Hand eczema: impact, treatment and outcome measures

Abstract

Hand eczema is common and can have a large impact on the quality of life of those affected. In this thesis, this impact is studied. Studies into the financial cost of hand eczema are reviewed. Total yearly costs per person vary from €1311 - €9792. Presenteeism (working while having a disease) is often overlooked. It is shown that it is common in more severe hand eczema, often with an occupational cause, and frequently has intrinsic reasons. Studies into the treatment of hand eczema show that azathioprine may be considered in severe hand eczema, although it often has side effects. The novel drug dupilumab probably holds promise for the future treatment of hand eczema. Performing studies and measuring patients is not very useful if unvalidated measurement instruments are used. Therefore, the Quality Of Life in Hand Eczema Questionnaire (QOLHEQ) and the Hand Eczema Severity Index (HECSI) are extensively studied in this thesis. For the QOLHEQ national validation of the Dutch version is performed and cross-cultural validation was done for multiple language versions. For the QOLHEQ and HECSI, interpretability is studied to assign meaning to single scores and change scores. Also, it is assessed what the minimally important change is that a patient needs to obtain on these instruments to be regarded truly and importantly changed when compared with an earlier measurement.