Relation between patients' and physicians' severity assessment of occupational hand eczema.

BACKGROUND: Severity assessment of occupational hand eczema (OHE) is important not only in clinical settings but also in research. Questionnaires with self-rated assessment of severity may be an attractive tool for assessing severity because of their cost efficiency in comparison with expensive clinical examinations. OBJECTIVES: To evaluate the relation between self-rated severity and severity assessment based on standardized medical certificates issued by dermatologists in a population of patients with OHE. METHODS: Between October 2001 and November 2002 (58 weeks) we identified all new cases of recognized OHE from the Danish National Board of Industrial Injuries (DNBII) registry. Each patient was examined by a dermatologist, who issued a standardized medical certificate. The severity assessment in the DNBII registry was based on this medical certificate, which comprised information on morphology and extent of eczema, and frequency of eruptions. All participants received a self-administered questionnaire and were asked to classify severity of their OHE on a visual analogue scale from 0 to 10. The relation between DNBII-assessed and self-rated severity was illustrated by a receiver operating characteristic analysis. RESULTS: Of 758 patients included in the study, 621 returned the questionnaire and 602 (79%) provided information on self-rated severity. The proportion of severe cases was significantly higher among patients' assessments compared with the rating by the DNBII. Almost 18% were categorized as severe cases by the DNBII while 40% of patients had assessed themselves as having severe eczema. The optimal cut-off point had a sensitivity and specificity of self-rated severity according to the DNBII assessment of 65% and 66%, respectively. The positive predictive value was 29% and the negative predictive value was 90%. CONCLUSIONS: The low positive predictive value suggests major differences in the criteria for self-rated severity vs. DNBII-rated severity. We recommend researchers to include ratings from both patients and physicians in future investigations of severity. The methods may address different aspects of OHE.

The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability.

BACKGROUND: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). OBJECTIVES: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE. METHODS: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. RESULTS: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment. ICC for intraobserver agreement was 0.90. CONCLUSIONS: Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.

Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema.

BACKGROUND: Epidemiological studies indicate that occupational hand eczema (OHE) often is associated with persistent dermatitis and prolonged sick leave, which may lead to unemployment. Previous studies suggest that OHE caused by allergic contact dermatitis and atopic dermatitis (AD) carries the worst prognosis. OBJECTIVES: To evaluate and compare the severity and consequences of recognized OHE in different diagnostic and subdiagnostic groups. METHODS: Between October 2001 and November 2002, all new cases of recognized OHE were identified from the Danish National Board of Industrial Injuries Registry (758 cases). Severity was graded from 0 to 2 depending on the intensity of skin response and the frequency of relapse. To supplement the information from the Registry, we surveyed the study population using a postal questionnaire which included questions about disease duration, sick leave, current occupation and loss of job. RESULTS: The overall response rate to the questionnaire was 82%. We observed substantially greater severity among those with occupational irritant contact dermatitis (ICD) and AD than for any other diagnoses. Age above 50 years was also associated with increased severity of OHE. Prolonged sick leave due to OHE was reported by 19.9% and was associated with AD and severe OHE. We found a higher proportion of prolonged sick leave among those in food-related occupations (27.2%) compared with those in wet occupations (20.1%) and other occupations (16.5%). Twenty-three per cent reported that they had lost their job at least once during the past 12 months due to OHE. The only strong association with loss of job was food-related occupations. CONCLUSIONS: Occupational ICD and AD appear to be strongly associated with severity of OHE. AD and severity of OHE were independently associated with prolonged sick leave. Having a food-related occupation appears to be associated with increased risk of loss of job.

Hydroxyisohexyl 3-cyclohexene carboxaldehyde- known as Lyral: quantitative aspects and risk assessment of an important fragrance allergen.

Hydroxyisohexyl 3-cyclohexene carboxaldehyde, also known as Lyral, is a fragrance ingredient identified as the cause of contact allergic reactions in 2-3% of eczema patients undergoing patch testing. Lyral has been included in the standard patch test series in many clinics due to its importance as an allergen. It has been used without restrictions in cosmetic products, until now. In the present study, the dose-response relationship of Lyral contact allergy was studied with doses relevant for normal exposure in cosmetic products. 18 eczema patients, who previously had given a positive patch test to Lyral 5% petrolatum, were included along with 7 control subjects. All cases were tested with a serial dilution of Lyral in ethanol 6% to 6 p.p.m and subjected to a 2-week, repeated open application test with a low dose of Lyral in ethanol. In the case of no reaction, this was followed by another 2 weeks of testing with a higher dose. The test was performed at the volar aspect of the forearm. In 16 of 18 cases (89%), a positive use test developed, 11 reacting to the low and 5 to the high concentration. None reacted to the vehicle control of ethanol applied to the contralateral arm. All controls were negative to both the test solutions of Lyral and the ethanol control. The difference between the test and the control group was statistically significant (Fisher's test, P < 0.001). It is concluded that Lyral at the current usage levels is inducing sensitization in the community. The same levels were shown to elicit allergic contact dermatitis in almost all sensitized individuals. A significant reduction in usage concentrations is recommended to prevent contact allergic reactions.