BACKGROUND: Topical corticosteroid phobia is associated with poor treatment adherence and is common among patients with skin disease. Knowledge about corticosteroid phobia and treatment adherence among patients with chronic hand eczema (CHE) is limited.
OBJECTIVE: Investigate patient-reported outcomes regarding topical corticosteroids (TCS), and their impact on treatment adherence in CHE patients.
METHODS: CHE patients from the Danish Skin Cohort answered a questionnaire including the Topical Corticosteroid Phobia (TOPICOP) scale and Medication Adherence Report Scale (MARS-5). Response rate was 69.2%.
RESULTS: Of 927 with CHE, 75.5% totally or almost agreed that TCS damage the skin, 48.9% totally or almost agreed that TCS would affect their future health and 36.3% reported some degree of fear of TCS even though they were unaware of any TCS-associated risks. Most patients (77.9%) always or often stop treatment as soon as possible while 54.8% always or often wait as long as possible before starting treatment. Overall, 38.8% reported that they had taken less medicine than prescribed and 54.0% had stopped treatment throughout a period. Treatment adherence decreased with increasing corticosteroid phobia (p=0.004).
CONCLUSIONS: TOPICOP has not been validated in CHE patients.
CONCLUSIONS: Corticosteroid phobia is common among CHE patients and negatively associated with treatment adherence.

Hand eczema is a common allergic disease characterized by a chronic relapsing course with a 15% lifetime prevalence. Human immunodeficiency virus-infected individuals have a higher risk of Staphylococcus aureus infection which is associated with the severity of hand eczema. Incidences of allergic diseases including hand eczema and chronic itch are higher in patients with human immunodeficiency virus. Pruritus is one of the most common symptoms in hand eczema, sometimes intractable pruritus provokes repeated scratching, picking, disfigurement, and can even worsen the lesion. Currently, there is no ideal treatment for hand eczema, the treatment of hand eczema in human immunodeficiency virus patients is even more difficult. Here, we present a case of recurrent and therapy-resistant hand eczema patients combined with Staphylococcus aureus infection, human immunodeficiency virus infection was better improved by being treated with topical ozone therapy.

暂无摘要。

Previously case reports showed dupilumab may benefit for hand eczema treatment, but relatively comprehensive assessments are lacking. A 45-year-old male with multiple severe vesicles, bullae and pustule on the palmar aspects of both hand and foot diagnosed dyshidrotic eczema by pathology was treated with dupilumab at an initial dose of 600 mg subcutaneously, followed by 300 mg every 2 weeks. The physician\'s assessment of the patient revealed an excellent response to the treatment with dupilumab; the lesions and symptoms achieved dramatic improvement on the third day, and at 6 weeks, the hands and feet became completely normal without relapse in the past 1.5 years of discontinuation. Systematic literature searches were performed, and 6 case reports, 5 case series, 2 prospective observational studies and 1 retrospective review with a total of 150 patients were identified to describing the evaluation of efficacy and safety of dupilumab treatment for hand and foot eczema. Dupilumab appears to be safe and well tolerated with clinical benefit in recalcitrant hand and foot eczema. Larger randomized controlled trials using validated outcome measures and detailed hand eczema type and population classification are needed before dupilumab can be applied in clinical settings.

OBJECTIVE: To explore the therapeutic effect of narrow-band UVB combined with compound clobetasol propionate on hand eczema patients.
METHODS: From June 2017 to June 2020, 102 patients with hand eczema in our hospital were recruited for this study and divided into group A (GA) and group B (GB). The 50 patients in GA were treated with narrow-band UVB irradiation only, and the 52 patients in GB were treated with compound clobetasol propionate in addition to the treatment administered to GA. The patients\' general data and therapeutic effects were observed in both groups. The adverse reactions were also observed during the treatment. The severity index scores (EASI) of the pruritus and eczema areas of the skin lesions were observed before and after the therapy. The IFN-γ and IL-4 levels in the serum were tested using ELISA. After the therapy, the quality of life and any recurrences within 3 months were observed in both groups.
RESULTS: There were no differences in the baseline data between the two groups (P>0.05). The curative effect in GB was better than it was in GA (P<0.05). The incidence of adverse reactions in GB was significantly lower than the incidence in GA (P<0.05). After the therapy, the EASI scores of the pruritus and eczema areas of the skin lesions in GB were significantly lower than they were in GA (P<0.05). After the therapy, the patients\' serum IFN-γ and IL-4 levels in GB were significantly better than they were in GA. After the therapy, the quality of life of the patients in GB was significantly higher than it was in in GA (P<0.05). After 3 months of therapy, the recurrence rate in GB was significantly lower than it was in GA (P<0.05).
CONCLUSIONS: Narrow-band UVB combined with compound clobetasol propionate is effective at treating patients with hand eczema, as it can effectively improve their clinical symptoms and is very safe.

UNASSIGNED: Healthcare workers are at high risk of developing hand eczema. This study aimed to investigate the association between occupational hygiene and self-reported hand eczema among nurses and doctors in Guangzhou.
UNASSIGNED: A cross-sectional study using a self-administrated questionnaire sent to 740 health care workers in two tertiary hospitals between 1st April and 1st July 2019 was conducted.
UNASSIGNED: In total, 521 healthcare workers responded (70.4%). The prevalence of self-reported hand eczema was 9.6% [95% confidence interval (CI): 7.1-12.1%], with 10.8% in nurses and 6.9% in doctors. According to multivariable logistic regression analysis, the prevalence was higher in those who were excessively exposed to hair dye (OR: 3.871, 95% CI: 1.106-13.549) and those having a history of food allergy were at 3.013 (95% CI: 1.314-6.907) times greater risk of having hand eczema than those who did not. The odds of having hand eczema were 4.863 (95% CI: 1.037-22.803) times greater in those who hand washed more than 50 times daily in comparison to those who washed hands less than 10 times per day. The symptoms of hand eczema were mild during the investigation period.
UNASSIGNED: Hand eczema is common among healthcare workers in Guangzhou. The prevention of hand eczema by educational programs is needed for Chinese healthcare workers.

Although a compromised epidermal permeability barrier can contribute to the development of contact dermatitis, whether subjects with hand eczema display abnormalities in baseline epidermal permeability barrier function in their uninvolved skin remains unknown. The aim of the present study was to assess epidermal permeability barrier function in subjects with and without hand eczema in clothing manufacturers. Upon approval by the institutional review board, volunteers were recruited from clothing manufacturers in Guangzhou City, China. An 11-item questionnaire was used to collect general data from the volunteers. The diagnoses of self-proclaimed hand eczema were further confirmed by a dermatologist. Epidermal biophysical properties, including transepidermal water loss (TEWL) rates, stratum corneum hydration and skin surface pH were measured on the flexural surface of the left forearm in all volunteers. Epidermal biophysical properties were compared among cohorts of subjects with active hand eczema, a prior history of hand eczema and without any history of hand eczema. A total of 650 questionnaires were collected from 462 females and 188 males, with a mean age of 36.7 ± 0.46 years (range 16-69 years; 95% CI 35.8-37.59). Thirty-five subjects (5.4%) currently had hand eczema, while 28 subjects (4.3%) reported a prior history of hand eczema that was inactive currently. The prevalence of hand eczema did not differ significantly between genders. Neither a prior personal nor a family history of allergies was associated with the prevalence of hand eczema, but certain occupations and frequent contact with disinfectants were independently associated with the prevalence of hand eczema. In the overall cohort, males displayed higher TEWL rates and stratum corneum hydration levels than did females. Both skin surface pH and TEWL rates differed significantly among normal controls and subjects with active hand eczema or a prior history of hand eczema (p < 0.05). In conclusion, the uninvolved skin site of subjects with hand eczema exhibits abnormalities in epidermal perme-ability barrier, supporting a pathogenic role of epidermal dysfunction in hand eczema. Whether subjects with hand eczema in other occupations also display altered epidermal function on uninvolved skin remains to be explored.

OBJECTIVE: To investigate whether the skin barrier function is impaired with regard to the pH value, water content, transepidermal water loss (TEWL), and the integrity of the stratum corneum, and whether the expression of caspase-14 is altered in moderate to severe chronic hand eczema (CHE).
METHODS: Thirty patients with moderate to severe CHE treated at our institute and 30 healthy volunteers were included in this study. The pH value, water content, TEWL, and the integrity of the stratum corneum were measured in all subjects.
RESULTS: Significantly increased pH value, decreased water content, elevated TEWL, and impaired integrity of the stratum corneum were observed in the lesional skin of CHE patients compared with the nonlesional skin of CHE patients and the normal skin of healthy volunteers. The expression of caspase-14 decreased in the lesional and nonlesional skin of CHE patients compared with the normal skin of healthy volunteers, especially prominent in the nonlesional skin. The mean optical density (OD) value of immunohistochemical staining for caspase-14 was significantly lower in the nonlesional skin than in the lesional skin and normal skin (p < 0.01 for both). Although the mean OD value was lower in the lesional skin than in the normal skin, the difference was not statistically significant (p > 0.05).
CONCLUSIONS: Skin barrier dysfunction indeed occurs in CHE patients, which may be related to mechanisms associated with a downregulated expression of caspase-14.

OBJECTIVE: This study aimed to evaluate the prevalence of hand eczema among nurses in northern China and to analyse associated risk factors.
METHODS: A retrospective self-reported questionnaire was designed and distributed to 1322 nurses who were selected from three regional hospitals. Risk factors related to hand eczema in nurses were analysed using multivariable logistic regression.
RESULTS: Hand eczema was present in 183/934 respondents (20%) and was not significantly associated with gender or workplace (P > 0.05). Factors such as the use of moisturiser (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.3-1.0) and not wearing impervious gloves (OR 0.5; 95% CI 0.3-0.7) were associated with lower odds of developing hand eczema. A personal (OR 5.7; 95% CI 3.9-8.2) and family history (OR 2.3; 95% CI 1.5-3.5) of atopy, washing hands more than 20 times per day (OR 1.6; 95% CI 1.1-2.4), and more years working as a nurse (OR 1.1; 95% CI 1.0-1.1) were associated with higher odds of developing hand eczema.
CONCLUSIONS: A personal and familial history of atopy, the prolonged use of impervious gloves, washing hands more than 20 times per day and more years in work as a nurse are all risk factors for increased hand eczema in nurses.

Chronic hand eczema (CHE) is a common skin disorder with frequent relapses, and its treatment comprises a challenge due to its uncertain etiology. In particular, certain cases of CHE exhibiting severe keratinization have a very poor response to various treatments. The Daivobet ointment, a complex product comprising calcipotriol and betamethasone, has been successfully used for the treatment of patients with plaque-type psoriasis for ~10 years; however, there are few reports on the effect of the ointment on other skin disorders of abnormal keratinization, such as eczema. The present study reported 3 cases of refractory hyperkeratotic eczema of the hand that did not respond to several treatments, but responded well to topical Daivobet treatment.