A recent study conducted in China has identified significant risk factors for chronic hand eczema (CHE) in the general population. The study, which analyzed data from 121 patients at a Wuhan hospital, found that prolonged exposure to wet work (more than five hours per day) and chapped skin were the most notable risk factors linked to the development and severity of CHE.
The cross-sectional study, conducted from December 2018 to December 2019, included both male and female patients with an average age of 36 years. Participants were aged 12 and older, all diagnosed with CHE and having negative results for mycological tests. Each participant underwent a contact allergen patch test and provided responses through a detailed survey and interviews with healthcare providers.
Researchers tracked a range of factors including age, gender, family history, symptoms, disease duration, hand washing frequency, occupation, lifestyle habits, medications, and clinical test results such as transepidermal water loss (TEWL), Hand Eczema Severity Index (HECSI) scores, and Dermatology Life Quality Index (DLQI) scores. The mean DLQI score was 8, with participants spending an average of one hour per day performing wet work. Occupations varied widely, encompassing clerical work, construction, healthcare, cosmetology, farming, and foodservice, with seven participants being students.
The most commonly reported symptoms of CHE were itching (77.7%), scaling (74.4%), and chapped skin (73.6%). Patients with chapped skin were more likely to have severe HECSI scores (p=0.006), and those who worked with wet hands for longer durations also exhibited more severe symptoms (p=0.006).
Patch test results revealed that nickel sulfate was the most common trigger, found in 25.75% of patients, followed by p-phenylenediamine and Carba mix, each present in 22.73% of cases. Allergic contact dermatitis and irritant contact dermatitis were found to account for over 50% of CHE cases. However, despite positive patch test results in 67 patients, there was no significant correlation between patch test scores and HECSI scores.
The study identified that working with wet hands for more than five hours per day was the most significant risk factor for CHE (OR: 8.71, 95% CI: 1.27–59.97, p=0.028). Chapped skin, which leads to an impaired skin barrier, was also a significant factor associated with severe CHE (OR: 3.72, 95% CI: 1.27–10.91, p=0.017). Participants with chapped skin also had a higher TEWL, indicating increased skin moisture loss. Additionally, strong correlations were found between DLQI and HECSI scores (p=0.002), as well as between TEWL and HECSI scores (p=0.034).
The authors emphasized the psychosocial burden of CHE, noting its impact on patients’ quality of life, including potential contributions to conditions like depression and anxiety. “The chronicity and frequent recurrence of hand eczema significantly affect patients’ quality of life,” the researchers stated.
However, the study acknowledged several limitations, including its reliance on a single-center approach with a small sample size and a patch test that only included common allergens. The authors recommended further research to better understand the risk factors for CHE in the Chinese population, which could inform clinical treatments.
Previous studies have shown that workers exposed to wet environments, such as healthcare workers, hairdressers, and food handlers, have a higher incidence of CHE, with rates ranging from 0.7 to 1.5 cases per 1,000 workers per year. The current study also noted that symptoms improved significantly for patients who were removed from wet work environments, suggesting potential benefits of reducing exposure in future interventions. Further trials will be necessary to explore this aspect in more detail.
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