BACKGROUND: Few population-based clinical follow-up studies on hand eczema are reported. Objectives: The aim of this study was to characterize clinical symptoms and to examine occupational and medical consequences as well as persistence of hand eczema in a population-based twin cohort. PATIENTS/METHODS: A total of 274 individuals with and without hand eczema were examined, patch tested, and interviewed in 1997-1998 and 2005-2006. Data on 188 individuals with hand eczema in 2005-2006 were analysed. RESULTS: Erythema and scaling were the most frequent symptoms, and fingers and palms were most often affected. Mean hand eczema severity index score in individuals with clinical symptoms was 12.0. Sick leave was reported by 12.4%; job change by 8.5%. Being in the lowest socio-economic group and atopic dermatitis were risk factors for sick leave [odds ratio (OR) = 5.6; 95% confidence interval (95% CI) 1.5-22.9 and OR = 2.9; 95% CI 1.0-8.1]. The majority (63.4%) had seen a doctor at least once, and atopic dermatitis was a risk factor for more than 1 visit (OR = 3.0; 95% CI 1.4-6.4). Duration of >10 years was a risk factor for persistence of symptoms, which was reported by 67.7%. CONCLUSIONS: The clinical picture and consequences of hand eczema vary; however, the majority experience chronic symptoms.
Genetic factors have been shown to influence the risk of hand eczema, and may theoretically influence the frequency of eruptions as well as age at onset of the disease. However, the result may be confounded by atopic dermatitis, which is a major risk factor for development of hand eczema and is known to be influenced by genetic factors. In this study, the importance of genetic and environmental risk factors in the etiology of hand eczema, independent of atopic dermatitis, was investigated in a population-based twin cohort. In addition, any possible genetic influence on frequency of hand eczema eruptions and age at onset was explored. In all, 4,128 twin individuals (response rate 82%) answered a questionnaire on self-reported hand eczema. Similarity within twin pairs was estimated and quantitative genetic modelling performed. Controlling for age and atopic dermatitis, the effect of genetic risk factors was moderate and explained 41% of the variance in liability to develop hand eczema, leaving 59% of the variance to be caused by environmental factors. Genetic factors accounted for 31% of the variance in liability regarding frequency of eruptions. Environmental factors explained the variance in liability concerning age at onset.
Population-based studies on contact allergy with retesting of individuals are infrequently performed. Variable degrees of persistence are reported when individuals with contact allergy are retested with years in between. The patch test results of 270 individuals tested in 2005-2006 are presented and the pattern and frequency of sensitization discussed. Persistence when compared with patch test results from 1997-1998 is reported. 270 twin individuals with and without hand eczema underwent patch testing with the TRUE Test((R)) (Mekos Laboratories AS, Hilleroed, Denmark) in 1997-1998 and again in 2005-2006 as part of a larger study. In 2005-2006, a total of 74 (27.4%) of the 270 individuals had at least 1 positive patch test and 20 (7.4%) of the 270 had 2. The frequency in men and women was 9/90 (10%) and 65/180 (36.1%), respectively. The frequency of contact allergy in individuals with and without hand eczema was 59/185 (31.3%) and 15/85 (17.6%), respectively. The most prevalent contact allergies were to nickel, thiomersal, and fragrance mix I. All together, 74% of the positive reactions were reproduced. The frequency of contact allergy in this population-based cohort with hand eczema was comparable with previous reports. Persistence of contact allergy after many years was confirmed.