Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Nickel, chromate, formaldehyde, methyldibromo glutaronitrile and sesquiterpene lactone mix were allergens associated with the greatest severity of hand eczema. Patients with chromate allergy had the worst prognosis.

Hand eczema is a disease with a potentially profound effect on an individual's life in terms of daily ftmctioning and interpersonal relationships. Accordingly, methods for measuring health-related quality of life (QoL) are increasingly used to evaluate the effect of various treatments.In studies of skin diseases the most widely used dermatology-specific questionnaire is the Dermatology Life Quality Index (DLQI) (1). The various scales applied, in the context of skin diseases, were evaluated by Both et al.(2). Their paper, which evaluated the interpretability of the DLQI, revealed a need for reports concerning the minimal change of score that is relevant to the patients. A similar need was expressed in a review by Basra et al. (3).The aim of the present study was to explore potential factors related to a low health-related QoL among patients with hand eczema and to examine the responsiveness of the DLQI score to clinical changes. MATERIALS AND METHODSThe study involved six private clinics and three outpatient clinics at university hospitals. The study population comprised consecutive hand eczema patients, aged 18 years or older, referred with present hand eczema to one of the clinics and enrolled during the period January 2006 to February 2007. At the first consultation the clinical severity of hand eczema was assessed by the patients using a self-administered photographic guide (4). All patients were patch-tested with the European Baseline Series (5). In the case of exposure to other known allergens, additional patch tests were applied, for example the hairdressing series in hairdressers. Patients completed a self-administered questionnaire at the time of patch testing.Approximately 6 months later (median 7 months; range 4-15 months) patients received a questionnaire package by post, which included a follow-up questionnaire and a selfadministered photographic guide. The DLQI questions were included in both the baseline and the follow-up questionnaire (permission granted). A detailed description of the study cohort including a dropout analysis of the non-respondents has been published previously (6).The DLQI is a 10-item questionnaire covering six aspects of daily life experienced during the past week. It is calculated by summing the score, of each question, with a maximum score of 30 and a minimum score of 0; the higher the score, the greater the impairment in QoL (1). In this study cut-off points were made dichotomizing the DLQI total score into low QoL corresponding to the one-third of the cohort with the highest score (score 7-30) and a score < 7 identifying those with moderate to high QoL at baseline. By subtracting the DLQI score, the course from baseline to follow-up was defined as improved or unchanged/diminished QoL.The data from the DLQI questionnaires were analysed by non-parametric statistics, as the DLQI score of the cohort was not normally distributed (Kolmogorov-Smimov test, p < 0.001 ).The Wilcoxon signed-rank test was used to compare paired data, and the Mann-Whitney test or Kruskal-Wallis test wa...

A poorer prognosis of hand eczema was associated with longer delay before medical attention.