Update on Hand Eczema with Special Focus on the Impact of Moisturisers

Chapter

Abstract

Hand eczema is a common and distressing condition. It is thought to be a multifactorial skin disorder in which skin barrier impairment is involved in the pathogenesis. A wide range of approaches is available for the management of chronic hand eczema. The development of topical agents that improve skin barrier function is a promising approach for the management of hand dermatitis. However, although clinical experience suggests an important role for moisturisers, more controlled studies are considered essential to support this scientifically.

Keywords

Stratum Corneum Allergic Contact Dermatitis Topical Steroid Dermatology Life Quality Index Mometasone Furoate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1.  1.
    Thyssen JP, Johansen JD, Linneberg A, Menne T (2010) The epidemiology of hand eczema in the general population – prevalence and main findings. Contact Dermatitis 62:75–87PubMedCrossRefGoogle Scholar
  2.  2.
    Meding B (1990) Epidemiology of hand eczema in an industrial city. Acta Derm Venereol Suppl (Stockh) 153:1–43Google Scholar
  3.  3.
    Rystedt I (1985) Long term follow-up in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 114:117–120Google Scholar
  4.  4.
    Thyssen JP, Carlsen BC, Menne T et al (2010) Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population study. Br J Dermatol 163:115–120PubMedGoogle Scholar
  5.  5.
    Meding B, Wrangsjo K, Jarvholm B (2005) Fifteen-year follow-up of hand eczema: persistence and consequences. Br J Dermatol 152:975–980PubMedCrossRefGoogle Scholar
  6.  6.
    Halkier-Sorensen L (1996) Occupational skin diseases. Contact Dermatitis 35(Suppl 1):1–120PubMedGoogle Scholar
  7.  7.
    Diepgen TL, Andersen KE, Brandao FM et al (2009) Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema. Br J Dermatol 160:353–358PubMedCrossRefGoogle Scholar
  8.  8.
    Koch P (2001) Occupational contact dermatitis. Recognition and management. Am J Clin Dermatol 2:353–365PubMedCrossRefGoogle Scholar
  9.  9.
    Dickel H, Kuss O, Blesius CR, Schmidt A, Diepgen TL (2001) Occupational skin diseases in Northern Bavaria between 1990 and 1999: a population-based study. Br J Dermatol 145:453–462PubMedCrossRefGoogle Scholar
  10. 10.
    Cvetkovski RS, Rothman KJ, Olsen J, Mathiesen B, Iversen L, Johansen JD, Agner T (2005) Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol 152:93–98PubMedCrossRefGoogle Scholar
  11. 11.
    Fowler JF, Ghosh A, Sung J et al (2006) Impact of chronic hand dermatitis on quality of life, work productivity, activity impairment, and medical costs. J Am Acad Dermatol 54:448–457PubMedCrossRefGoogle Scholar
  12. 12.
    Agner T, Andersen KE, Brandao FM et al (2008) Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients. Contact Dermatitis 59:43–47PubMedCrossRefGoogle Scholar
  13. 13.
    Lerbaek A, Kyvik KO, Ravn H et al (2008) Clinical characteristics and consequences of hand eczema – an 8-year follow-up study of a population-based twin cohort. Contact Dermatitis 58:210–216PubMedCrossRefGoogle Scholar
  14. 14.
    Susitaival P, Hannuksela M (1995) The 12-year prognosis of hand dermatosis in 896 Finnish farmers. Contact Dermatitis 32(4):233–237PubMedCrossRefGoogle Scholar
  15. 15.
    Diepgen TL, Agner T, Aberer W, Berth-Jones J, Cambazard F, Elsner P, McFadden J, Coenraads PJ (2007) Management of chronic hand eczema. Contact Dermatitis 57:203–210PubMedCrossRefGoogle Scholar
  16. 16.
    van Gils RF, Boot CRL, van Gils PF et al (2011) Effectiveness of prevention programmes for hand ­dermatitis: a systematic review of the literature. Contact Dermatitis 64:63–72PubMedCrossRefGoogle Scholar
  17. 17.
    Nielsen NH, Linneberg A, Menné T, Madsen F, Frolund L, Dirksen A, Jørgensen T (2002) The association between contact allergy and hand eczema in two cross-sectional surveys 8 years apart. Contact Dermatitis 47:71–77PubMedCrossRefGoogle Scholar
  18. 18.
    Wrangsjo K, Wallenhammar LM, Ortengren U, Barregard L, Andreasson H, Bjorkner B, Karlsson S, Meding B (2001) Protective gloves in Swedish dentistry: use and side effects. Br J Dermatol 145:32–37PubMedCrossRefGoogle Scholar
  19. 19.
    Ramsing DW, Agner T (1996) Effect of glove occlusion on human skin. (I). Short-term experimental exposure. Contact Dermatitis 34(1):1–5PubMedCrossRefGoogle Scholar
  20. 20.
    Ramsing DW, Agner T (1996) Effect of glove occlusion on human skin (II). Long-term experimental exposure. Contact Dermatitis 34(4):258–262PubMedCrossRefGoogle Scholar
  21. 21.
    Strauss RM, Gawkrodger DJ (2001) Occupational contact dermatitis in nurses with hand eczema. Contact Dermatitis 44:293–296PubMedCrossRefGoogle Scholar
  22. 22.
    Schürer NY, Klippel U et al (2005) Secondary individual prevention of hand dermatitis in geriatric nurses. Int Arch Occup Environ Health 78:149–157PubMedCrossRefGoogle Scholar
  23. 23.
    Schwanitz HJ, Riehl U et al (2003) Skin care management: educational aspects. Int Arch Occup Environ Health 76(5):374–381PubMedCrossRefGoogle Scholar
  24. 24.
    Weisshaar E, Radulescu M et al (2007) Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees: aims, experiences and descriptive results. Int Arch Occup Environ Health 80(6):477–484PubMedCrossRefGoogle Scholar
  25. 25.
    English J, Aldridge R, Gawkrodger DJ, Kownacki S, Statham B, White JM et al (2009) Consensus statement on the management of chronic hand eczema. Clin Exp Dermatol 34:761–769PubMedCrossRefGoogle Scholar
  26. 26.
    Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee et al (2000) Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Morb Mortal Wkly Rep 51(RR-16):1–45Google Scholar
  27. 27.
    Loffler H, Kampf G, Schermund D, Maibach HI (2007) How irritant is alcohol? Br J Dermatol 157:74–81PubMedCrossRefGoogle Scholar
  28. 28.
    Frosch PJ, SchulzeDirk A, Hoffmann M et al (1993) Efficacy of skin barrier creams. (I). The repetitive irritation test (RIT) in the guinea pig. Contact Dermatitis 28(2):94–100PubMedCrossRefGoogle Scholar
  29. 29.
    Kresken J, Klotz A (2003) Occupational skin-protection products – a review. Int Arch Occup Environ Health 76(5):355–358PubMedCrossRefGoogle Scholar
  30. 30.
    Saary J, Qureshi R, Palda V, DeKoven J, Pratt M, Skotnicki-Grant S et al (2005) A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 53:845–855PubMedCrossRefGoogle Scholar
  31. 31.
    Kelterer D, Fluhr JW, Elsner P (2003) Application of protective creams: use of a fluorescence-based training system decreases unprotected areas on the hands. Contact Dermatitis 49(3):159–160PubMedCrossRefGoogle Scholar
  32. 32.
    Bendsoe N, Bjornberg A, Lowhagen GB, Tengberg JE (1987) Glass fibre irritation and protective creams. Contact Dermatitis 17:69–72PubMedCrossRefGoogle Scholar
  33. 33.
    Elsner P (2007) Skin protection in the prevention of skin diseases. Curr Probl Dermatol 34:1–10PubMedCrossRefGoogle Scholar
  34. 34.
    Krajewska D, Rudzki E (1976) Sensitivity to epoxy resins and triethylenetetramine. Contact Dermatitis 2:135–138PubMedCrossRefGoogle Scholar
  35. 35.
    Winker R, Salameh B, Stolkovich S, Nikl M, Barth A, Ponocny E et al (2009) Effectiveness of skin protection creams in the prevention of occupational dermatitis: results of a randomized, controlled trial. Int Arch Occup Environ Health 82:653–662PubMedCrossRefGoogle Scholar
  36. 36.
    (NHS Plus 2008) NHS Plus/Royal College of Physicians (2008) Latex allergy: occupational health aspects of management: a national guideline. Royal College of Physicians, LondonGoogle Scholar
  37. 37.
    Loden M, Andersson AC (1996) Effects of topically applied lipids on surfactant irritated skin. Br J Dermatol 134:215–220PubMedCrossRefGoogle Scholar
  38. 38.
    Ramsing DW, Agner T (1997) Preventive and therapeutic effects of a moisturizer. Acta Derm Venereol 77:335–337PubMedGoogle Scholar
  39. 39.
    Hoare C, Li Wan Po A, Williams H (2000) Systematic review of treatments for atopic eczema. Health Technol Assess 4:1–191PubMedGoogle Scholar
  40. 40.
    Buraczewska I, Berne B, Lindberg M, Torma H, Loden M (2007) Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial. Br J Dermatol 156:492–498PubMedCrossRefGoogle Scholar
  41. 41.
    Held E, Sveinsdottir S, Agner T (1999) Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants. Acta Derm Venereol 79:49–51PubMedCrossRefGoogle Scholar
  42. 42.
    Zachariae C, Held E, Johansen JD, Menne T, Agner T (2003) Effect of a moisturizer on skin susceptibility to NiCl2. Acta Derm Venereol 83:93–97PubMedCrossRefGoogle Scholar
  43. 43.
    Vilaplana J, Coll J, Trullás C, Axón A, Pelejero C (1992) Clinical and non-invasive evaluation of 12% ammonium lactate emulsion for the treatment of dry skin in atopic and non-atopic subjects. Acta Derm Venereol 72:28–33PubMedGoogle Scholar
  44. 44.
    Loden M (2005) The clinical benefit of moisturizers. J Eur Acad Dermatol Venereol 19:672–688PubMedCrossRefGoogle Scholar
  45. 45.
    Halkier-Sorensen L, Thestrup-Pedersen K (1993) The efficacy of a moisturizer (Locobase) among cleaners and kitchen assistants during everyday exposure to water and detergents. Contact Dermatitis 29:1–6CrossRefGoogle Scholar
  46. 46.
    Hannuksela A, Kinnunen T (1992) Moisturizers prevent irritant dermatitis. Acta Derm Veneroel (Stockh) 72:42–44Google Scholar
  47. 47.
    Loden M (1997) Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream. Contact Dermatitis 36:256–260PubMedCrossRefGoogle Scholar
  48. 48.
    Held E, Agner T (1999) Comparison between 2 test models in evaluating the effect of a moisturizer on irritated human skin. Contact Dermatitis 40:261–268PubMedCrossRefGoogle Scholar
  49. 49.
    Goh CL, Gan SL (1994) Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metalworkers: a prospective study. Contact Dermatitis 31:176–180PubMedCrossRefGoogle Scholar
  50. 50.
    Williams C, Wilkinson SM, McShane P et al (2010) A double-blind, randomized study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use. Br J Dermatol 162(5):1088–1092PubMedCrossRefGoogle Scholar
  51. 51.
    Held E (2001) So moisturizers may cause trouble! Int J Dermatol 40:12–13PubMedCrossRefGoogle Scholar
  52. 52.
    Held E, Lund H, Agner T (2001) Effect of different moisturizers on SLS-irritated human skin. Contact Dermatitis 44:229–234PubMedCrossRefGoogle Scholar
  53. 53.
    Loden M (2004) Do moisturizers work? J Cosmet Dermatol 2:141–149CrossRefGoogle Scholar
  54. 54.
    Kucharekova M, Van De Kerkhof PC, Van Der Valk PG (2003) A randomized comparison of an emollient containing skin related lipids with a petrolatum-based emollient as adjunct in the treatment of chronic hand dermatitis. Contact Dermatitis 48:293–299PubMedCrossRefGoogle Scholar
  55. 55.
    Lodén M, Barany E (2000) Skin-identical lipids versus petrolatum in the treatment of tape-stripped and detergent-perturbed human skin. Acta Derm Venereol 80:412–415PubMedCrossRefGoogle Scholar
  56. 56.
    Elias PM, Hatano Y, Williams ML (2008) Basis for the barrier abnormality in atopic dermatitis: outside-inside-outside pathogenic mechanisms. J Allergy Clin Immunol 121:1337–1343PubMedCrossRefGoogle Scholar
  57. 57.
    Andersson A-C, Lindberg M, Lodén M (1999) The effect of two urea-containing creams on dry, eczematous skin in atopic patients. I. Expert, patient and instrumental evaluation. J Dermatol Treat 10:165–169CrossRefGoogle Scholar
  58. 58.
    Lodén M, Andersson A-C, Lindberg M (1999) Improvement in skin barrier function in patients with atopic dermatitis after treatment with a moisturizing cream (Canoderm®). Br J Dermatol 140:264–267PubMedCrossRefGoogle Scholar
  59. 59.
    Wirén K, Nohlgård C, Nyberg F, Holm L, Svensson M, Johannesson A et al (2009) Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial. J Eur Acad Dermatol Venereol 23:1267–1272PubMedCrossRefGoogle Scholar
  60. 60.
    Loden M, Wiren K, Smerud K et al (2010) Treatment with a barrier-strengthening moisturizer prevents relapse of hand eczema: an open, randomized, prospective, parallel group study. Acta Derm Venereol 90:602–606PubMedCrossRefGoogle Scholar
  61. 61.
    Veien NK, Olholm Larsen P, Thestrup-Pedersen K et al (1999) Long-term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol 140:882–886PubMedCrossRefGoogle Scholar
  62. 62.
    Schnopp C, Remling R, Möhrenschlager M et al (2002) Topical tacrolimus (FK506) and mometasone furoate in treatment of dyshidrotic palmar eczema: a randomized, observer-blinded trial. J Am Acad Dermatol 46:73–77PubMedCrossRefGoogle Scholar
  63. 63.
    El-Batawy MM, Bosseilo MA, Marshaly HM et al (2009) Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis. J Dermatol Sci 54:76–87PubMedCrossRefGoogle Scholar
  64. 64.
    Hanifin JM, Stevens V, Sheth P et al (2004) Novel treatment of chronic severe hand dermatitis with bexarotene gel. Br J Dermatol 150:545–553PubMedCrossRefGoogle Scholar
  65. 65.
    Lindelof B, Wrangsjo K, Liden S (1987) A double-blind study of Grenz ray therapy in chronic eczema of the hands. Br J Dermatol 117:77–80PubMedCrossRefGoogle Scholar
  66. 66.
    Wollina U, Karamfilov T (2002) Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left-right comparison. J Eur Acad Dermatol Venereol 16:40–42PubMedCrossRefGoogle Scholar
  67. 67.
    Odia S, Vocks E, Rakoski J, Ring J (1996) Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol 76:472–474PubMedGoogle Scholar
  68. 68.
    Rosen K, Mobacken H, Swanbeck G (1987) Chronic eczematous dermatitis of the hands. A comparison of PUVA and UVB treatment. Acta Derm Venereol 67:48–54PubMedGoogle Scholar
  69. 69.
    Schmidt T, Abeck D, Boeck K et al (1998) UVA1 irradiation is effective in treatment of chronic vesicular dyshidrotic hand eczema. Acta Derm Venereol 78:318–319PubMedCrossRefGoogle Scholar
  70. 70.
    Ruzicka T, Lynde CW, Jemec GB et al (2008) Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol 158:808–817PubMedCrossRefGoogle Scholar
  71. 71.
    Scerri L (1999) Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol 455:343–348PubMedCrossRefGoogle Scholar
  72. 72.
    Granlund H, Erkko P, Eriksson E et al (1996) Comparison of cyclosporine and topical betamethasone-17,21-dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol 76:371–376PubMedGoogle Scholar
  73. 73.
    Granlund H, Erkko P, Reitamo S (1998) Long-term follow-up of eczema patients treated with cyclosporine. Acta Derm Venereol 78:40–43PubMedCrossRefGoogle Scholar
  74. 74.
    Schmitt J, Schmitt N, Meurer M (2007) Cyclosporin in the treatment of patients with atopic eczema – a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 21(5):606–619PubMedGoogle Scholar
  75. 75.
    Egan CA, Rallis TM, Meadows KP, Krueger GC (1999) Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Dermatol 40:612–614PubMedCrossRefGoogle Scholar
  76. 76.
    Thestrup-Pedersen K, Andersen KE, Menné T et al (2001) Treatment of hyperkeratotic dermatitis of the palms (eczema keratoticum) with oral acitretin. A single-blind placebo-controlled study. Acta Derm Venereol 81:353–355PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of DermatologyLeeds General InfirmaryLeedsUK

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