Hand dermatitis – differential diagnoses, diagnostics, and treatment options

Abstract

SummaryThe pathogenesis of hand dermatitis is multifactorial, and includes factors such as genetic predisposition and exposure. A high incidence rate is associated with female gender, contact allergy, atopic dermatitis, and wet work. The most important risk factors for the persistence of hand dermatitis include its extent, contact allergic or atopic etiology, childhood dermatitis, and early onset (before the age of 20). The cost of illness of hand dermatitis corresponds to this seen in moderate to severe psoriasis. The diagnostic workup of hand dermatitis and its differential diagnoses requires a detailed assessment of occupational and recreational exposure. In case of possible work-related triggers, early notification of the accident insurer should be sought (via the dermatologist's report). Exposure to a contact allergen is a contributing factor in one-half of all cases of hand dermatitis. It is therefore imperative that all patients with hand dermatitis persisting for more than three months undergo patch testing. Successful and sustainable treatment of hand dermatitis starts with the proper identification and elimination of individual triggers, including the substitution of identified contact allergens and irritants, as well as optimizing preventive measures. Graded therapy taking the clinical severity into account is essential. Validated instruments may be used to monitor therapeutic efficacy. IntroductionThe pathogenesis of hand dermatitis is multifactorial. Both genetic as well as environmental factors play a role in the development of hand dermatitis. Despite the small body surface area affected (maximum of 4 % according to the rule of nines [1]), hand dermatitis is marked by great economic and sociomedical significance, impacting all aspects of life [2]. Hand dermatitis represents the majority of occupational skin diseases. The present article summarizes current knowledge with respect to this pathogenetically and morphologically heterogeneous entity and its differential diagnoses, and provides practical information on diagnosis and treatment. Epidemiology Incidence and prevalence of hand dermatitisHand dermatitis is common. Based on an analysis of 36 studies on the prevalence of hand dermatitis, the average point prevalence in the general Analysis of seven studies revealed a mean incidence of 5.5 cases/1,000 personyears (9.6 in women, 4.0 in men) [3].The only population-based study on the prevalence of hand dermatitis conducted in Germany to date (random sample n = 2,500, response rate 72 %, age range 18-70 years) found a point prevalence of 3.4 % (95 % confidence interval [CI] 2.6-4.4 %) and a one-year prevalence of 6.4 % (95 % CI 5.3-7.7 %) in the Heidelberg area [4]. Risk factorsAtopic dermatitis, gender, age, contact allergy, and wet work Numerous studies, recently summarized in a review article, have investigated the incidence and risk factors of hand dermatitis: a high incidence is associated with female gender, contact allergies, atopic dermatitis, and wet work [3]. Atopic dermatitis has been id...

Dermatite de Contacto Alérgica em Profissionais de Saúde

“…19 Moreover, wet work and the irritant effect of some of these substances, also favours sensitization in hand dermatitis. 34 Interestingly, in our study there was no apparent relation between positive PT and atopy.…”

The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis

“…HE classification systems have been proposed comprising both morphological and aetiological factors . Similar to AD, the aetiopathogenesis of HE is complex, and while both genetic and environmental factors play a role, pivotal risk factors include female sex, a history of AD, contact allergy, as well as domestic and occupational irritant exposures …”

Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries

“…The most frequent manifestation of OSD is hand eczema of various aetiopathologies (irritant, contact allergic, atopic) . Only rarely triggered by a single cause, the majority of hand dermatitis cases is multifactorial . It is therefore necessary to identify all causative factors, and establish corresponding avoidance measures in order to achieve sustained improvement and resolution of OSD.…”