Management of chronic hand eczema

Abstract

Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the 'management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidencebased approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity. Without doubt, hand eczema (HE) is a very common dermatological condition that often has a high impact on the affected individual and the society. HE is not a uniform disease and varies because of aetiology, severity, and morphology. Although different treatment options exist, the management of patients with chronic HE is often unsatisfactory. In this article, we briefly review the epidemiology, the burden of chronic HE, its classification and diagnostic procedures, and the current status of treatment options. Epidemiology of HEEczema is the most frequent dermatosis affecting the hands. Clinically, HE is characterized by signs of erythema, vesicles, papules, scaling, fissures, hyperkeratosis, and symptoms of itch and pain. If also mild cases are included, the 1-year prevalence of HE is estimated to be up to 10% in the general population (1, 2). About 50% of all patients with hand dermatitis seek dermatological treatment, and about 5% of those are on sick leave from work (3). The proportion of chronic severe HE is estimated to be 5-7% in all patients with HE and those who are refractory to topical treatment are estimated to represent 2-4%. If inability to work is taken as a parameter of severity, 15% of HE cases result in an exclusion from the labour market (4). In most studies, the prevalence among women is higher than among men. Recent results indicate that the high frequency of HE in women in comparison with men is caused by environmental and not genetic factors (5). The increased risk for women to develop HE seems to be present in the age group 20-29 years only, while no increased risk for women is present beyond the age of 30 years (6). Based on a retrospective questionnaire study, the annual incidence of HE is estimated at 5 per 1000 (6). The incidence of notified (i.e. usually more severe) occupation-related cases is estimated to be above 0.7 people per 1000 per year (7). However, the prevalence of work-related HE is underreported and might be 30-50 times higher (8). Among certain occupational groups engaged in wet work or exposed to irritant and/or allergic substances such as hairdressers, cooks, health care workers, metal industry workers, cleaners etc., the 1-year pre...

Alitretinoin in treatment of chronic hand eczema – mechanism of action

“…retinoid X receptors -RXR), z których każdy występuje w różnych izoformach (α, β, g). Główną rolą RAR jest regulacja podziału i róż-nicowania komórki, podczas gdy RXR odpowiada za kontrolowanie apoptozy [2,17]. Alitretynoina wykazuje powinowactwo do obu receptorów jądrowych, jednak wykazano jej wyższe powinowactwo do RAR i w związku z tym bierze ona prawdopodobnie udział w regulacji apoptozy i hamowaniu proliferacji komórek [2].…”

“…Wyprysk dotyczy częściej kobiet [1]. Ostre zmiany u około 5-7% pacjentów przechodzą w formę przewlekłą, trwającą ponad 6 miesięcy, wyjątkowo oporną na leczenie [2]. W badaniach wykazano częsty wpływ warunków środowiska pracy na rozwój tej dermatozy.…”

Tratamiento del eccema de manos

“…Sin embargo, no existe tratamiento satisfactorio para el eccema de manos crónico severo (5-7%) o el refractario al tratamiento tópico (2-4%) 9 .…”

“…A pesar de la amplia disponibilidad de tratamientos sistémicos, se ha visto que son capaces de inducir remisiones temporales, pero no llegan a controlar la enfermedad a largo plazo 9 .…”

Alitretinoin for the treatment of severe chronic hand eczema

“…3 Management of hand eczema includes avoidance of allergens and irritants, skin protection measures and use of topical corticosteroids where necessary. Patients with chronic disease may require treatment with the most potent steroid preparations available because drug penetration is impaired by significant hyperkeratosis of the hands.…”