title: Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study.
abstract: BACKGROUND
  Hand eczema (HE) is a common skin disease with major medical psychological and socio-economic implications. Onset and prognosis of HE are determined by individual as well as environmental factors. So far, most epidemiological data on HE have been reported from Scandinavian and recently German studies.
  
  
  OBJECTIVE
  To investigate the characteristics and medical care of patients with chronic HE (CHE) in Switzerland, and identify risk factors.
  
  
  METHODS
  In this cross-sectional study, data from patients with chronic HE were obtained by means of medical history, dermatological examination and patient questionnaires. Multiple logistic regression analysis was applied to identify risk factors for high severity and dermatology life quality index (DLQI).
  
  
  RESULTS
  In seven dermatology departments, 199 patients (mean age 40.4 years, 50.8% female) with CHE (mean duration 6.6 years) were enrolled. Moderate to severe HE was reported by 70.9% of patients, and was associated with age <30 or >50 years, localization of lesions and pruritus. Because of the CHE, 37.3% of patients were on sick leave over the past 12 months, 14.8% had changed or lost their job. Practically all patients applied topical therapy, 21% were treated with alitretinoin, and 21% with psoralen plus UVA light (PUVA). The effects on the health-related quality of life was moderate to large in 33.7% and 39.4% of CHE patients, respectively. Factors associated with a high impact on DLQI (mean 9.7 ± 5.8) were female sex, lesions on back of the hands and pruritus as well as mechanical skin irritation and wearing gloves.
  
  
  CONCLUSIONS
  In agreement with recent studies, the Swiss data demonstrate the high impact of CHE on medical well-being, patient quality of life and work ability. As it is associated with an intense use of health care services, high rate of sick leave, job loss and change, CHE may cause a high socio-economic burden.
authors.affiliation: Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland.|Centro Studi GISED, Bergamo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cazzaniga
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: B K
authors.initials: BK
authors.lastname: Ballmer-Weber
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Gräni
authors.affiliation: Department of Dermatology, University Hospital of Lausanne CHUV, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Spring
authors.affiliation: Department of Dermatology, University Hospital Basel, Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Bircher
authors.affiliation: Department of Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Anliker
authors.affiliation: Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: A K
authors.initials: AK
authors.lastname: Sonntag
authors.affiliation: Department of Dermatology, Geneva University Hospitals (HUG), Geneva, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Piletta
authors.affiliation: Department of Dermatology, Geneva University Hospitals (HUG), Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Huber
authors.affiliation: Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Borradori
authors.affiliation: Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital, Ruprecht Karls University, Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Diepgen
authors.affiliation: Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Apfelbacher
authors.affiliation: Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Simon
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004485:Eczema / Q000628:therapy*; D005260:Female; D006229:Hand Dermatoses / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012959:Socioeconomic Factors