Risk Factors in Hand Eczema

Abstract

Hand eczema is one of the most disabling skin conditions in terms of its impact on quality of life and occupation. Hand eczema (HE) is not a homogeneous disease entity, but instead occurs in various forms, and a comprehensive differential diagnosis is necessary. Acute HE can be defined as eczema, localized to the hands, that lasts for less than 3 months and does not occur more than once per year, whereas chronic HE refers to an eczematous process that lasts for more than 3 months or relapses twice or more often per year. HE is a multifactorial disease in which both exogenous and endogenous risk factors play a role. There is no single, universally accepted classification for HE. Most published classifications invoke a combination of etiological factors (irritant, allergic, atopic disease) and morphological features (pompholyx, vesicular, hyperkeratotic eczema). Irritant HE may be caused by exposure to agents such as wet work, food, gloves, oils, and cleansing agents. Allergic HE is caused by exposure to allergens, such as chromate, nickel, biocides, and rubber chemicals. The most important endogenous risk factor is an atopic skin diathesis. Atopic skin has a disturbed barrier function and a reduced resistance to irritants; consequently, individuals with a history of or with current atopic eczema have a tendency to develop an atopic hand eczema but also an irritant HE. Often a combination of irritant, allergic, and endogenous factors are acting in concert. In this chapter, the different risk factors involved in hand eczema are discussed with a special focus on occupational hand eczema and its prevention.