Management of Atopic Hand Dermatitis.

Atopic hand dermatitis (AHD), a manifestation of atopic dermatitis, can have a profound negative effect on a patient's disease-related quality of life due to its visibility, chronic nature, and overall discomfort that it causes. AHD differs from other forms of chronic hand eczema due to its likely distinct, complex pathogenesis, which is a combination of environmental triggers, genetic predisposition, and immune dysfunction. A proper diagnosis of AHD is made through clinical evaluation and the ability to establish subtle clinical differences between AHD and other conditions. Diagnosis is the first step to a treatment plan that diverges from a one-size-fits-all approach.

The correlation between self-reported hand eczema and clinically based diagnosis in professional cleaners.

BACKGROUND: Most studies investigating the prevalence of hand eczema (HE) in professional cleaners use self-reported questionnaire-based data. However, no validation studies of self-reporting of HE among professional cleaners have previously been conducted. OBJECTIVES: To investigate (1) the point prevalence of self-reported HE, (2) the point prevalence of HE estimated by physical examination of the hands and (3) the sensitivity and specificity of self-reporting of HE compared with the diagnosis based on physical examination among professional cleaners. METHODS: Professional cleaners at three different hospitals in Region Zealand were invited to fill out a questionnaire. The point prevalence of self-reported HE was estimated based on questions from the Nordic Occupational Skin Questionnaire. After completing the questionnaire, each cleaner underwent a physical examination of the hands by a dermatologist on the same day. RESULTS: In total, 234 cleaners were invited to participate in the study, and 224 (response rate = 96.0%) agreed to take part. Based on the self-reported questionnaires, 5.3% (n = 12) of the cleaners had current HE. Based on an examination by a physician, 19.2% (n = 43) of the cleaners had current HE. The sensitivity of self-reported HE was found to be 28.0%, while the specificity was found to be 100.0%. The positive predictive value was found to be 100.0%, while the negative predictive value was 85.0%. CONCLUSION: The true point prevalence of HE among professional cleaners is underestimated when based on self-reporting.

Prevalence and risk factors for onychomycosis in acute care dermatology wards.

We conducted a cross-sectional study on the clinical and mycological features of onychomycosis in patients in the dermatology ward of Iwate Medical University Hospital, an acute care hospital. Of the 226 hospitalized patients, 73 (32.3%) had onychomycosis and 61 (26.9%) were diagnosed after admission. The toenail was the most common site of onychomycosis (94.5%), while toenail plus fingernail and fingernail only sites were 4.1% and 1.4%, respectively. The most common clinical form of onychomycosis was distal and lateral subungual onychomycosis (79%) with Trichophyton rubrum (66.7%) and T. interdigitale (27.8%) as the main causative species. Patients who were older, or had neurological diseases, or needed stretcher transfer had onychomycosis significantly more frequently than those who were obese, had diabetes, cancer, needed an escort for moving, or could move independently. Our study suggests that there is likely to be a significant number of untreated and undiagnosed patients with onychomycosis in acute care hospitals. Therefore, it is necessary to increase awareness of onychomycosis in hospitals.

Symmetrical plaques on the dorsum of hands - a clinicopathological challenge.

A 60-year-old female with diabetes and hypothyroidism presented with a 2-year history of asymptomatic elevated lesions on the dorsum of her hands.

Professional Cleaners' and Healthcare Workers' Ability to Recognize Hand Eczema.

Timely intervention reduces the risk of a poor prognosis in hand eczema, making early recognition of symptoms important in high-risk professions. However, limited data exist regarding the ability of cleaners and healthcare workers to recognize hand eczema. The aim of this study was to examine cleaners' and healthcare workers' ability to recognize hand eczema in clinical photographs and to assess the severity of the disease. Cleaners and healthcare workers completed a questionnaire consisting of 16 questions and participated in a structured interview referring to a validated photographic severity guide for chronic hand eczema, which comprised clinical photographs of hand eczema at varying levels of severity. Eighty cleaners and 201 healthcare workers (total N = 281) participated in the study. The rates of correctly identified hand eczema in clinical photographs (cleaners/ healthcare workers) were: 41.2%/57.7% (mild hand eczema), 81.2%/92.0% (moderate hand eczema), 85.0%/94.5% (severe hand eczema) and 82.5%/97.0% (very severe hand eczema). The proficiency of healthcare workers in recognizing hand eczema was significantly higher than that of cleaners. The results indicate that a large proportion of cleaners and healthcare workers fail to recognize mild hand eczema in clinical photographs. Healthcare workers had higher success rates in recognizing hand eczema in all severity categories. Symptom underestimation may lead to under-reporting of the true prevalence of hand eczema, with consequent loss of opportunities for prevention.