title: Classification of hand eczema.
abstract: BACKGROUND
  Classification of hand eczema (HE) is mandatory in epidemiological and clinical studies, and also important in clinical work.
  
  
  OBJECTIVE
  The aim was to test a recently proposed classification system of HE in clinical practice in a prospective multicentre study.
  
  
  METHODS
  Patients were recruited from nine different tertiary referral centres. All patients underwent examination by specialists in dermatology and were checked using relevant allergy testing. Patients were classified into one of the six diagnostic subgroups of HE: allergic contact dermatitis, irritant contact dermatitis, atopic HE, protein contact dermatitis/contact urticaria, hyperkeratotic endogenous eczema and vesicular endogenous eczema, respectively. An additional diagnosis was given if symptoms indicated that factors additional to the main diagnosis were of importance for the disease.
  
  
  RESULTS
  Four hundred and twenty-seven patients were included, 379 (89%) of the patients could be classified directly into one of the six diagnostic subgroups, with irritant and allergic contact dermatitis comprising 249 patients (58%). For 32 (7%) more than one of the six diagnostic subgroups had been formulated as a main diagnosis, and 16 (4%) could not be classified. 38% had one additional diagnosis and 26% had two or more additional diagnoses. Eczema on feet was found in 30% of the patients, statistically significantly more frequently associated with hyperkeratotic and vesicular endogenous eczema.
  
  
  CONCLUSIONS
  We find that the classification system investigated in the present study was useful, being able to give an appropriate main diagnosis for 89% of HE patients, and for another 7% when using two main diagnoses. The fact that more than half of the patients had one or more additional diagnoses illustrates that HE is a multifactorial disease.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Agner
authors.affiliation: Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Aalto-Korte
authors.affiliation: Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: K E
authors.initials: KE
authors.lastname: Andersen
authors.affiliation: Unit of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Foti
authors.affiliation: Department of Dermatology, Hospital del Mar, Institut Mar d'Investigations Mediques, Universitat Autònoma, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Gimenéz-Arnau
authors.affiliation: Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Goncalo
authors.affiliation: Department of Dermatology, University Hospital, K. U. Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Goossens
authors.affiliation: Cabinet de Dermatologie and Laboratoire de Dermatochimie, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Coz
authors.affiliation: Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital, Heidelberg, Germany.
authors.forename: T L
authors.initials: TL
authors.lastname: Diepgen
mesh_terms: D000328:Adult; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis; D003876:Dermatitis, Atopic / Q000175:diagnosis; D017453:Dermatitis, Irritant / Q000175:diagnosis; D004485:Eczema / Q000145:classification* / Q000175:diagnosis; D011146:Eczema, Dyshidrotic / Q000175:diagnosis; D005260:Female; D006229:Hand Dermatoses / Q000145:classification* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014581:Urticaria / Q000175:diagnosis