The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis

Abstract

Summary Atopic dermatitis (AD), a common type of eczema, is a skin disease of early childhood. It causes intense itching and dry skin. Most children and adults experience eczema of the flexures (bends of the knees and elbows), but some adult patients also have eczema on the face, hands and feet. Traditional atopic hand eczema (HE) is located on the dorsal aspects (backs) of the hands, probably because the skin is thinner here than on the palms. However, AD also increases the risk of HE that develops due to irritants such as soap and water, so-called ‘irritant contact dermatitis’. This subtype of HE often begins on the skin between or on the sides of the fingers but can be located anywhere on the hands including the palms. Importantly, HE can prevent people being able to work and can reduce their enjoyment and quality of life. The present study looked into the link between AD and HE by reviewing published literature and scientific studies. In each study we searched for data on the association between AD and HE. We combined the results from 26 studies, which showed that patients with present or past AD had a 3 to 4-fold increased risk of HE when looking at one-year- and lifetime prevalence of HE (meaning people who developed HE at any point over the course of a given year, or ever in their lives so far, even if they did not have it currently). A slightly weaker association was found when studying the link with current HE. Similar positive associations were found when looking at HE due to exposure to irritants from different occupations, and HE reported in the general population. In conclusion, our analysis showed that patients with AD had a strongly increased likelihood of HE. Clinicians should continue to guide patients with AD away from occupations with high risk of HE where possible. Furthermore, future studies should focus on the importance of determining the association between AD and different types of HE.