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Background: Hand eczema (HE) is common in health care workers (HCWs). During the last decade, new recommendations have supported increased use of alcohol-based hand rub (ABHR) to partially replace hand washings to lower the prevalence of HE. However, newer data on this recommendation is lacking., Objectives: To assess current 1-year prevalence of HE in HCWs, to investigate exposure, and the extent of subjective discomfort to hand washings and ABHR., Methods: A digital questionnaire was sent to 4876 HCWs from April to May 2020., Results: Of 2125 respondents (1779 women, 346 men), 14.7% reported HE within the last year. In total, 9.1% reported >20 hand washings per shift and 76.0% reported ABHR use >20 times per shift. HE was significantly associated with hand washings (adjusted odds ratio [OR] 1.73 [95% confidence interval [CI] 1.26-2.36]) and glove use on wet skin (adjusted OR 1.99 [95% CI 1.27-3.12]). Subjective discomfort to ABHR was reported significantly more often than to hand washings (P < .001) and significantly more often in HCWs with HE than in those without HE (P < .001)., Conclusions: The current 1-year HE prevalence in HCWs of 14.7% was lower than in previously reported Scandinavian data. HE was related to frequent hand washings, as previously reported, and to glove use on wet skin, which is a possible risk factor for HE that should be further explored., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Occupational hand eczema (HE) has continuously been the most frequently recognised occupational disease, comprising > 95% of all recognised occupational skin diseases. Irritant contact dermatitis constitutes > 70%, where wet work is the main eliciting factor. Knowledge on the dose-response relationship between wet work and HE is pivotal concerning preventive interventions, job counselling and medico-legal regulations, which is summarised in this review. New findings indicate a significant risk of having HE at an exposure level of no more than 30 minutes of wet work per day.

Objective Albeit a pivotal risk for the development of hand eczema (HE), the exposure-response relationship between wet work and HE remains to be further investigated. Knowledge on exposure-response is important regarding preventive measures, medico-legal regulations and job-counseling. Recently, a job-exposure matrix (JEM) for wet work was developed, providing information on the likelihood of wet work. By combining the JEM with data on HE we aimed to investigate the relationship between extent of wet work and HE. Methods This study is a case-referent study including patients registered in the National Database of Contact Allergy, Denmark, and comprises data on sex, age, atopic dermatitis, HE, face eczema and patch testing results. Patients with HE served as cases and patients with facial eczema served as referents. Information on profession was retrieved from the DOC*X database in accordance with the DISCO-88 classification system. A wet-work-specific JEM provides - for each profession - an estimate for (i) the likelihood of wet work lasting ≥2 hours/day and (ii) the average number of hours of wet work per day. Results After two hours of wet hands and glove wear, the odds ratio (OR) was 3.49 and 3.19, respectively, for females and 2.41 and 1.82, respectively, for males. Females had a higher risk of HE than males with probability of wet hands <75% (OR 2.34, 95% CI 2.12-2.58 compared to males 1.68, 95% CI 1.22-2.31) and regarding glove wear at all exposure levels. Conclusion Our data confirms a close association between wet work and HE. Exposure lasting less than the current definition of wet work (having wet hands for ≥2 hours per day) may be of importance.

Background: Concerns have been raised that a chronic course of hand eczema (HE) could be fostered by a lack of efficient treatment at an early stage., Objectives: First, to assess the prevalence of systemic treatment in patients with chronic occupational HE (OHE) and relate this to demographic data, HE severity, and atopic dermatitis (AD). Second, to explore the use of complementary and alternative medicine (CAM) in the same population., Methods: Baseline data were obtained from a registry-based study including patients with recognized OHE in a 2-year period in Denmark, comprising a total of 2703 workers. A follow-up questionnaire after 4 to 5 years included questions on disease severity and treatments., Results: A total of 1565 participants responded to the questionnaire, and of these 1203 had ongoing HE at follow-up and were included in the study. In total, 10.0% had received systemic therapy, whereas this share was 13.3% in those with self-reported moderate-to-severe HE. Age >35 years, previous or current AD, and severe eczema were factors related to use of systemic treatment. Use of CAM was reported by 6.2% of the study population., Conclusions: We suggest that chronicity of HE may be perpetuated by the lack of efficient treatment., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Sickness absence in hand eczema patients has been associated with stress rather than disease severity, indicating that personal aspects regarding hand eczema should be investigated further., Objectives: To examine whether patient education vs treatment as usual can influence behaviour and knowledge regarding skin protection and care, as well as personal resources, in patients with occupational hand eczema., Methods: PREVEX is an individually randomized clinical trial investigating the 1-year effects of a simple, low-cost group-counselling programme vs treatment as usual for patients with notified occupational hand eczema. Exploratory outcomes were behaviour, knowledge, self-efficacy, and self-evaluated skin care ability., Results: In total, 1668 patients with notified occupational skin disease were invited to participate, of whom 769 were randomized and 756 were analysed: intervention group (n = 376) vs control group (n = 380). Behaviour was improved and the knowledge score increased in the intervention group as compared with the control group (respectively: estimate 0.08; 95%CI: 0.02-0.19; P = .01; and estimate 0.49; 95%CI: 0.28-0.70; P < .001). Self-efficacy was lower in the intervention group as compared with the control group (estimate -0.78; 95%CI: -1.25 to -0.30; P = .001). No difference was found regarding skin care abilities., Conclusions: The intervention had a positive influence on 1-year behaviour and knowledge, but was insufficient to result in long-term positive changes in personal resources regarding dealing with hand eczema., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: An inverse relationship between disease severity and health-related quality of life (HR-QoL) in patients with hand eczema is well established, but modifying effects of demographic variables have been less well studied., Objective: To identify the influence of metropolitan versus non-metropolitan residence on the relationship between disease severity and HR-QoL in patients with occupational hand eczema., Methods: The city of Copenhagen and the rest of Zealand were defined as metropolitan and non-metropolitan areas, respectively. Participants were 773 persons with occupational hand eczema. A questionnaire on the severity of hand eczema and HR-QoL was sent to all participants., Results: The odds for reporting moderate to high severity of occupational hand eczema were significantly lower in the metropolitan population than in the non-metropolitan population [odds ratio (OR): 0.42; 95%CI: 0.23-0.75], whereas low dermatology-related quality of life was more prevalent in metropolitan than in non-metropolitan patients (OR: 1.31; 95%CI: 0.83-2.05), indicating that hand eczema had a more pronounced negative effect in metropolitan patients, in spite of less severe eczema., Conclusion: Our data indicate that area of residence has a modifying effect on the relationship between disease severity and HR-QoL, with a more negative impact on HR-QoL in metropolitan than in non-metropolitan areas. This information is important with respect to fully appreciating the burden of occupational hand eczema., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Wet work is an important risk factor for occupational hand eczema., Objectives: To examine the effect of job change in workers with occupational hand eczema caused by wet work, and to evaluate the dose-response relationship between intensity of wet work and eczema., Method: The study is based on a subgroup (n = 954) from a descriptive, registry-based study including all participants with occupational hand eczema caused by wet work recognized by the Danish Labour Market Insurance Authority in 2010 and 2011. A follow-up questionnaire was sent out 4-5 years later (response 58%)., Results: Change of profession and being outside the labour market had a positive effect on healing and improvement of hand eczema. Inverse dose-response relationships were found between the amount of time spent with wet hands at work and healing (p = 0.001) and improvement (p < 0.001), and between the frequency of hand washing at work and healing (p = 0.013) and improvement (p < 0.001)., Conclusions: Leaving the profession has a positive effect on eczema; however, even minor changes in exposure to wet work were associated with healing and improvement. This information has implications with respect to advice given to patients with occupational hand eczema caused by wet work., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective Occupational hand eczema has adverse health and socioeconomic impacts for the afflicted individuals and society. Prevention and treatment strategies are needed. This study aimed to assess the effectiveness of an educational intervention on sickness absence, quality of life and severity of hand eczema. Methods PREVEX (PreVention of EXema) is an individually randomized, parallel-group superiority trial investigating the pros and cons of one-time, 2-hour, group-based education in skin-protective behavior versus treatment as usual among patients with newly notified occupational hand eczema, with follow-up after one year. Co-primary outcomes were total sickness absence, health-related quality of life (HR-QoL), and self-reported severity of hand eczema. Results Patients (N=1668) with notified occupational skin diseases from July 2012 to November 2014 were invited to participate in the trial. Of these, 756 were randomized to the intervention (N= 376) versus control (N=380) group. The intervention group had 21% fewer sickness absence days compared with the control group [95% confidence interval (CI) -55-40%, P=0.43]. We found no significant difference in the change of HR-QoL for the intervention compared with the control group (4% lower in the intervention group, 95% CI -18-13%, P=0.67). The ordinal odds of scoring worse on self-reported hand eczema severity was 15% lower in the intervention compared with the control group (95% CI -39-18%, P=0.34). Post-hoc sub-group analyses indicated that the effect of the intervention on severity differed between occupations, being detrimental to healthcare workers and beneficial in all other occupations. Conclusion The educational skincare program had no marked effect on the primary outcomes sickness absence, HR-QoL, and severity of hand eczema when compared with treatment as usual.

Background: Occupational hand eczema and/or contact urticaria may have social consequences such as change of profession or not remaining in the workforce., Objectives: To identify factors associated with job change in a cohort of participants with recognised occupational hand eczema/contact urticaria METHODS: A registry-based study including 2703 employees with recognised occupational hand eczema/contact urticaria in Denmark in 2010/2011. Four to five years later the participants received a follow-up questionnaire, comprising questions on current job situation (response rate 58.0%)., Results: At follow-up, 51.3% of the participants were no longer in the same profession. 32.5% had changed profession and 18.8% were no longer in employment. Change of profession was associated with young age, positive patch test, low educational level and severity of hand eczema/contact urticaria. With regard to specific professions, cleaning personnel changed profession significantly more often than other workers [71.4% (OR = 2.26)], health care workers significantly less often than other workers [34.0% (OR = 0.36)]., Conclusion: Job change occurs frequently during the first years after recognition of occupational hand eczema/contact urticaria and more often among patients with positive patch test reactions, with severe hand eczema/contact urticaria. Whether job changes improve the prognosis of occupational hand eczema/contact urticaria remains to be established., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Hairdressers are at risk of developing occupational contact dermatitis because of their intense contact with wet work in combination with chemicals., Objectives: To perform an analysis of a cohort study of hairdressers with occupational contact dermatitis recognized in the period 2006-2011, focusing on individual and environmental factors associated with the disease., Methods: The study was a descriptive, register-based survey including all hairdressers with recognized occupational contact dermatitis in Denmark in the period January 2006 to September 2011. Data were obtained from the Danish National Board of Industrial Injuries., Results: The study comprised 381 patients (373 women and 8 men). The median age was 25 years, 64.8% were apprentices, and 35.2% were fully trained hairdressers. The prevalence of atopic dermatitis was 36.0%, and was significantly higher among apprentices than among fully trained hairdressers (44.9% and 19.4%, respectively) (p < 0.001). Of the patients, 48.3% had their dermatitis recognized as occupational irritant contact dermatitis, 46.7% had their dermatitis recognized as as occupational allergic contact dermatitis or combined allergic and irritant contact dermatitis, and 5.0% were recognized as having occupational contact urticaria., Conclusion: The low median age, the high percentages of atopic dermatitis in apprentices and the fact that more apprentices than fully trained hairdressers had recognized occupational contact dermatitis underlines the importance of early prevention., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Patch testing is mandatory for diagnosing contact dermatitis. It is, however, crucial that patients understand and remember the result of the test., Objectives: The aim of our study was to evaluate the impact of patch testing with respect to patients' ability to remember patch test results and the results of natural rubber latex protein allergy after 2 years., Methods: One hundred and ninety-nine patients diagnosed with relevant occupational epoxy or rubber chemical contact allergy, or allergy to natural rubber latex protein, were invited to participate in a questionnaire study about their knowledge of contact allergies after 2 years., Results: The response rate was 75%. Of the respondents, 13% did not remember their occupational contact allergy to rubber chemicals or epoxy. Ability to remember was not significantly influenced by sex or Dermatology Life Quality Index, but was decreased by age >60 years (p < 0.01). Of patients with an additional contact allergy, <36% remembered this correctly. Of patients allergic to natural rubber latex proteins, 50% remembered this correctly., Conclusions: The impact of patch testing depends on the patients' ability to understand and remember the results of the test. Attention should be drawn to the importance of this, and patients with increased need for information should be identified., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Skin disorders accounted for one third of all recognised occupational diseases in Denmark in 2010. Wet work is a risk factor for the development of occupational hand eczema. The consequences of occupational hand eczema include sick leave, loss of job and impaired quality of life., Objectives: The aim of the present study was to investigate exposures related to cleaning and the effect of an evidence-based educational intervention on the prevention of hand eczema among hospital cleaners., Patients/materials/methods: The intervention consisted of a 1 hr course in hand protective behaviour. All full-time cleaners working at Bispebjerg Hospital in January 2013 were invited to participate. The outcome measures were self-reported skin behaviour, exposures, knowledge of skin protection and hand eczema severity index (HECSI)., Results: One hundred and five cleaners were invited to participate, of these 86 (82%) were included. At follow-up after 3 months there was a shift towards fewer daily hand washings and hand disinfections (p < 0.001 and p = 0.001 respectively). The number of correct answers to the knowledge questions rose from 6.3 to 7.3 (p = 0.006). The mean HECSI score decreased from 2.8 to 1.8 at follow-up (p = 0.002)., Conclusions: Data indicates a positive effect of a low-cost on-site educational intervention for hospital cleaners., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Skin diseases are the most commonly recognized occupational diseases in Denmark, and occupational contact dermatitis (OCD) comprises ∼95% of all cases., Objectives: To prevent occupational contact dermatitis, it is important to specifically identify exposures and work routines related to outbreak of the disease. The aim of this study was to give an overview of exposures for patients with occupational contact dermatitis in Denmark in 2010, and relate this to line of work and disease severity., Material and Methods: The study was a descriptive, register-based study including patients with recognized occupational contact dermatitis in Denmark in 2010. Data were obtained from the National Board of Industrial Injuries in Denmark, and comprised information about the skin disease as well as the occupation/industry of employment and exposures., Results: One thousand five hundred and four patients, 1020 women and 484 men, were included in the study. Irritant contact dermatitis accounted for 70% of all cases; 68% of these were caused by wet work. Forty-six per cent of all patients were employed either in the healthcare sector, in cleaning, or as kitchen workers. Among contact allergies, the most common were to rubber additives from gloves and epoxy in patients employed in the windmill industry., Conclusion: The data are important for planning preventive efforts in the future. The workers in the healthcare sector, kitchen workers and cleaners constitute almost half of all cases, and future preventive efforts should be directed at these occupations., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The incidence of occupational hand eczema is approximately 0.32 per 1,000 person years. The burden of the disease is high, as almost 60% has eczema-related sick leave during the first year after notification, and 15% are excluded from the workforce 12 years after disease onset. New treatments and prevention strategies are needed., Trial Design: The PREVEX trial is a randomised, parallel-group, superiority trial., Participants: All individuals from the Capital Region of Denmark and Region Zealand with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial. Inclusion criteria are: self-reported hand eczema and informed consent. Exclusion criteria are: age <18 years or >65 years; permanent exclusion from the workforce; inability to understand the Danish language; any serious medical condition; and lack of written informed consent. We plan to randomise 742 participants., Interventions: The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to the participants' specific occupation. Also, a telephone hotline is available and a subgroup will be offered a work-place visit. The experimental and the control group have access to usual care and treatment. All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work. 12 months after randomisation follow-up is completed., Objective: To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational hand eczema. Randomisation: PARTICIPANTS are centrally randomised according to a computer-generated allocation sequence with a varying block size concealed to investigators. Blinding: It is not possible to blind the participants and investigators, however, data obtained from registers, data entry, statistical analyses, and drawing of conclusions will be blinded., Outcomes: The three co-primary outcomes, assessed at 12 months, are: total number of self-reported days with sick leave; health-related quality of life; and subjective assessment of hand eczema severity. Explorative outcomes are: self-reported eczema-related sick leave, absence from work registered by the DREAM-register and by self-report, risk behaviour, knowledge of skin protection and performance management (self-efficacy; and self-evaluated ability to self-care)., Discussion: The PREVEX trial will be the first individually randomised trial to investigate the benefits and harms of group-based education in patients with newly notified occupational hand eczema., Trial Registration: ClinicalTrials.gov Identifier: NCT01899287.

Background: The aim of the present study was to examine the knowledge of skin care and treatment of hand eczema (HE) in a sample of patients with newly reported occupational HE., Materials and Methods: A questionnaire consisting of 13 questions about knowledge of skin care and treatment of HE was sent to all patients with occupational HE reported to the National Board of Industrial Injuries in the period 1 January 2010 to 31 March 2010., Results: Three hundred and seventy individuals, 269 females and 101 males, with a mean age of 39.9 years, responded to the questionnaire (response rate of 73%). The overall percentage of correct answers was 73%. Variables significantly influencing the level of knowledge were sex and age, with a need for more information in males and in patients above the age of 50 years. No significant influence of level of education, eczema activity, previous information about HE, previous or current atopic eczema or dermatology life quality index (DLQI) was found., Conclusion: There is still potential for improvement of the level of knowledge among patients with occupational HE. Special attention should be paid to males and patients above the age of 50 years., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)