Relationship between Hand Eczema Severity and Occupational Stress: A Cross-Sectional Study

Abstract

Background Stress has been recently implicated as a contributing factor of hand eczema (HE) severity. However, published data are both rare and contradictory justifying the need of further research. The purpose of this study was to evaluate the relation between stress and HE severity. Methods This is a cross-sectional study enrolling all patients who have been attending the Dermato-allergology unit of Farhat Hached University Hospital of Sousse over a period of one year. The HE severity was assessed by the Osnabrück Hand Eczema Severity Index (OHSI). The stress level was assessed by the Perceived Stress Scale-10 (PSS-10) in its validated Arabic version. Results During the study period, 109 participants meeting the inclusion criteria were identified. The mean age was 40 ± 9.9 years with a sex-ratio of 0.8. Severe eczema was found in 76 participants (69.7%). A high level of perceived stress was found in 18.3% of cases. A statistically significant association was noted between HE severity and the high level of perceived stress (p=0.039, OR = 4.46, 95% CI [0.96–20.59]) and the number of dependent children ≥3 (p=0.0039, OR = 1.92, 95% CI [0.51–7.22]). Leisure activity was found to be a protective factor against HE severity (p=0.031, OR = 0.27, 95% CI [0.09–0.80]). Conclusion Although the link between the severity of eczema and atopy, wet work, and contact with irritants and allergens is well known, the relation remains questionable for other factors including stress.

Therapeutic considerations related to stress levels associated with hand eczema: A c linico‐etiological study

“…Although with some differences, most studies 3,15,20 Studies have shown that severity of hand eczema and frequency of eruption correlated directly with decreased quality of life. 21,22 In these studies, stress levels of patients presenting with hand eczema 10 had studied the role of stress and had noted a statistically significant association between hand eczema severity and high levels of stress. In a questionnaire-based survey, Anveden et al, 12 had studied the role of stress and it was found that hand eczema was more common among individuals who reported stress.…”

“…It is known to have established and acceptable psychometric properties. 13,14,25,26 Even though PSS has been widely used in dermatology in recent years, [27][28][29][30][31] except for the study by Hafsia et al, 10 it has not been used to assess the role of stress in cases of hand eczema, and hence is underutilised. In the present study, PSS scores was calculated for all the 62 participants and it was found that 42 (67.7%) of them had increased stress scores, of which 10 (6.1%)…”

“…In these studies, stress levels of patients presenting with hand eczema have not been exclusively studied, except as a part of Quality of life scores. Hafsia et al, 10 had studied the role of stress and had noted a statistically significant association between hand eczema severity and high levels of stress. In a questionnaire‐based survey, Anveden et al, 12 had studied the role of stress and it was found that hand eczema was more common among individuals who reported stress.…”

“…2 Psychologic stress is implicated as one of the contributory factors, but the results of studies are contradictory. [10][11][12] Hand eczema remains as a distressing condition for the patient and a difficult to treat disease for the dermatologist. A study on the clinical and etiological aspects of hand eczema with an assessment of the role of stress, may improve our understanding of this entity, which in turn may lead to better management.…”

“…Of the endogenous causes, atopic diathesis is the most common 2 . Psychologic stress is implicated as one of the contributory factors, but the results of studies are contradictory 10‐12 . Hand eczema remains as a distressing condition for the patient and a difficult to treat disease for the dermatologist.…”