Evidence-Based Management of Hand Eczema

  • Marie Louise A. SchuttelaarEmail author
  • Jart A. F. Oosterhaven
  • Wietske A. Christoffers
  • Geertruida L. E. Romeijn
  • Angelique N. Voorberg
Reference work entry


Hand eczema is a common skin disease with a wide variation in morphology and a complex etiology based on endogenous and exogenous factors.

The diagnosis of hand eczema is based on patient history, exposure assessment, physical examination, and the results of patch testing. Management of hand eczema starts with education of the patient on the etiology of the disease, and the needed changes in behavior regarding skin care and preventive measures, and avoidance of relevant exposure factors. In many cases, medical treatment is needed for successful management of the disease; use of medication can only be successful with proper education and avoidance of relevant exposure.


Hand eczema Management Diagnosis Topical therapy Systemic therapy 


  1. Adams RM (1999) Prevention, treatment, rehabilitation, and plant inspection. In: Adams RM (ed) Occupational skin disease, 3rd edn. W.B. Saunders, PhiladelphiaGoogle Scholar
  2. Agarwal US, Besarwal RK (2013) Topical clobetasol propionate 0.05% cream alone and in combination with azathioprine in patients with chronic hand eczema: an observer blinded randomized comparative trial. Indian J Dermatol Venereol Leprol 79:101–103PubMedCrossRefGoogle Scholar
  3. Agner T (2000) Guidelines for the management of hand eczema. In: Menné T, Maibach HI (eds) Hand eczema, 2nd edn. CRC Press, Boca RatonGoogle Scholar
  4. Agner T (2011) Hand eczema. In: Johansen JD, Frosch P, Lepoittevin JP (eds) Contact dermatitis, 5th edn. Springer, HeidelbergGoogle Scholar
  5. Agner T, Aalto-Korte K, Andersen KE, Foti C, Gimenez-Arnau A, Goncalo M, Goossens A, Le Coz C, Diepgen TL, E.E. and C.D.R. Group (2015) Classification of hand eczema. J Eur Acad Dermatol Venereol 29:2417–2422PubMedCrossRefGoogle Scholar
  6. Ajzen I (1985) From intentions to action: a theory of planned behaviour. In: Kuhl J, Beckmann J (eds) From cognition to behaviour. Springer, HeidelbergGoogle Scholar
  7. Bauer A, Lange N, Matterne U, Meurer M, Braeutigam M, Diepgen TL (2012) Efficacy of pimecrolimus 1% cream in the long term management of atopic hand dermatitis. A double-blind RCT. J Dtsch Dermatol Ges 10:426–432PubMedGoogle Scholar
  8. Bauer A, Rönsch H, Elsner P et al (2018) Interventions for preventing occupational hand dermatitis. Cochrane Database Syst Rev 4:CD004414PubMedGoogle Scholar
  9. Belsito DV, Fowler JF Jr, Marks JG Jr et al (2004) Pimecrolimus cream 1%: a potential new treatment for chronic hand dermatitis. Cutis 73(1):31–38PubMedPubMedCentralGoogle Scholar
  10. Berardesca E, Vignoli GP, Distante F et al (1995) Effects of water temperature on surfactant-induced skin irritation. Contact Dermatitis 32(2):83–87PubMedCrossRefGoogle Scholar
  11. Berndt U, Wigger-Alberti W, Gabard B et al (2000) Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis. Contact Dermatitis 42(2):77–80PubMedCrossRefGoogle Scholar
  12. Bissonnette R, Worm M, Gerlach B et al (2010) Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema. Br J Dermatol 162(2):420–426PubMedCrossRefGoogle Scholar
  13. Bornhovd E, Burgdorf WH, Wollenberg A (2001) Macrolactam immunomodulators for topical treatment of inflammatory skin diseases. J Am Acad Dermatol 45(5):736–743PubMedCrossRefGoogle Scholar
  14. Brans R, Kolomanski K, Mentzel F et al (2016) Multicentre cohort study ‘rehabilitation of occupational skin diseases – optimization and quality assurance of inpatient management (ROQ)’: results from a 3-year follow-up. Contact Dermatitis 75(4):205–212CrossRefGoogle Scholar
  15. Brass D, Farr P, Reynolds N, Stocken D, Macdonald C, Wahie S et al (2015) An observer-blinded randomized controlled pilot study comparing localised psoralen-ultraviolet A with localized narrowband ultraviolet B for the treatment of hand eczema. Br J Dermatol 173:13Google Scholar
  16. Christoffers WA, Politiek K, Coenraads PJ et al (2016) Drug survival of cyclosporine in the treatment of hand eczema: a multicentre, daily use study. J Eur Acad Dermatol Venereol 30:63–66PubMedPubMedCentralCrossRefGoogle Scholar
  17. Coenraads PJ, Diepgen TL (1998) Risk for hand eczema in employees with past or present atopic dermatitis. Int Arch Occup Environ Health 71(1):7–13CrossRefGoogle Scholar
  18. Crane M, Webb D, Watson E, Cunliffe T, English J (2017) Hand eczema and steroid-refractory chronic hand eczema in general practice: prevalence and initial treatment. Br J Dermatol 176:955–964PubMedCrossRefGoogle Scholar
  19. de Almeida E, Borges LF, Silva BL, Gontijo Filho PP (2007) Hand washing: changes in the skin flora. Am J Infect Control 35(6):417–420CrossRefGoogle Scholar
  20. de Vries H, Dijkstra M, Kuhlman P (1988) Self-efficacy: the third factor besides attitude and subjective norm as a predictor of behavioural intentions. Health Educ Res 3:273–282CrossRefGoogle Scholar
  21. Diepgen TL, Agner T, Aberer W et al (2007) Management of chronic hand eczema. Contact Dermatitis 57(4): 203–210CrossRefGoogle Scholar
  22. Diepgen TL, Pfarr E, Zimmermann T (2012) Efficacy and tolerability of alitretinoin for chronic hand eczema under daily practice conditions: results of the TOCCATA open study comprising 680 patients. Acta Derm Venereol 92:251–255CrossRefGoogle Scholar
  23. Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J et al (2015) Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 13:e1–e22CrossRefGoogle Scholar
  24. Dirschka T, Reich K, Bissonnette R, Maares J, Brown T, Diepgen TL (2011) An open-label study assessing the safety and efficacy of alitretinoin in patients with severe chronic hand eczema unresponsive to topical corticosteroids. Clin Exp Dermatol 36:149–154PubMedCrossRefGoogle Scholar
  25. Drake LA, Dinehart SM, Farmer ER et al (1996) Guidelines of care for the use of topical glucocorticosteroids. American Academy of Dermatology. J Am Acad Dermatol 35(4):615–619PubMedCrossRefGoogle Scholar
  26. Dykes P (1998) Surfactants and the skin. Int J Cosmet Sci 20(1):53–61PubMedCrossRefGoogle Scholar
  27. Egan CA, Rallis TM, Meadows KP et al (1999) Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Dermatol 40(4):612–614PubMedPubMedCentralCrossRefGoogle Scholar
  28. English J, Aldridge R, Gawkrodger DJ et al (2009) Consensus statement on the management of chronic hand eczema. Clin Exp Dermatol 34(7):761–769CrossRefGoogle Scholar
  29. Erasmus V, Brouwer W, van Beeck EF et al (2009) A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Infect Control Hosp Epidemiol 30(5):415–419PubMedCrossRefGoogle Scholar
  30. Flyvholm MA (2001) Exposure assessment. In: Rycroft RJG et al (eds) Textbook of contact dermatitis, 3rd edn. Springer, BerlinGoogle Scholar
  31. Flyvholm MA, Mygind K, Sell L et al (2005) A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses. Occup Environ Med 62(9): 642–649PubMedPubMedCentralCrossRefGoogle Scholar
  32. Fowler JF, Graff O, Hamedani AG (2014) A phase 3, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of alitretinoin (BAL4079) in the treatment of severe chronic hand eczema refractory to potent topical corticosteroid therapy. J Drugs Dermatol 13:1198–1204PubMedPubMedCentralGoogle Scholar
  33. 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(5):371–376Google Scholar
  34. Grief C, Wigger-Alberti W, Elsner P (2000) Emoillients and barrier creams in the prevention of hand eczema. In: Menné T, Maibach HI (eds) Hand eczema, 2nd edn. CRC Press, Boca RatonGoogle Scholar
  35. Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362(9391):1225–1230PubMedCrossRefGoogle Scholar
  36. Grunewald AM, Gloor M, Gehring W et al (1995) Damage to the skin by repetitive washing. Contact Dermatitis 32(4):225–232PubMedCrossRefGoogle Scholar
  37. Hogan DJ, Dannaker CJ, Lal S et al (1990) An international survey on the prognosis of occupational contact dermatitis of the hands. Derm Beruf Umwelt 38(5): 143–147PubMedGoogle Scholar
  38. Hordinsky M, Fleischer A, Rivers JK, Poulin Y, Belsito D, Hultsch T (2010) Efficacy and safety of pimecrolimus cream 1% in mild-to-moderate chronic hand dermatitis: a randomized, double-blind trial. Dermatology 221(1): 71–77PubMedGoogle Scholar
  39. Ibler KS, Jemec GB, Diepgen TL et al (2012) Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomized clinical trial. BMJ 12(345):e7822CrossRefGoogle Scholar
  40. Johansen JD, Hald M, Andersen BL et al (2011) Classification of hand eczema: clinical and aetiological types. Based on the guideline of the Danish Contact Dermatitis Group. Contact Dermatitis 65(1):13–21PubMedCrossRefGoogle Scholar
  41. Johansen JD et al (2015) European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice. Contact Dermatitis 73(4):195–221CrossRefGoogle Scholar
  42. Johnston GA, Exton LS, Mohd Mustapa MF, Slack JA, Coulson IH, English JS et al (2017) British Association of Dermatologists’ guidelines for the management of contact dermatitis 2017. Br J Dermatol 2:317–329CrossRefGoogle Scholar
  43. Jungbauer FH, van der Harst JJ, Groothoff JW et al (2004) Skin protection in nursing work: promoting the use of gloves and hand alcohol. Contact Dermatitis 51(3):135–140PubMedCrossRefGoogle Scholar
  44. Kampf G, Loffler H (2003) Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection. J Hosp Infect 55(1):1–7PubMedCrossRefGoogle Scholar
  45. Kampf G, Loffler H (2007) Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review. Ind Health 45(5):645–652PubMedCrossRefGoogle Scholar
  46. Kampf G, Loffler H, Gastmeier P (2009) Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int 106(40):649–655PubMedPubMedCentralGoogle Scholar
  47. Katsarou A, Makris M, Papagiannaki K, Lagogianni E, Tagka A, Kalogeromitros D (2012) Tacrolimus 0.1% vs mometasone furoate topical treatment in allergic contact hand eczema: a prospective randomized clinical study. Eur J Dermatol 22(2):192–196PubMedGoogle Scholar
  48. Kircik LH, Eastman WJ, Gwazdauskas J (2013) A randomized, double-blind phase 4 study of the efficacy and safety of ethanol-free clobetasol propionate foam, 0.05%, vs vehicle foam in the treatment of chronic hand dermatitis. J Drugs Dermatol 12(3):328–334PubMedGoogle Scholar
  49. Kligman AM (1996) Hydration injury to human skin. In: van der Valk PG, Maibach HI (eds) The irritant contact dermatitis syndrome. CRC Press, Boca RatonGoogle Scholar
  50. Klotz A, Veeger M, Rocher W (2003) Skin cleansers for occupational use: testing the skin compatibility of different formulations. Int Arch Occup Environ Health 76(5):367–373PubMedCrossRefGoogle Scholar
  51. Korting HC, Braun-Falco O (1996) The effect of detergents on skin pH and its consequences. Clin Dermatol 14(1):23–27PubMedCrossRefGoogle Scholar
  52. Krejci-Manwaring J, McCarty MA, Camacho F et al (2008) Topical tacrolimus 0.1% improves symptoms of hand dermatitis in patients treated with a prednisone taper. J Drugs Dermatol 7(7):643–646PubMedGoogle Scholar
  53. Kresken J, Klotz A (2003) Occupational skin-protection products – a review. Int Arch Occup Environ Health 76(5):355–358CrossRefPubMedPubMedCentralGoogle Scholar
  54. Kucharekova M, Van De Kerhof 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(6):293–299PubMedCrossRefGoogle Scholar
  55. Kutting B, Drexler H (2003) Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine. Int Arch Occup Environ Health 76(4):253–259PubMedGoogle Scholar
  56. Kutting B, Drexler H (2008) The three-step programme of skin protection a useful instrument of primary prevention or more effective in secondary prevention? Dtsch Med Wochenschr 133(5):201–205PubMedCrossRefGoogle Scholar
  57. Lachapelle JM (2001) Principles of prevention and protection in contact dermatitis (with special reference to occupational dermatology). In: Rycroft RJG et al (eds) Textbook of contact dermatitis, 3rd edn. Springer, BerlinGoogle Scholar
  58. Loden M (2005) The clinical benefit of moisturizers. J Eur Acad Dermatol Venereol 19(6):672–688PubMedCrossRefGoogle Scholar
  59. Loden M, Buraczewska I, Edlund F (2003) The irritation potential and reservoir effect of mild soaps. Contact Dermatitis 49(2):91–96PubMedCrossRefGoogle Scholar
  60. Lodén M, Wirén 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 6:602–606CrossRefGoogle Scholar
  61. Loffler H, Effendy I (2002) Prevention of irritant contact dermatitis. Eur J Dermatol 12(1):4–9PubMedGoogle Scholar
  62. Lynde C, Guenther L, Diepgen TL, Sasseville D, Poulin Y, Gulliver W et al (2010) Canadian hand dermatitis management guidelines. J Cutan Med Surg 6:267–284CrossRefGoogle Scholar
  63. Lynde C, Cambazard F, Ruzicka T, Sebastian M, Brown TC, Maares J (2012) Extended treatment with oral alitretinoin for patients with chronic hand eczema not fully responding to initial treatment. Clin Exp Dermatol 37:712–717PubMedCrossRefGoogle Scholar
  64. Mahler V, Erfurt-Berge C, Schiemann S et al (2010) Dirt-binding particles consisting of hydrogenated castor oil beads constitute a nonirritating alternative for abrasive cleaning of recalcitrant oily skin contamination in a three-step programme of occupational skin protection. Br J Dermatol 162(4):812–818PubMedCrossRefGoogle Scholar
  65. McCormick RD, Buchman TL, Maki DG (2000) Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers. Am J Infect Control 4:302–310CrossRefGoogle Scholar
  66. McFadden J (2001) Hand Eczema. In: Rycroft RJG et al (eds) Textbook of contact dermatitis, 3rd edn. Springer, BerlinGoogle Scholar
  67. Meding B, Swanbeck G (1989) Epidemiology of different types of hand eczema in an industrial city. Acta Derm Venereol 69(3):227–233PubMedPubMedCentralGoogle Scholar
  68. Menné T, Johansen JD, Sommerlund M et al (2011) Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema. Contact Dermatitis 65(1):3–12PubMedCrossRefGoogle Scholar
  69. Mygind K, Sell L, Flyvholm MA et al (2006) High-fat petrolatum-based moisturizers and prevention of work-related skin problems in wet-work occupations. Contact Dermatitis 54(1):35–41CrossRefGoogle Scholar
  70. Nghiem P, Pearson G, Langley RG (2002) Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol 46(2):228–241PubMedCrossRefGoogle Scholar
  71. O’Shea PM, Lugo-Somolinos A (2015) Methotrexate versus Acitretin in the treatment of chronic hand dermatitis. J Drugs Dermatol 14(12):1389–1391PubMedGoogle Scholar
  72. Ohlenschlaeger J, Friberg J, Ramsing D et al (1996) Temperature dependency of skin susceptibility to water and detergents. Acta Derm Venereol 76(4):274–276PubMedGoogle Scholar
  73. Oosterhaven JAF, Politiek K, Schuttelaar M-LA (2017) Azathioprine treatment and drug survival in patients with chronic hand eczema – results from daily practice. Contact Dermatitis 76:304–307PubMedCrossRefGoogle Scholar
  74. Pedersen LK, Held E, Johansen JD et al (2005) Short-term effects of alcohol-based disinfectant and detergent on skin irritation. Contact Dermatitis 52(2):82–87PubMedCrossRefGoogle Scholar
  75. Pickenacker A, Luger TA, Schwarz T (1998) Dyshidrotic eczema treated with mycophenolate mofetil. Arch Dermatol 134(3):378–379PubMedPubMedCentralCrossRefGoogle Scholar
  76. Politiek K, Christoffers WA, Coenraads P-J, Schuttelaar M-LA (2016a) Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study. Dermatol Ther 29:364–371PubMedCrossRefGoogle Scholar
  77. Politiek K, van der Schaft J, Christoffers WA et al (2016b) Drug survival of methotrexate treatment in hand eczema patients: results from a retrospective daily practice study. J Eur Acad Dermatol Venereol 30: 1405–1407PubMedCrossRefGoogle Scholar
  78. Ramsing DW, Agner T (1997) Effect of water on experimentally irritated human skin. Br J Dermatol 136(3): 364–367PubMedCrossRefGoogle Scholar
  79. Robertson L (2009) New and existing therapeutic options for hand eczema. Skin Therapy Lett 14(3):1–5PubMedGoogle Scholar
  80. Rocha LA, Ferreira de Almeida E, Borges L, Gontijo Filho PP (2009) Changes in hands microbiota associated with skin damage because of hand hygiene procedures on the health care workers. Am J Infect Control 37(2): 155–159PubMedCrossRefGoogle Scholar
  81. Ruzicka T, Larsen FG, Galewicz D et al (2004) Oral alitretinoin (9-cis-retinoic acid) therapy for chronic hand dermatitis in patients refractory to standard therapy: results of a randomized, double-blind, placebo-controlled, multicenter trial. Arch Dermatol 140(12): 1453–1459CrossRefGoogle Scholar
  82. 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(4):808–817CrossRefGoogle Scholar
  83. Said NH, Lim KS, Chong WS, Theng CTS (2011) A comparative study of UVA-1 phototherapy versus betamethasone valerate 0.1% cream for chronic vesicular hand eczema. Ann Acad Med Singap 40(11 Suppl 1):S28Google Scholar
  84. Scerri L (1999) Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol 455:343–348PubMedPubMedCentralCrossRefGoogle Scholar
  85. Schmid-Wendtner MH, Korting HC (2006) The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol 19(6):296–302PubMedCrossRefGoogle Scholar
  86. Schnopp C, Remling R, Mohrenschlager 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(1): 73–77PubMedPubMedCentralCrossRefGoogle Scholar
  87. Schwanitz HJ, Riehl U, Schlesinger T et al (2003) Skin care management: educational aspects. Int Arch Occup Environ Health 76(5):374–381PubMedCrossRefGoogle Scholar
  88. Sezer E, Etikan I (2007) Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. Photodermatol Photoimmunol Photomed 23(1):10–14PubMedPubMedCentralCrossRefGoogle Scholar
  89. Skudlik C, Weisshaar E, Scheidt R et al (2009) Multicenter study “medical-occupational rehabilitation procedure skin – optimizing and quality assurance of inpatient-management (ROQ)”. J Dtsch Dermatol Ges 7: 122–127Google Scholar
  90. Slotosch CM, Kampf G, Loffler H (2007) Effects of disinfectants and detergents on skin irritation. Contact Dermatitis 57(4):235–241PubMedCrossRefGoogle Scholar
  91. Soost S, Worm M (2009) Therapy of occupational skin diseases. Hautarzt 60(9):718–721PubMedCrossRefGoogle Scholar
  92. Soost S, Abdollahnia M, Kostev K, Worm M (2012) Topical therapy of hand eczema – analysis of the prescription profile from dermatologists in private practice. J Dtsch Dermatol Ges 10:180–184PubMedGoogle Scholar
  93. Thaçi D, Augustin M, Westermayer B, Kamps A, Hennig M (2016) Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real-world observational study. J Dermatolog Treat 27:577–583PubMedCrossRefGoogle Scholar
  94. 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(5):353–355CrossRefGoogle Scholar
  95. Thyssen JP, Johansen JD, Linneberg A, Menné T (2010) The epidemiology of hand eczema in the general population – prevalence and main findings. Contact Dermatitis 62(2):75–87CrossRefGoogle Scholar
  96. Tupker RA, Coenraads PJ (1996) Cleansing. In: van der Valk PG, Maibach HI (eds) The irritant contact dermatitis syndrome. CRC Press, Boca RatonGoogle Scholar
  97. Van Coevorden AM, Coenraads PJ, Svensson A, Bavinck JN, Diepgen TL, Naldi L, Elsner P, Williams HC, European Dermato-Epidemiology Network (Eden) (2004) Overview of studies of treatments for hand eczema-the EDEN hand eczema survey. Br J Dermatol 151(2):446–451PubMedCrossRefGoogle Scholar
  98. van Gils RF, Boot CR, van Gils PF et al (2011) Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis 64(2):63–72CrossRefGoogle Scholar
  99. Veien NK (2011) Clinical features. In: Johansen JD, Frosch P, Lepoittevin JP (eds) Contact dermatitis, 5th edn. Springer, HeidelbergGoogle Scholar
  100. Veien NK, Ølholm Larsen P, Thestrup-Pedersen K, Schou G (1999) Long-term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol 140:882–886CrossRefGoogle Scholar
  101. Wigger-Alberti W, Fischer T, Greif C et al (1999) Effects of various grit-containing cleansers on skin barrier function. Contact Dermatitis 41(3):136–140PubMedGoogle Scholar
  102. Wilke A, Gediga K, Schlesinger T et al (2012) Sustainability of interdisciplinary secondary prevention in patients with occupational hand eczema: a 5 year follow-up survey. Contact Dermatitis 66(2):79–86PubMedCrossRefGoogle Scholar
  103. Willis I (1973) The effects of prolonged water exposure on human skin. J Invest Dermatol 60(3):166–171PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Marie Louise A. Schuttelaar
    • 1
    Email author
  • Jart A. F. Oosterhaven
    • 1
  • Wietske A. Christoffers
    • 1
  • Geertruida L. E. Romeijn
    • 1
  • Angelique N. Voorberg
    • 1
  1. 1.Department of DermatologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands

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