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Background: The accuracy of self-reported hand eczema (HE) is currently unclear, and it is unknown how well self-reported signs and symptoms of skin lesions that indicate HE correlate with self-reported HE., Objectives: To correlate self-reported signs and symptoms of skin lesions on the hands with self-reported HE, to assess the sensitivity and specificity, and to suggest a definition for HE., Method: Seven hundred ninety-five (47.8%) of 1663 invited healthcare workers completed a digital questionnaire, and were asked to report if they experienced HE or any of the following skin signs/symptoms in past 11 months: scaling, erythema, fissures, vesicles, dryness, itch, stinging., Results: HE during the past 11 months was reported by 11.9%. Of these, 91.4% reported at least one skin sign versus 32.3% of those without self-reported HE. The highest sensitivity and specificity were found for erythema (77.4% and 78.2%, respectively) and itch (78.5% and 78.6%, respectively), both separately and combined. The combination of ≥2 signs (erythema, scaling, fissures and vesicles) and itch, reached a sensitivity of 52.7% and specificity of 93.9%., Conclusion: The marked difference between self-reported HE and signs/symptoms highlights the importance of differentiating between data based on self-reported HE and signs/symptoms. As a first step towards diagnostic HE criteria, ≥2 signs combined with itch could be considered, but clinical studies are needed to verify the precision., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

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.)

Hand eczema is frequently colonized with Staphylococcus aureus. Some patients with hand eczema wear occlusive gloves regularly; however, the effect of this on the density of S. aureus is unexplored. The aim of this study is to examine the effect of occlusive gloves on the density of S. aureus sampled from the hands of patients with hand eczema. In an experimental set-up, patients with moderate-to-severe hand eczema wore an occlusive glove on one hand for 4 h with a 30-min break. Bacterial swabs were collected from the most severe eczema lesion on the hand before and immediately after glove exposure. S. aureus colony-forming units were counted and log-transformations used for comparison of before- and after-values. Among 30 patients, 19 (63%) were colonized with S. aureus. After glove occlusion S. aureus colony-forming units increased by a factor of 1.72 (p < 0.01). In conclusion, the density of sampled S. aureus on eczematous skin after prolonged wearing of occlusive gloves is greatly increased.

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.

Background: While Staphylococcus aureus (S. aureus) colonization has been thoroughly studied in atopic dermatitis (AD), where S. aureus is related to flares and considered a trigger factor, S. aureus colonization in hand eczema (HE) has only been sparsely studied., Objectives: To examine the 1-week prevalence of S. aureus colonization in HE patients, and its association with severity, HE subtype, AD, and nasal S. aureus colonization compared with healthy controls., Methods: In a case-control study of 50 adult HE patients and 50 healthy controls, bacterial swabs from lesional skin (patients only), non-lesional skin (dorsal hand), and the nasal cavity were sampled for culturing of S. aureus on days 1, 3, 5 and 8. Participants were characterized by demographics, AD, HE subtype, filaggrin gene mutation status, and HE severity., Results: Twenty-seven HE patients (54%) were colonized with S. aureus on the hand compared to one control (2%) (P < .01). Nasal S. aureus colonization was found in 72% of patients and 22% of controls (P < .01). For patients, S. aureus colonization on the hands was associated with an atopic HE subtype and HE severity (P = .01 and P < .01, respectively)., Conclusions: Both hand and nasal S. aureus colonization were highly prevalent among HE-patients and may have an impact on the persistence of HE., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

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: Several studies have assessed the effect of patient education regarding hand eczema (HE) severity and quality of life. Few studies, however, have evaluated patients' knowledge., Objectives: To examine knowledge of skin protection in HE patients following a guided talk, and to identify variables associated with knowledge., Methods: HE patients referred to the outpatient dermatological clinic, Bispebjerg Hospital, between January 2013 and July 2014 were offered a guided talk on HE prevention. HE severity and the Dermatology Life Quality Index (DLQI) score were assessed. A questionnaire comprising 10 questions about skin protection was sent 1 to 2.5 years later., Results: One hundred and twenty patients responded to the questionnaire (response 53.5%). The mean percentage of correct answers was 74.7%. Sixty per cent responded correctly to at least eight questions. Male sex, older age and education for >5 years were associated with a low level of knowledge. Education for 3 to 4 years (P = 0.045) was associated with a higher level of knowledge. No significant impact of previous/current atopic dermatitis, HE severity or previous information on skin protection was found with respect to level of knowledge., Conclusions: Females and patients with education for 3 to 4 years showed the highest level of knowledge, whereas males, older patients and patients with education for >5 years should be brought more into focus in skin protection programmes., (© 2019 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: 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.)

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: 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: It has been suggested that lifestyle factors such as smoking, overweight and stress may influence the prevalence and severity of hand eczema., Objectives: To investigate the association between lifestyle factors and hand eczema severity in a cohort of patients with work-related hand eczema., Methods: Individuals with work-related hand eczema notified in the period between June 2012 and November 2013 were included in this questionnaire-based cross-sectional study. Participants responded to a questionnaire including questions on lifestyle factors, as well as a photographic guide for assessment of severity of hand eczema and questions on quality of life., Results: A total of 773 individuals (546 women and 227 men) responded to the questionnaire and were included in the study. A strong association was found between tobacco smoking and hand eczema severity (p = 0.003), whereas no significant association was found for body weight and stress. Other factors linked to severe eczema were male sex and older age (p = 0.04 and p = 0.01, respectively), and wet work (p = 0.08)., Conclusion: The data from the present study strongly support an association between smoking and hand eczema severity. However, owing to the cross-sectional design of the study, no conclusion on causation can be drawn., (© 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: 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.)

Purpose: The aim of this study was to create a job-exposure matrix (JEM) for wet work. A JEM is a tool used to assess exposure to potential health hazards in occupational epidemiological studies. It can be used when counselling concerning job change/job choice, as a medico-legal tool when recognizing diseases as occupational and when planning interventions regarding prevention of, in this case, occupational hand eczema. Methods: The study population was based on results from national surveys on working environment performed by the National Research Centre for the Working Environment in Denmark in 2000, 2005, and 2010 (National Research Centre for the Working Environment). We assessed responses on questions regarding wet hands, glove wear and total wet work. For the JEM a cutoff of 2 h total wet work/day was chosen as the exposure measurement. The proportion of responses of 2 h total wet work/day in each profession is illustrated as a number between 0 and 1 equal to 0–100% of the responses. Results: Total wet work was most frequent among cleaners (domestic, office, and hotel cleaning), butchers and fishmongers, cooks, beauticians (hairdressers, barbers, related work) and health care workers (home-based personal workers, dentists, dental assistants). Regarding differences between sexes we found that indifferent of age and profession, women had 78% higher odds of having wet work. Conclusion: We found that wet work as an exposure varies among professions depending on whether wet hands or glove wear is assessed. A JEM is a useful tool to assess the extent of the exposure, wet work, independent of prior perceptions of classical wet work professions. [ABSTRACT FROM AUTHOR]