Severe chronic hand eczema is a disease whose symptoms are localized to that part of the body that is visible and necessary for daily functioning. Severe chronic hand eczema causes great discomfort related to pain, insomnia, itching and a burning sensation, often excluding from personal, social and professional life. Fear of meeting, shaking hands, rejection or losing a job - these are common fears of people with severe chronic hand eczema.

Contents:

  1. Severe chronic hand eczema - causes, types
  2. Severe chronic hand eczema - risk groups
  3. Severe chronic hand eczema - symptoms
  4. Severe chronic hand eczema - diagnosis
  5. Severe chronic hand eczema - treatment
  6. Severe chronic hand eczema - the social effects
  7. Severe chronic hand eczema - economic effects

Severe chronic hand eczemarefractory chronic hand eczema (SR-CHE) is persistent (lasting more than 3 months or recurring 2 or more times a day). year), not related to infection, inflammation of the skin of the hands.

It includes cases of high intensity of lesions, with the presence of inflammatory infiltration, lichenification (thickening, darkening of the skin, deepened furrowing) and cracks in the epidermis, it covers a large area and - as already mentioned - is resistant to treatment with local glucocorticosteroids.

For hand eczema to be considered resistant to treatment, treatment with very potent topical corticosteroids must last 1 month.

SR-CHE is the most advanced form of hand eczema (HE), accounting for 5-7% of the all cases of HE.¹

Based on epidemiological indicators from 2022, it is estimated that there are approximately 2,490 adults living with SR-CHE in Poland .¹

In the light of the above estimate, the only data available in Poland, published by the Institute of Occupational Medicine Prof. J. Nofera in Łódź, they are most likely underestimated. The number of patients with occupational skin disease proposed by IMP is 65 in 2016.¹

The mean age of SR-CHE patients is 49 years, with the mean age of diagnosis being 46. According toexperts 61% of patients are women (range 50% to 70%).

The disease usually lasts from 3 to 7 years, however, it takes an average of 4 years (from one to 8 years) from the onset of the first symptoms to the correct diagnosis .¹

Severe chronic hand eczema - causes, types

This skin disease can be triggered by:

1. skin damage from irritation (irritation contact dermatitis)

Occupational or home skin exposure to humid conditions, excessive contact with water or frequent irritants, such as detergents, organic solvents or cutting fluids, predispose to the development of the disease. Sweat can also be an irritant.

Hand eczema is conditioned by genetic, environmental (allergenic and irritating) factors and atopy. These causes may coexist or change with the course of the disease.

2. contact allergy (allergic contact dermatitis)

Important allergens in the development of the disease are metals, gums, glues, preservatives, dyes or plant allergens that can penetrate the skin. Also, latex or dietary proteins are important in the development of allergic contact dermatitis.

3. atopy (atopic hand eczema)

Atopy is considered to be a major individual risk factor for the development and persistence of chronic hand eczema, and may affect approximately one-third to half of those struggling with this condition .²

It is worth knowing that foot involvement is considered a new criterion for distinguishing CHE subtypes. If foot involvement was observed in patients without contact allergy, atopy, or damage from sole irritation, it was a criterion for the diagnosis of idiopathic CHE (i.e., of unknown cause), regardless of a history of hand exposure to irritants.

Worth knowing

Among the most common factors causing hand eczema, experts mention: organic acids, building materials, industrial rubber products, cosmetics, poor care, cleaning agents and household chemicals, occupational factors (metals and their compounds, metacrylins, adhesives, paints, contact with lubricants, metalworking coolants, oils, photographic reagents, dental materials, frequent hand washing), secondary allergy in the course of mycosis in a different location, primary skin irritating / allergenic factors, parts of plants, endogenous factors.

Severe chronic hand eczema - risk groups

The highest annual incidence is observed among cleaning professionals (21.3%) and medical workers (15.9%). The length is decisiveexposure to water, detergents, chemicals and disinfectants .¹

Over 60% are currently working patients (especially hairdressers, beauticians, office workers, catering workers, nurses and other he althcare workers, steel workers, electricians and mechanics) .¹

Worth knowing

Breakdown of eczema by duration and recurrence:

  • spicy and sub-spicy - lasts less than 3 months and does not occur more than once a year
  • chronic (CHE) - lasts more than 3 months or recurs 2 or more times a year

Breakdown of eczema according to the severity of skin changes:

  • mild - quickly disappears under the influence of proper dermatological treatment and the patient's cooperation
  • of moderate intensity - may persist for several weeks despite proper treatment and patient cooperation
  • severe - includes cases of high intensity of changes, with the presence of inflammatory infiltration, lichenification and epidermal cracks, covers a large area (over 30%) and is resistant to treatment

Severe chronic hand eczema - symptoms

Chronic hand eczema is a condition with typical symptoms:

Chronic hand eczema can NOT be caught, e.g. by shaking hands with a sick person.

  • blush
  • inflammatory infiltrate
  • exfoliating
  • swelling
  • bubbles
  • hyperkeratosis (hyperkeratosis of the epidermis)
  • erosions
  • cracks in the epidermis

Skin lesions can cause itching, pain, and insomnia.

Severe chronic hand eczema refractory to glucocorticoid treatment - as already mentioned - includes cases of high intensity of lesions, with the presence of inflammatory infiltrate, lichenification and epidermal cracks, it covers a large area (over 30%).

According to an expertprof. dr hab. n med. Beata Kręcisz, head of the Dermatology Clinic of the Provincial Complex Hospital in Kielce

Severe chronic hand eczema and patients' quality of life

Chronic hand eczema significantly affects the quality and state of life of patients. The situation of patients depends on the severity of the eczema. If the changes are intense, they often make it impossible to continue working, because they may be deep clefts that occur mainly on the palms and dorsal surfaces of the hands, limiting the mobility of the hand. This disease significantly reduces the quality of life, is the cause of stigmatization, and also causes various types of troublesome ailments - from itching to burning skin, and often pain.

Severe chronichand eczema - diagnosis

In order to make an accurate diagnosis, you need a history (including possible exposure to irritants, allergens or a tendency to atopy) and laboratory tests - results of skin patch and point tests, IgE concentration, foot involvement and clinical picture of changes.

  • ALLERGY TESTS - when to do allergy tests and what kind of allergy test to take

Severe chronic hand eczema - treatment

The basis of the procedure is to try to eliminate the putative triggering factor. The most important thing is that this factor is detected as soon as possible, and thus the treatment is started as soon as possible.

However, due to the multifactorial, not fully understood etiology, it is often difficult or impossible, and the disease takes a chronic and relapsing course .²

The patient should be informed about the important role of emollients and the protection of the hand skin against irritants.

The difficulty in diagnosing the disease is also caused to a large extent by the embarrassment of the patients.

There are many treatment options for treatment. Topical glucocorticosteroids (line 1 of treatment) are used first.

If they do not help, the following applies: calcineurin inhibitors, phototherapy, immunosuppressants. There is treatment that is often unsatisfactory due to a lack of a satisfactory result or side effects .²

In addition, Polish patients with severe chronic hand eczema have limited access to effective therapy due to its cost, unlike in other countries, where drugs for patients with unresponsive hand eczema are reimbursed from the state budget.

According to an expertprof. dr hab. n med. Beata Kręcisz, head of the Dermatology Clinic of the Provincial Complex Hospital in Kielce

The Polish system can offer medical care and diagnostics. However, it should be remembered that diagnosis for hand allergic contact eczema is usually performed many years later. Moreover, the National He alth Fund does not reimburse the full diagnosis of contact eczema. Currently, only a short series of ten allergens is reimbursed, which is completely inadequate.

It should be remembered that chronic eczema is not only allergic dermatitis, but also irritation contact dermatitis or endogenous eczema. To differentiate this, patch tests need to be performed, sometimes you need to take a slice for histopathological examination and finally think about the cause of these eczema changes.

Without determining the factorcausation, it is very difficult to effectively lead the patient and prevent recurrences, as it may be an irritant reaction caused, among others, by working conditions. Without a clear and early diagnosis, therapeutic success is severely limited.

Severe chronic hand eczema - the social effects

From the report "The disease is in the palm of your hand. Consequences of chronic hand eczema for the patient, society and the entire he alth system ”³ prepared by the Arcana Institute on behalf of GSK, we learn that as many as 81% of the surveyed patients avoid physical contact with others (e.g. they avoid shaking hands).

Nearly 1/3 of respondents believe that the disease affects the quality of relationships with a partner. The same number of people believed that the disease causes tensions and misunderstandings with the immediate environment.

Patients very often feel the need to cover the affected skin. Some of them are wearing gloves, others are hiding their hands in their pockets.

These people are usually withdrawn, avoid contact with others, and very often feel increasing frustration. The disease can also cause depression or alienation from the environment.

  • Mental problems may be related to skin conditions

There are also situations in which the patient begins to abuse alcohol or psychoactive substances to reduce suffering.

People with chronic hand eczema are more sensitive in social contacts, experience greater discomfort, are more shy, but also explosive and react with anger more often - emphasizes psychologist Anna Kędzierska, co-author of the report.

  • Psychodermatology - psychological support for people with skin diseases

Severe chronic hand eczema - economic effects

The disease is associated with reduced productivity and often forces you to quit your profession and increases socio-economic problems.

The authors of the report emphasize that among patients with severe chronic hand eczema, the average number of days of absence from work is approximately 47 days, and 40% of patients were on sick leave .³

Long-term struggle with the disease and its recurring nature cause more frequent sick leave, and ultimately - even loss of job.

Additionally, about 30% of patients are not sufficiently independent in their daily life, and thus - require the support of their relatives in carrying out their daily duties .³

These factors are related to the total loss from PLN 4,781.33 to PLN 10,225.58 of GDP per working patient with severe chronic hand eczema per year, resulting from absenteeismrelated to the disease - as emphasized by the authors of the report .³

Bibliography:

1. Arcana Institute Report “The disease is in the palm of your hand. Consequences of chronic hand eczema for the patient, society and the entire he alth system ", December 2022.

2. Molin S., Diepgen T.L., Ruzicka T., Prinz J.C., The algorithm for the diagnosis of chronic hand eczema: an aid in classification in clinical practice, "Dermatology after Diploma" 2012, vol. 3, no. 2

3. Batycka-Baran1 A., Baran W., Szepietowski1 J., Treatment of chronic hand eczema, "Postępy Dermatologii i Allergologii" 2009, No. 2

Category:

Dermatology