title: An ethnographic study into the psychological impact and adaptive mechanisms of living with hand eczema.
abstract: BACKGROUND
  Hand eczema (HE) severely impairs patients' quality of life, and causes significant psychological and social distress. There has been little focus on how people with HE perceive their disease and how they may be adapting their behaviours to cope with their condition.
  
  
  OBJECTIVE
  A survey was carried out to investigate how the physical and aesthetic impact of HE may affect patients psychologically, and to assess their associated behavioural changes and disease perception.
  
  
  METHODS
  A 22-item survey covering demographics, disease-related questions and psychosocial items was completed by patients with HE via a website.
  
  
  RESULTS
  In total, 1023 people with HE completed the survey. Of these, 89% stated they were embarrassed/self-conscious about their eczema, with 70% of respondents reporting wearing gloves or hiding their hands in their pockets. Many respondents reported their HE affected their daily activities and choices, with 74% of patients reporting that their condition affects the way they handle objects or touch people. Regarding relationships, 27% of respondents said physical relationships with their partners were affected, and 27% said that tension/disagreements between them and their partner or family/friends occurred because HE had stopped them doing certain activities.
  
  
  CONCLUSIONS
  HE can have a very large psychological impact on sufferers, hugely reducing their self-esteem, and as a consequence, having a detrimental effect on their daily activities and relationships. The impact of these psychosocial comorbidities has been underinvestigated and often underestimated by clinicians, despite being of great importance to patients.
authors.affiliation: Department of Dermatology, Royal Free Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Dermatology, Royal London Hospital, Whitechapel, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Psychology, London Guildhall University, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Papadopoulos
authors.affiliation: Department of Dermatology, Royal London Hospital, Whitechapel, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bewley
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015897:Comorbidity; D004485:Eczema / Q000523:psychology*; D005260:Female; D006229:Hand Dermatoses / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012649:Self Concept; D011795:Surveys and Questionnaires; D055815:Young Adult