Skin diseases among adults in Tasiilaq, East Greenland.

Cold climate and unique genetic and environmental factors may influence the prevalence of skin diseases in Greenland. However, there is a lack of epidemiological studies on skin diseases in the adult Greenlandic population. To address this unmet need a cross-sectional study, run by dermatologists from Denmark, the UK, and Switzerland estimated the prevalence and clinical manifestations of skin diseases among adults in East Greenland in May 2022. All adults ≥18 years in the town of Tasiilaq were invited, and 295 individuals aged 18-78 years participated (22.5% of the overall adult population in Tasiilaq). Two-hundred and three participants (69%) had visible signs of current skin disease, and among these, 242 cases of dermatoses were identified. The most common skin diseases were hand eczema (22.4%), lichen simplex (9.5%), discoid eczema (7.1%), psoriasis, atopic dermatitis and acne vulgaris (5.8% each). Scabies was the most frequent infectious skin disease (4.4%). No cases of skin cancer were identified. Atopic dermatitis and psoriasis presented with disease that was of limited extent and different from the classical presentations. Skin diseases showed a high prevalence among adults in East Greenland, and some of them were severe. This indicates a noteworthy public health problem that warrants better access to dermatologist support.

Assessment of Hypersensitivity to House Dust Mites in Selected Skin Diseases Using the Basophil Activation Test: A Preliminary Study.

Background and Objectives: Allergy to dust mites (HDMs) plays an important role in atopic dermatitis (AD). However, the role of this allergy in other dermatoses is little known. The aim of this study was to assess hypersensitivity to HDMs in patients with AD or hand disease using the basophil activation test. Material and Methods: A total of 52 patients with AD, 57 with hand eczema disease, and 68 healthy volunteers qualified for this study. Diagnosis was based on the Hanifin and Rajka criteria, dermatological assessment, and exclusion of other dermatoses. The participants underwent skin prick tests (SPTs), a basophil activation test (BAT) with D. pteronyssinus allergen extract, and the concentration of specific IgE (sIgE) for the same allergen in blood serum was determined. Results: Positive results in all tests (SPT, sIgE, and BAT) were obtained (24 (46.2%) patients with AD, 9 (15.8%) with hand disease, and none in the control group for p < 0.05). The results of the SPT, sIgE, and BAT correlated with each other in the AD and hand eczema groups (Spearmen correlation test, r = 0.72 or 0.85, p < 0.05). However, the BAT was positive more often than the SPT and sIgE for D. pteronyssinus. Conclusions: House dust mite hypersensitivity is common in patients with AD and eczema. The BAT may be more sensitive for assessing sensitization to house dust mites, especially in patients with hand eczema.

Risk factors that limit use of oral JAK inhibitors in chronic hand eczema: Findings from the Danish Skin Cohort.

Background: Oral Janus kinase inhibitors (JAKis) have black-box warnings of infections, cancer risk, and cardiovascular and venous thromboembolic events. They may be used off-label for chronic hand eczema (CHE). Objectives: Assess the prevalence of risk factors potentially impacting oral JAKi safety in CHE patients. Methods: In the Danish Skin Cohort, CHE patients were examined for risk factors affecting oral JAKi use at baseline and followed for 12 months. Data were collected through register linkage (eg, cancer history) and through patient interviews (eg, smoking habits). Results: Of 941 adults with CHE (66.2% women; mean age 55.5 [SD 13.3] years), 768 (81.6%) patients had at least one risk factor potentially impacting oral JAKi use, of which 682 (72.5%) had nonmodifiable risk factors. Most common risk factors were current or former heavy smoking (62.8%, n = 591), obesity (28.1%, n = 264), hypercholesterolemia (21.5%, n = 202), and hypertension (18.8%, n = 177). Among patients without any risk factors at baseline (n = 173), 20.2% (n = 35) developed ≥1 risk factor during the following 12 months. Limitations: Certain risk factors may be underreported. Conclusion: Most CHE patients have risk factors limiting appropriateness of oral JAKi use. Health care providers should assess risk factors in their patients when choosing treatment for CHE.

COVID-19-Related Risk Factors for Developing Occupational Contact Dermatitis Along With Its Incidence, Prevention, and Management: A Systematic Review.

Occupational contact dermatitis (OCD) is an eczematous local inflammatory skin irritation caused by repeated use of hand sanitizer and other chemical substances. Occupational irritant contact dermatitis (OICD) and occupational allergic contact dermatitis (OACD) are the two variants of CD that cannot be identified clinically. Hand dermatitis (HD) is typically assessed as a clinical consequence because it affects the hands most frequently at work as per epidemiological studies on OCD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were followed when conducting this umbrella review. We used the search terms "Occupational Contact Dermatitis AND COVID-19" to search for the most pertinent papers in full text on the databases PubMed/MedLine, ScienceDirect, and PubMed Central (PMC). Additionally, the reference section of the papers was used to find more articles. A total of 11,646 results were found, and eight papers remained after applying the inclusion criteria (full-text papers, English language, studies published in the previous 10 years, involving humans, and only systematic reviews). After completing the title and abstract screening, we obtained five papers. Next, the full-text screening and AMSTAR quality check were completed, yielding the same five papers. After searching ScienceDirect, five papers that met the inclusion criteria were included, and six papers were selected from the references, yielding a total of 11 papers. The causes of occupational dermatitis from protective face masks are discussed in this review. We anticipate an increase in the incidence of occupational dermatitis linked to face mask use given that a large segment of healthcare workers (HCWs) wear protective face masks. To understand the prevalence and available therapies for mask-related occupational dermatitis, further well-designed research is required.

Hand Eczema. Part 1: epidemiology, pathogenesis, diagnosis and work-up.

Hand eczema (HE), also referred to as hand dermatitis, is a frequent medical condition that can have an important negative impact on quality of life. Occupational HE is an important cause of medical disability. Multiple inflammatory pathways are upregulated, and barrier genes are downregulated in HE. Atopic dermatitis and wet work are two important risk factors for HE. Clinical presentation can be variable and location of may comprise palmar and dorsal aspects, fingers, fingertips and wrists of one or both hands. Work-up is directed at identifying causative factors and excluding other diagnoses. The first article of this CME series focuses on epidemiology, etiopathogenesis, differential diagnosis, work-up and patch testing.

Hand Eczema. Part 2: Prevention, management, and treatment.

Prevention methods are important for patients with hand eczema (HE), especially those with risk factors. Frequent use of moisturizers is encouraged. Few drugs have been approved specifically for HE. Topical corticosteroids remain the mainstay treatment. Several new topical and systemic drugs are currently in development for HE. Dupilumab has recently been shown effective for chronic HE. Established criteria can be used to help determine causality for occupational HE, which is important for worker's compensation. The second article of this CME series discusses prevention, management, treatment and worker's compensation for HE.

Treatment of chronic hand eczema with topical anti-inflammatory drugs other than topical corticosteroids.

Chronic hand eczema is a fluctuating, inflammatory, pruritic disease of the hands and wrists that is commonly treated with topical corticosteroids and emollients. In a recent report in The Lancet, Bissonnette et al. demonstrated that delgocitinib cream showed superior efficacy versus a cream vehicle and was well tolerated over 16 weeks in adults with moderate to severe chronic hand eczema.

Th1 and Th2 cytokine expression in hyperkeratotic chronic hand eczema and the role of Tofacitinib a oral JAK inhibitor.

Tissue cytokines in chronic hand eczema (CHE) can predict targeted therapy with novel drugs including JAK inhibitors. Our primary objective was to assess the tissue expression of cytokines of Th1 and Th2 cell lines in CHE patients and to study the efficacy of oral tofacitinib. We recruited patients presenting with recalcitrant CHE. Lesional and non-lesional tissue samples were assessed for Th1(IFN-γ, TNF-α) and Th2 related cytokines (IL-4, IL-13, IL-2,) using real time PCR. Tofacitinib 5 mg twice daily was initiated with 4 weekly assessment and we also noted relapses post therapy.Of 21 refractory hyperkeratotic CHE patients, cytokine analysis was performed in 11 patients which showed upregulation of IL-4 [n = 5/11, 1.87-fold increase], TNF-α (n = 5/11, 5.13-fold) and IFN-γ (n = 6/11, 1.98-fold) as compared to uninvolved skin. All patients (100%) had used topical corticosteroids (TCS) and 4/21 (19%) had failed methotrexate and 2/21 (9.5%) had failed acitretin. Tofacitinib 5 mg twice daily was given in 15/21 patients. The mean time to achieve hand eczema severity index 90 (HECSI 90) was 4 weeks (mean duration of treatment:5.8 months, n = 12). Side effects were observed in 4/12 (33.3%) patients and relapse was noted in 3/12 (25%) patients after a mean duration of 7 months after discontinuation of tofacitinib. Tofacitinib (pan-JAK inhibitor) showed an excellent response in refractory CHE patients with predominant tissue Th1/Th2 cells related cytokine expression.

Development and Validation of a Patient-Reported Outcome Measure of the Impact of Chronic Hand Eczema on Health-Related Quality of Life: the Hand Eczema Impact Scale (HEIS).

INTRODUCTION: Chronic Hand Eczema (CHE) is an inflammatory skin disease that causes significant impact on health-related quality of life (HRQoL). The Hand Eczema Impact Scale (HEIS) is a new patient-reported outcome (PRO) measure designed to assess the impact of CHE on key domains of HRQoL. This study aimed to develop and evaluate content and psychometric validity of the HEIS. METHODS: The HEIS was initially developed on the basis of a literature review and concept elicitation interviews. Qualitative cognitive debriefing interviews (n = 20) were conducted with patients with CHE to assess relevance and understanding of items, response options, and recall period. Psychometric properties (item performance, dimensionality, reliability, validity, responsiveness, and estimation of meaningful change thresholds) were then assessed using data (n = 258) from a phase 2b trial (NCT03683719). RESULTS: Cognitive debriefing confirmed all items were understood and relevant to patients. Inter-item correlations (all > 0.50) and confirmatory factor analysis (factor loadings ≥ 0.80) supported unidimensionality of the HEIS score, and mostly provided support for the HEIS Proximal Daily Activity Limitations (PDAL) score, with only one item loading below the prespecified threshold. Item properties and previous qualitative work supported retaining this item in the total score but removed from the HEIS PDAL domain. Internal consistency (Cronbach's alpha ≥ 0.89) and test-retest reliability (intra-class correlation coefficient ≥ 0.79) results were very strong. Strong correlations with concurrent measures (0.66-0.87) and significant differences between severity groups (p < 0.001) supported construct validity. Large effect sizes for mean change scores in participants that improved and significant differences between groups indicated ability to detect change. Anchor-based analyses supported within-individual responder definitions of ≥ 1.3 points for improvements in both HEIS score and HEIS PDAL score (covering three items) and of ≥ 1.5 points for HEIS embarrassment with the appearance of hands (Emb) score (covering two items). CONCLUSIONS: The 9-item HEIS is the first CHE-specific PRO measure developed and validated according to regulatory guidance for assessment of the impact of CHE on key domains of HRQoL. This article provides evidence of strong content and psychometric validity and shows improvements of ≥ 1.3 points in HEIS score and HEIS PDAL score, and improvements of ≥ 1.5 points in HEIS Emb score represent clinically meaningful, important changes. TRIAL REGISTRATION: NCT03683719.

Evaluation of validity, reliability and ability to detect change for the Hand Eczema Severity Index (HECSI) and evaluation of HECSI-75 and HECSI-90 as within-patient responder definitions.

BACKGROUND: The Hand Eczema Severity Index (HECSI) is a Clinician-Reported Outcome measure of the severity of hand eczema (HE). OBJECTIVES: This study aimed to evaluate the validity, reliability and ability to detect change of the HECSI, and the HECSI-75 and HECSI-90 as responder definitions. METHODS: Analyses were performed using data from a sample of n = 258 patients with Chronic Hand Eczema (CHE) from a Phase 2b, randomised, double-blind, vehicle-controlled trial of delgocitinib cream, pooled across treatment groups. The measurement properties of the HECSI were assessed and the adequacy of the HECSI-75 and HECSI-90 as responder definitions was explored through cross-tabulation. RESULTS: Inter-item correlations provided support for the scoring, whereby items are grouped by areas of the hand. HECSI demonstrated good test-retest reliability with intra-class correlations >0.70. Construct validity was supported by a logical pattern of correlations with concurrent measures and significant differences in HECSI scores across severity groups (p < 0.001). HECSI was responsive with statistically significant improvements over time and with significant differences (p < 0.001) between improved and stable groups. Data provided support for both HECSI-75 and HECSI-90 as within-patient responder definitions. CONCLUSIONS: HECSI has strong validity, reliability and ability to detect change as a measure of CHE severity. HECSI-75 and HECSI-90 are appropriate responder definitions.

Atopic dermatitis and hand eczema in Danish adults: A nationwide population-based study.

BACKGROUND: Atopic dermatitis (AD) and hand eczema often co-occur, particularly among adults. OBJECTIVES: To examine the interplay between AD and hand eczema in the general population, by characterising prevalence, disease severity, contact sensitization, and comorbidities in individuals with one or both conditions. MATERIALS AND METHODS: In this cross-sectional study, 100 000 randomly selected adults in the Danish general population received a questionnaire via a secure, digital mailbox linked to their civil registration number. Participants answered questions regarding eczema, disease severity, patch testing, and comorbidities. RESULTS: A total of 40 007 individuals responded to the question on a lifetime prevalence of AD, and the prevalence among adult Danes was 9.0%. Nearly one third of individuals with AD reported moderate to severe disease. AD was associated with contact sensitization and increased hand eczema prevalence. Individuals with both AD and hand eczema reported worse disease severity. Furthermore, having both conditions was associated with an increased risk of psychiatric comorbidities. CONCLUSIONS: This study provided updated information about unselected adults with AD in Denmark. Individuals with both AD and hand eczema represent a vulnerable subgroup that physicians should be attentive to.

Low sensitivity of a self-report questionnaire for hand eczema in hairdressing apprentices.

BACKGROUND: The validity of the self-report questionnaire for hand eczema (HE) among Croatian hairdressers was not investigated previously, leading to uncertainty in the prevalence estimated from self-reported data. OBJECTIVES: To (1) investigate the validity of the self-report questionnaire for HE in hairdressing apprentices and (2) examine the differences between apprentices who recognised their HE symptoms and those who did not. METHODS: Clinical examination for HE signs on hands and wrists was performed by the Osnabrueck Hand Eczema Severity Index for 408 apprentices at four visits covering the entire schooling period. Self-report HE was based on the Nordic Occupational Skin Questionnaire. RESULTS: Low sensitivity (7%-37%) with high specificity (≥95%) was observed, with both measures improving from baseline to last visit. The severity of HE signs was the only factor associated with the correct identification of HE signs in analyses adjusted for previous HE signs, health-related quality of life, and atopic dermatitis (adjusted odds ratios of 1.58 with 95% confidence interval [1.06-2.35] and 1.74[1.38-2.19] at second and third follow-up visit, respectively). CONCLUSIONS: Self-report questionnaire for HE showed low sensitivity in hairdressing apprentices, especially at the beginning of training and in those with mild symptoms. Further validation studies following questionnaire modifications aimed at adolescent population are advised.

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 association between wet work and hand eczema in the Dutch general population: Application of a job exposure matrix to the lifelines cohort study.

BACKGROUND: Studies on wet work and hand eczema (HE) frequently rely solely on self-reports regarding wet work. OBJECTIVES: To assess the association between wet work and moderate-to-very-severe HE, within the Dutch general population, by using a (sex-specific) job exposure matrix (JEM). METHODS: Within the Lifelines Cohort Study, participants with self-reported moderate-to-very-severe HE at worst in the past year were linked to data from the Danish (sex-specific) wet work JEM, a tool that links occupations with wet work indices (including duration and probability of glove use, wet hands and total wet work for at least 2 and 4 h/working day). RESULTS: In total, 56 978 (41.9%) participants were included. The multivariate binary logistic regression analyses showed significant associations between all facets of wet work and moderate-to-very-severe HE. When using the sex-specific JEM, significant associations were found in females, but not in males. CONCLUSIONS: This study is the first to use a wet work-specific JEM in a general population sample, and found positive associations between wet work and HE. The sex-specific findings should be interpreted with caution, due to limitations inherent in using a JEM, and should be further explored with observational studies, with a focus on duration, frequency, and exposure type.

Prevalence and clinical impact of topical corticosteroid phobia among patients with chronic hand eczema-Findings from the Danish Skin Cohort.

BACKGROUND: Topical corticosteroid phobia (TOPICOP) 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. OBJECTIVES: To investigate patient-reported outcomes regarding topical corticosteroids (TCSs), and their impact on treatment adherence in patients with CHE. METHODS: Patients with CHE from the Danish Skin Cohort answered a questionnaire including the TOPICOP scale and Medication Adherence Report Scale. 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 although they were unaware of any TCS-associated risks. Most patients (77.9%) always or often stop treatment as soon as possible, whereas 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 = .004). LIMITATIONS: TOPICOP has not been validated in patients with CHE. CONCLUSIONS: Corticosteroid phobia is common among patients with CHE and negatively associated with treatment adherence.

[Sustainability in occupational dermatology : Starting points, challenges, and potentials for sustainable care of work-related skin diseases]. / Nachhaltigkeit in der Berufsdermatologie : Ansatzpunkte, Herausforderungen und Potenziale für eine nachhaltige(re) Versorgung beruflich Hauterkrankter.

Sustainability is becoming increasingly important in healthcare and has moved into focus at various levels. This article aims to provide an overview of guiding principles, concepts, and target systems of sustainability and to transfer these to occupational dermatology. Current and future starting points are outlined for various levels, e.g., politics, research, industry, and patient care, in order to link sustainability and occupational dermatology in a structured and systematic way and to transform the structures of patient care in occupational dermatology care towards sustainability. Using the specific example of protective gloves, which is a pivotal personal protective measure to prevent work-related hand eczema, starting points, potentials, and challenges are analyzed and specific possibilities and perspectives for more ecologically sustainable action are presented.

Evaluation of comfort gloves made of semipermeable and textile materials in patients with hand dermatoses: Results of a controlled multicenter intervention study (ProTection II).

BACKGROUND: Comfort gloves are used in the management of hand dermatoses. OBJECTIVES: To compare the acceptance and tolerability of comfort gloves made of different materials in patients with hand dermatoses and their effects on skin lesions. METHODS: In a prospective multicenter study, 284 patients with hand dermatoses were invited to wear either a cotton glove (COT) or a semipermeable Sympatex glove underneath a cotton glove (SYM/COT) for two subsequent phases of 19 consecutive nights each. A total of 88 controls were asked not to wear any comfort gloves overnight. The severity of skin lesions over time was examined. Questionnaires were used to assess health-related quality of life (HRQoL) and acceptance and tolerability of the gloves. RESULTS: The hand dermatoses improved in all groups. No substantial intergroup differences regarding severity and HRQoL were observed. SYM/COT received better ratings regarding climate conditions and tactility while COT showed superiority in fit, wearing comfort, and practicality. CONCLUSIONS: We confirmed that SYM/COT and COT are well tolerated and accepted suggesting that SYM/COT is a good alternative for COT as comfort gloves in patients with hand dermatoses. Individual requirements, needs, and preferences may direct the material choice.

Hand eczema in Italian patients referred for patch testing: A retrospective SIDAPA study (2016-2023).

BACKGROUND: Hand eczema (HE) is a common skin disease with a negative impact on patients' quality of life in occupational and non-occupational settings. Up-to-date, data on HE in Italian patients referred for patch testing are lacking. OBJECTIVES: To characterise the profile in terms of demographics, aetiology and patch test results of Italian patients affected by HE referred for patch testing. METHODS: A retrospective descriptive study on consecutive patients affected by HE who underwent patch testing from 2016 to 2023 in eight dermatology clinics was performed. HE patients were divided into two groups according to the exclusive (HE-only group) and not-exclusive (HE+ group) hand involvement, and compared to patients with eczema localised in body areas other than hands (NHE group). RESULTS: One thousand five hundred and ninety-seven patients were affected by HE (35.3% males; mean age 42.7 years), 60.2% belonging to the HE-only group and 39.8% to the HE+ group. Occupational dermatitis was diagnosed in 33.2% of HE-only patients, 25.0% of HE+ patients and 5.2% of NHE patients (p < 0.001). HE-only patients presented: Allergic Contact Dermatitis (ACD), Irritant Contact Dermatitis (ICD), atopic HE in 48.1%, 47.5% and 7.1%, respectively; hyperkeratotic palmar, acute recurrent vesicular and nummular clinical subtypes in 52.2%, 43.9% and 11.9%, respectively; relevant positive patch test reactions in 48.1% (nickel sulphate 18.9%, methylchloroisothiazolinone/methylisothiazolinone 10.6%, methylisothiazolinone 8.6%, p-phenylenediamine 6.0% and potassium dichromate 4.7%). CONCLUSIONS: HE patients, and particularly those with exclusive hand involvement, show a particular profile in terms of demographic and clinical characteristics, etiologies and relevant positive patch test reactions.