Development of a Conceptual Model of Chronic Hand Eczema (CHE) Based on Qualitative Interviews with Patients and Expert Dermatologists

Abstract

Introduction: Chronic hand eczema (CHE) is a relapsing inflammatory dermatologic disease. Signs and symptoms can have a significant impact on patients' health-related quality of life (HRQoL). The aim of this study is to characterize the core signs, symptoms and impacts of CHE to develop a conceptual model. Methods: A structured literature search and qualitative interviews with 20 adult CHE patients in the US and 5 expert dermatologists were conducted to explore the patient experience of CHE signs, symptoms and impacts. Findings were used to support the development of a conceptual model. Results: There was a paucity of CHE qualitative research in the literature, supporting the need for the prospective qualitative research. The primary signs and symptoms identified from the literature review and interviews included itch, dryness, cracking, pain, thickened skin and bleeding. The most salient impacts included embarrassment and appearance concerns, frustration, impacts on work and sleep disturbance. Saturation was achieved for all signs, symptoms and impact concepts. Conclusions: Findings from this literature review and in-depth qualitative interviews supported the development of a comprehensive conceptual model documenting the signs, symptoms and impacts relevant to CHE patients. Such a model is of considerable value given the lack of existing studies in the literature focused on the qualitative exploration of the CHE patient experience. Limitations included the patient sample being only from the US and not including some CHE subtypes.

Patients' perspectives on quality of care for chronic hand eczema: A qualitative study

“…The topic guide was created to cover important domains based on existing literature and expert opinion. To prepare the topic guide, the recommendations of the guidelines, as published by the guidelines development group of the European Society of contact dermatitis, for diagnoses, prevention, and treatment of hand eczema were used, 14 together with a conceptual model of CHE 15 . The conceptual model of CHE was based on a literature search and qualitative interviews with patients and expert dermatologists and includes core signs, symptoms, and impact of CHE.…”

“…Several aspects of the conceptual model can serve as indicators of quality of care. Part of this model was used to create the topic guide (especially the part on the impact of CHE) 15 . In addition, relevant parts of a previous qualitative study in patients with CHE by Mollerup et al investigating the knowledge, attitudes, and behaviour in daily life of patients with CHE, were used 5 .…”

The pan‐JAK inhibitor delgocitinib in a cream formulation demonstrates dose response in chronic hand eczema in a 16‐week randomized phase IIb trial*

“…2,5 CHE is associated with high physical, psychological, occupational and socioeconomic burden. [11][12][13][14][15] No topical treatment has been specifically developed and approved for CHE. 4 Potent topical corticosteroids (TCS) are commonly used, but long-term use may be associated with atrophy and impairment of skin barrier, in turn preventing resolution.…”

Die (neue) Berufskrankheit Nr. 5101: „Schwere oder wiederholt rückfällige Hauterkrankungen“

“…Hinsichtlich der Ätiologie werden das atopische, kumulativ‐subtoxische/irritative und kontaktallergische Handekzem differenziert sowie die seltene Sonderform der Proteinkontaktdermatitis, wobei häufig eine Kombination verschiedener Ätiologien vorliegt; morphologisch kann es sich dyshidrosiform, hyperkeratotisch‐rhagadiform und nummulär darstellen [8]. Dabei kann die gleiche Morphe in unterschiedlicher Ausdehnung auftreten, was sich durch die Beteiligung einzelner Finger bis hin zur Beteiligung aller Finger zeigt [10] und dabei sowohl die dorsalen Hände als auch die Palmae betreffen kann [11]. Ebenso kann die Morphe im Hinblick auf die Schwere stark variieren, sodass Hauterscheinungen ohne subjektive Einschränkung auszumachen sind, bis hin zu ausgeprägter subjektiver Einschränkung mit beispielsweiser schwerer juckender Rhagaden‐ und Blasenbildung.…”