised, observer blinded parallel group superiority clinical trial.
  
  
  METHODS
  Three hospitals in Denmark.
  
  
  METHODS
  255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group.
  
  
  METHODS
  Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual.
  
  
  METHODS
  The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up.
  
  
  RESULTS
  Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema.
  
  
  CONCLUSIONS
  A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01012453.
authors.affiliation: Department of Dermatology, Roskilde Hospital, Health Science Faculty, Køgevej 7-13, 4000 Roskilde, Denmark. kristinaibler@hotmail.com
authors.forename: Kristina Sophie
authors.initials: KS
authors.lastname: Ibler
authors.forename: Gregor B E
authors.initials: GB
authors.lastname: Jemec
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Diepgen
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.forename: Jane
authors.initials: J
authors.lastname: Lindschou Hansen
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.forename: Simon Francis
authors.initials: SF
authors.lastname: Thomsen
authors.forename: Tove
authors.initials: T
authors.lastname: Agner
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D003718:Denmark / Q000453:epidemiology; D004485:Eczema / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D017575:Gloves, Protective; D006229:Hand Dermatoses / Q000453:epidemiology / Q000517:prevention & control*; D006235:Hand Disinfection; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control; D010328:Patch Tests; D011788:Quality of Life; D012044:Regression Analysis; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016037:Single-Blind Method; D017592:Skin Care