title: Hand eczema and steroid-refractory chronic hand eczema in general practice: prevalence and initial treatment.
abstract: BACKGROUND
  The self-reported annual prevalence of hand eczema (HE) in adults is about 10%. Incidence and prevalence data for HE, chronic HE (CHE) and steroid-refractory CHE (SR-CHE) in physician-attended populations are lacking.
  
  
  OBJECTIVE
  To estimate the prevalences of HE, CHE and SR-CHE in a primary-care population using a cross-sectional design; and to estimate the incidence of each and describe initial therapy using a cohort approach.
  
  
  METHODS
  The population was all patients in the Clinical Practice Research Datalink for 2000-10, 2005-10 and 2010-11. HE was defined as any of 12 diagnoses (six specific to the hand, six for contact dermatitis). HE became CHE if any of these 12, or three additional diagnoses, occurred 90-365 days after the first HE, and if the patient was prescribed at least one course of potent topical steroids. A patient with CHE was classified as having SR-CHE if they were (i) referred to a dermatologist and/or (ii) prescribed phototherapy, systemic immunomodulators, oral corticosteroids, alitretinoin or acitretin.
  
  
  RESULTS
  The 1-year adult prevalence of HE was 0·4%. The period prevalences of SR-CHE for 1, 5 and 10 years in adults were 0·008%, 0·036% and 0·072%, respectively; lifetime estimates were 0·071%, 0·080%, 0·098%. About one-half of cases of CHE were steroid refractory. All conditions were more common in female than in male patients. One-third of HE diagnoses were specific for the hand, the remainder were for contact dermatitis. The majority (62%) of newly diagnosed patients with HE were not prescribed treatment in the 12 months after diagnosis.
  
  
  CONCLUSIONS
  Although the prevalence of HE could be 2-3 times higher than reported herein, the proportion of adults seeking medical care for HE is a fraction of those who self-report HE. SR-CHE is rare.
authors.affiliation: GlaxoSmithKline, Research Triangle Park, NC, U.S.A.|Consultant epidemiologist, Chapel Hill, NC, U.S.A.
authors.forename: M M
authors.initials: MM
authors.lastname: Crane
authors.affiliation: GlaxoSmithKline, Stockley Park, U.K.
authors.forename: D J
authors.initials: DJ
authors.lastname: Webb
authors.affiliation: GlaxoSmithKline, Research Triangle Park, NC, U.S.A.|Consultant epidemiologist, Chapel Hill, NC, U.S.A.
authors.forename: E
authors.initials: E
authors.lastname: Watson
authors.affiliation: South Tees Hospitals NHS Foundation Trust, Northallerton, U.K.
authors.forename: T
authors.initials: T
authors.lastname: Cunliffe
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, U.K.
authors.forename: J
authors.initials: J
authors.lastname: English
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003879:Dermatologic Agents / Q000008:administration & dosage*; D060467:Disease Resistance; D004485:Eczema; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006229:Hand Dermatoses / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D013256:Steroids / Q000008:administration & dosage*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D013256:Steroids