Hand Eczema Patients Research Articles

Management of Hand Eczema with Unani Medicine: A Case Study

Background: Eczema, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. This paper presents the case of a 30-year-old male patient, who came to the outpatient department (OPD) of the Kashmir Tibbia College Hospital and Research Centre, Shilvath, Bandipora, Kashmir, India. Clinical presentation: His chief complaints were lesions on the palm of his left hand for one year. The patient also complains that his skin is black and thickened with severe itching on the affected area. Diagnosis: The patient was diagnosed clinically with hand eczema resembling Nar-e-Farsi in the Unani system of medicine. Interventions: For 30 days, Marham Kafoor was topically applied twice a day at a dose of 8-10 gm. Outcome: The patient was assessed before, the 15th day and 30th day of treatment based on the EASI, POEM, and VAS. Results: After the intervention, significant improvement was observed in all scales from baseline to 30th day. EASI changes from 18 (moderate) to 5 (mild), POEM changes from 19 (severe) to 7(mild), and VAS from 8 (severe) to 1 (mild). Conclusion: Marham Kafoor has been proven beneficial in treating hand eczema and enhancing patients' quality of life Keywords: Eczema; Marham Kafoor; Unani Medicine

Improving Outcomes and Quality of Life for Hand and Foot Eczema Patients: A Randomized Study of a Patient-Centered Monitoring App (Preprint)

Improving Outcomes and Quality of Life for Hand and Foot Eczema Patients: A Randomized Study of a Patient-Centered Monitoring App (Preprint)

433 Outcome measures demographics and characteristics in predicting hand eczema severity in atopic dermatitis patients

433 Outcome measures demographics and characteristics in predicting hand eczema severity in atopic dermatitis patients

The Endogenous Dual Retinoid Receptor Agonist Alitretinoin Exhibits Immunoregulatory Functions on Antigen-Presenting Cells.

Retinoids are a frequently used class of drugs in the treatment of inflammatory as well as malignant skin diseases. Retinoids have differential affinity for the retinoic acid receptor (RAR) and/or the retinoid X receptor (RXR). The endogenous dual RAR and RXR agonist alitretinoin (9-cis retinoic acid) demonstrated remarkable efficacy in the treatment of chronic hand eczema (CHE) patients; however, detailed information on the mechanisms of action remains elusive. Here, we used CHE as a model disease to unravel immunomodulatory pathways following retinoid receptor signaling. Transcriptome analyses of skin specimens from alitretinoin-responder CHE patients identified 231 significantly regulated genes. Bioinformatic analyses indicated keratinocytes as well as antigen presenting cells as cellular targets of alitretinoin. In keratinocytes, alitretinoin interfered with inflammation-associated barrier gene dysregulation as well as antimicrobial peptide induction while markedly inducing hyaluronan synthases without affecting hyaluronidase expression. In monocyte-derived dendritic cells, alitretinoin induced distinct morphological and phenotypic characteristics with low co-stimulatory molecule expression (CD80 and CD86), the increased secretion of IL-10 and the upregulation of the ecto-5'-nucleotidase CD73 mimicking immunomodulatory or tolerogenic dendritic cells. Indeed, alitretinoin-treated dendritic cells demonstrated a significantly reduced capacity to activate T cells in mixed leukocyte reactions. In a direct comparison, alitretinoin-mediated effects were significantly stronger than those observed for the RAR agonist acitretin. Moreover, longitudinal monitoring of alitretinoin-responder CHE patients could confirm in vitro findings. Taken together, we demonstrate that the dual RAR and RXR agonist alitretinoin targets epidermal dysregulation and demonstrates strong immunomodulatory effects on antigen presenting cell functions.

Effect of upadacitinib on atopic hand eczema in patients with moderate-to-severe atopic dermatitis: Results from two randomized phase 3 trials.

Approximately 60% of patients with atopic dermatitis have involvement of the hands adding to the burden of disease. This analysis aims to evaluate the effect of upadacitinib monotherapy on atopic hand eczema in patients with moderate-to-severe AD over 16 weeks in the Measure Up 1 and 2 studies. Data from patients (ages 12-75) randomized 1:1:1 to receive upadacitinib 15 mg, 30 mg, or placebo once daily in the Measure Up 1 and 2 studies were analysed for impact on atopic hand eczema assessed using the Hand Eczema Severity Index (HECSI). The percent change from baseline in HECSI score was a prespecified additional endpoint at all visits. The proportion of patients with at least a 75% improvement in HECSI score (HECSI 75) was evaluated post hoc. Patients treated with upadacitinib 15 mg or 30 mg experienced greater improvement in HECSI score compared with placebo as early as Week 1, which was maintained through Week 16. At Week 16, the mean change from baseline in HECSI score for patients receiving upadacitinib 15 mg, 30 mg, and placebo was -68%, -74%, and -15% in Measure Up 1 and -68%, -74% and +21% (positive change indicates worsening for placebo) in Measure Up 2, respectively. A greater proportion of upadacitinib-treated patients achieved HECSI 75 compared with placebo at all timepoints beginning at Week 1 through Week 16. Upadacitinib 15 mg and 30 mg monotherapy provided rapid and sustained improvement in atopic hand eczema compared with placebo through Week 16 in patients with moderate-to-severe AD. At Week 16, the observed mean improvements in HECSI score in upadacitinib-treated patients were clinically meaningful based on previous interpretability studies. These results suggest that upadacitinib may be an effective treatment option for atopic hand eczema in patients with moderate-to-severe AD.

Oral spleen tyrosine kinase/Janus Kinase inhibitor gusacitinib for the treatment of chronic hand eczema: Results of a randomized phase 2 study

Gusacitinib is an oral inhibitor of Janus and Spleen tyrosine kinases. The efficacy and safety of gusacitinib were evaluated in a double-blind, placebo-controlled, multicenter, phase 2 study in 97 chronic hand eczema patients randomized (1:1:1) to placebo or gusacitinib (40 or 80mg) for 12weeks (part A). Then, in part B (through week 32), the patients received gusacitinib. At week 16, patients receiving 80mg gusacitinib showed a 69.5% (P <.005) decrease in the modified total lesion-symptom score versus 49.0% for 40mg(P =.132), and 33.5% for placebo. Considerable improvement in Physician's Global Assessment was seen in 31.3% of patients receiving 80mg versus 6.3% of placebo (P <.05). A 73.3% decrease in the hand eczema severity index versus placebo (21.7%) occurred in patients receiving 80mg(P <.001). Patients receiving 80mg experienced a considerable decrease in hand pain (P <.05). As early as week 2, considerable reductions over placebo in modified total lesion-symptom score (P <.005), Physician's Global Assessment (P =.04), and hand eczema severity index (P <.01) were observed (80mg gusacitinib). Adverse events included upper respiratory infection, headache, nausea, and nasopharyngitis. Gusacitinib showed rapid improvement in chronic hand eczema patients and was well tolerated, warranting further investigations.

The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis-52 week results from the Dutch BioDay Registry.

BackgroundThe hands are a common predilection site of atopic dermatitis (AD). Dupilumab is licensed for the treatment of AD but not for chronic hand eczema (CHE), while CHE is challenging to treat.ObjectivesTo evaluate the long‐term effect of dupilumab on hand eczema (HE) in patients with AD from the BioDay Registry.MethodsA prospective observational study of adult patients with HE, treated for AD with dupilumab. Patients with a HE severity of at least moderate at baseline were considered for analysis. Patients with other concomitantly systemic immunosuppressive treatments were excluded. Clinical effectiveness on HE severity, using the Hand Eczema Severity Index (HECSI) and photographic guide, and health‐related quality of life, using the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), were evaluated.ResultsA total of 72 patients were included. HECSI‐75 was achieved by 54/62 patients (87.1%) and HECSI‐90 by 39/72 (62.9%) at 52 weeks. Based on the photographic guide, 56/62 patients (90.3%) achieved the endpoint of ‘clear’ or ‘almost clear’. Mean QOLHEQ reduction was −63.5% (95% confidence interval −38.23 to −27.41). There was no difference in response between HE subtypes.ConclusionsThe results from this study hold promise for dupilumab to be a suitable treatment option for isolated CHE.

Translated article] Epidemiological, Clinical, and Allergy Profile of Patients With Atopic Dermatitis and Hand Eczema: Evaluation of the Spanish Contact Dermatitis Registry (REIDAC)

BackgroundHand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. ObjectiveTo describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. MethodsAnalysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. ResultsWe included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). ConclusionsAD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.

Perfil epidemiológico, clínico, y alérgico en pacientes con dermatitis atópica y dermatitis de las manos. Evaluación del Registro Español de Dermatitis de Contacto (REIDAC)

BackgroundHand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. ObjectiveTo describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. MethodsAnalysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. ResultsWe included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). ConclusionsAD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.

New evidence for construct validity and interpretability of the German Quality of Life in Hand Eczema Questionnaire (QOLHEQ).

The Quality of Life in Hand Eczema Questionnaire (QOLHEQ) is a disease-specific instrument used to assess health-related quality of life (HRQoL) in patients with hand eczema according to the domains of (a) symptoms, (b) emotions, (c) functioning, and (d) treatment/prevention. Today it is not clear what a single score of the QOLHEQ in its German-language version means to a patient. It was the aim of this study to band the QOLHEQ score to an anchor question (AQ) in order to obtain meaningful categories of the QOLHEQ to aid its interpretation. In addition, we assessed the minimal important change (MIC) by using anchor- and distribution-based methods. Overall n = 440 hand eczema patients were included in the study. Mean age was 47.5 years (SD 11.9); 38.4% of the sample were female. With a weighted kappa of 0.62, the total QOLHEQ score showed the best agreement for the following band: QOLHEQ of <17 = no impairment; QOLHEQ of 18-28 = slight impairment; QOLHEQ of 29-41 = moderate impairment; QOLHEQ of 42-79 = severe impairment; and QOLHEQ of >79 = very severe impairment. The MIC for the total score was found to be 16.5 points. This banding represents a standardized means of interpreting the QOLHEQ total score. Our results indicate that a banding study should be performed for each language version of the QOLHEQ.

Hand eczema: treatment.

Hand eczema is a highly prevalent, multietiological disease with a wide spectrum of severity and chronicity. The treatment of hand eczema, especially in severe and chronic cases, is a challenge to the dermatologist requiring not only diagnostic and therapeutic, but also excellent patient communication skills. This review discusses the spectrum of therapeutic options for hand eczema, the evidence for their efficacy and safety, and proposes a stepwise approach of intensity of treatment depending on disease severity and chronicity. In the near future, hand eczema patients may benefit from new therapeutic principles such as biologics for the treatment of atopic eczema and topical Janus Kinase inhibitors.

Latent class analysis categorizes chronic hand eczema patients according to skin barrier impairment.

Chronic hand eczema (CHE) is the most common skin disorder affecting the hands. It causes major physical and psychological burden for patients. Classification of CHE remains challenging because of its aetiological and clinical heterogeneity. Using latent class analysis (LCA) on a large categorical data set, our aim was to identify distinct phenotypes in a cohort of unselected CHE patients based upon clinical, genetic, molecular and physical parameters of the affected skin. We performed two independent LCA on a cohort of 71 well-characterized patients that initially integrated clinical severity, total immunoglobulin E plasma level, transepidermal water loss, hydration index, interleukin(IL)-8 lesional skin level, Staphylococcus (aureus and epidermidis) colonization, FLG genotype and the expression (mRNA) of genes involved either in the filaggrin degradation and the natural moisturizing factor synthesis, the cornified envelope formation, the tight junctions' structure and the desquamation process, or encoding antimicrobial peptides and chemokines. The first LCA categorized patients into a group displaying high severity of CHE, high skin barrier impairment, high Staphylococcus colonization, high IL-8 skin level and high frequency of mutation in the FLG gene and a second group with opposite characteristics. The second LCA identified two independent groups of patients categorized by their low or high level of skin barrier impairment and corresponding changes in the expression of the related genes. Our study suggests that the degree of skin barrier dysfunction is the most important parameter to discriminate CHE patients and probably plays a pivotal role in the pathogenesis of the disease whatever the aetiological factors. As far as we know, this is the first study to address this topic using a statistical categorization method without preconception.

Study of clinical profile and association of severity with contact sensitivity of hand eczema patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This present study was to evaluate the clinical profile, severity and its pattern as well as association between contact sensitivity with its severity in hand eczema patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A detailed demographic profile, occupation, history regarding onset of disease, duration, progress of hand dermatitis, aggravating and relieving factors, seasonal variations, presence of atopy in self or family, day to day work, hobbies, and past and present treatment were performed to all cases of hand eczema. Severity of hand eczema was assessed by using hand eczema severity index (HECSI). Patch test was applied to all cases with standard Indian patch test battery as approved by contact dermatitis and occupational dermatoses forum of India. Data was applied by using SPSS version 26 software. P value was taken equal to or less than 0.05 for significant differences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Hand eczema was commonly seen in male and middle age group (31-45 years) patients. Masons, house wives and farmers were mostly infected with hand eczema. Hyperkeratotic eczema and wear and tear dermatitis were the most common type of hand eczema. Potassium dichromate and nickel were the most common antigen/allergens. HECSI score 40-60 was seen in majorities of hand eczema cases. And there was no statistical significant association seen in between severity and positive patch test sensitivity in patients with hand eczema.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Works associated with exposure to various chemical agents are at higher risk for developing hand eczema. Our study will of immense help to patients for identification of contact sensitizer and prevention from hand eczema.&lt;/p&gt;

Multispectral imaging of hand eczema.

Hand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer-dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema. To investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features. Patients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument. Areas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging-based severity assessment and PGA was found. The imaging-based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging-based algorithm was not capable of differentiating hand eczema patients from controls. Multispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful.

Most important contact allergens in hand eczema

The head and hands are the two most common locations for allergic contact dermatitis manifestation. In hand eczema, contact with acontact allergen is afrequent (co-)factor in the triggering and maintenance of eczema. For all hand eczemas lasting longer than 3months, an allergological examination by means of patch testing is recommended. In patients with allergic contact dermatitis of the hands, nickel, MCI/MI, fragrance mixI, cobalt, thiuram mix, Balsam of Peru, chromium and fragrance mixII have been described in amulticenter European study as the most common contact allergens of the standard series. In the information network of dermatological clinics (IVDK) atotal of 56,170 patients were patch-tested in the years 2014 to 2018. In all, 16,807 of these patients (29.9%) suffered from hand eczema, of which 7725 (46.0%) had occupational dermatosis (OD) and 6820 (40.6%) had no OD. For the remaining patients this was unknown. The top 30-list of allergens in hand eczema patients without and with OD included 22common contact allergens, but with different reaction frequency. In hand eczema patients without OD, the following contact allergens also belong to this list: octyl gallate, sorbic acid, tert-butylhydroquinone, propylene glycol, mercury(II) amide chloride, tolubalsam, jasmine absolute, and sandalwood oil. For hand eczema patients with OD, these are instead: tetramethylthiurammonosulfide, tetramethylthiuramdisulfide, 1,3-diphenylguanidine, p‑phenylenediamine, p‑toluylenediamine, iodopropinylbutylcarbamate, glutaraldehyde, and monoethanolamine. In the case of OD of the hands, early involvement of the responsible statutory accident insurance by initiating the dermatologist procedure ("Hautarztverfahren") is necessary in order to work together towards successful allergen avoidance by means of substitution and optimizing personal protective equiment.

Pathogenese des Handekzems

The pathogenesis of hand eczema is multifactorial. Exogenous factors such as skin irritation and contact sensitization contribute to this as well as an endogenous atopic predisposition. This article provides a review of the pathogenetic factors relevant to the development of hand eczema. An evaluation of the current literature on the pathogenesis of hand eczema was carried out. Impairment of the epidermal barrier function plays an essential role for the development of hand eczema. The molecular biological basis and the possible significance of agenetic predisposition beyond atopy are not yet fully understood. Immunological processes involved in the pathogenesis of allergic contact dermatitis and atopic eczema are likely to play arole in the development of certain subtypes of hand eczema. This might contribute to an expansion of the therapeutic armamentarium for hand eczema in the future. The exact understanding of the individual pathogenesis in single hand eczema patients is essential in order to provide specific advice on allergen avoidance, skin protection and basic treatment and to initiate appropriate therapeutic measures.

Epidemiology of hand eczema in Germany : A retrospective view of the past 10 years of hand eczema research in Germany

There is alack of epidemiological data describing patterns of hand eczema with reference to the general German population. Epidemiological data were extracted from all internationally published clinical studies which investigated hand eczema in Germany. A search was carried out for all clinical studies performed in Germany in the previous 10years involving hand eczema patients. Inclusion criteria were that at least one author was listed with aGerman affiliation, that the study included original data and was published in an international journal with peer review. This review included 39studies, which were performed based on 29original data sets. The median proportion of women was 53.7% and the median age 45.1 years. The 1‑year prevalence of hand eczema varied depending on the sample and type of data collection from 0.24% to 9.2%. The lifetime prevalence was estimated to be 2.6-16.0% and the point prevalence in dermatological practice was 6.7 %. In studies assessing the impact of hand eczema in specific occupations, women were underrepresented, large studies were carried out for metal workers but only a few small studies for nursing personnel. There is alack of knowledge concerning the epidemiology of hand eczema in the general German population. While international studies found the first occurrence of hand eczema to be between the ages of 26 and 28years, the mean age of patients seen in private dermatological practice in Germany was 20years higher. These findings suggest that patients do not consult adermatologist when hand eczema first appears, which can lead to amore severe course of the disease.

Effect of dupilumab on hand eczema in patients with atopic dermatitis: An observational study.

Systemic treatment options for chronic hand eczema are limited. Dupilumab is used in atopic dermatitis (AD) but is not licensed for (isolated) hand eczema. In this observational prospective study we aimed to determine the response of hand eczema to dupilumab in patients with AD. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. Primary outcome was a minimum improvement of 75% on the Hand Eczema Severity Index after 16 weeks (HECSI‐75). Secondary outcomes were severity, measured using the Photographic guide; quality of life improvement as patient‐reported outcome, measured using the Dermatology Life Quality Index (DLQI); and AD severity, measured using the Eczema Area and Severity Index (EASI). Forty‐seven patients were included (32 males; mean age, 45 years). HECSI‐75 was achieved by 28 (60%). Mean HECSI score reduction was 49.2 points (range, 0–164; 95% within‐subject confidence interval, 46.4–52.0), which was already significantly decreased after 4 weeks (P < 0.001). DLQI score mean improvement was 8.8 points (standard deviation [SD], 6.0) or 70.0% decrease (SD, 26.4) (P < 0.001). Eighteen patients (38%) were classified as responders on the Photographic guide. There was no difference in response between chronic fissured and recurrent vesicular clinical subtypes. Similar percentages of patients achieving EASI‐75 and HECSI‐75 were seen after 16 weeks. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. This raises the question whether a response will also be seen in isolated hand eczema.

Hand eczema patients' knowledge of skin protection following a guided talk-A retrospective study with a follow-up questionnaire.

Several studies have assessed the effect of patient education regarding hand eczema (HE) severity and quality of life. Few studies, however, have evaluated patients' knowledge. To examine knowledge of skin protection in HE patients following a guided talk, and to identify variables associated with knowledge. HE patients referred to the outpatient dermatological clinic, Bispebjerg Hospital, between January 2013 and July 2014 were offered a guided talk on HE prevention. HE severity and the Dermatology Life Quality Index (DLQI) score were assessed. A questionnaire comprising 10 questions about skin protection was sent 1 to 2.5 years later. One hundred and twenty patients responded to the questionnaire (response 53.5%). The mean percentage of correct answers was 74.7%. Sixty per cent responded correctly to at least eight questions. Male sex, older age and education for >5 years were associated with a low level of knowledge. Education for 3 to 4 years (P = 0.045) was associated with a higher level of knowledge. No significant impact of previous/current atopic dermatitis, HE severity or previous information on skin protection was found with respect to level of knowledge. Females and patients with education for 3 to 4 years showed the highest level of knowledge, whereas males, older patients and patients with education for >5 years should be brought more into focus in skin protection programmes.

Filaggrin gene mutations in hand eczema patients in the Indian subcontinent: A prospective case-control study.

There are no Indian studies on the association between filaggrin gene (FLG) mutations and any dermatosis, including hand eczema. To determine the prevalence of FLG mutations in Indian hand eczema patients, and examine associations between such mutations and any aetiological type of hand eczema. A total of 163 patients and 86 controls were included. Patients were categorized into aetiological subtypes of hand eczema. FLG polymorphisms (S2889X, 2282del4, R501X, and Q2417X) were determined in patients and controls, and correlated with subtypes. The prevalences of FLG mutations were 33.7% in cases and 3.5% in controls. Mutations in S2889X constituted 96.4% of all FLG mutations. No carrier of R501X and Q2417X mutations was identified. Among 55 patients with mutations, irritant contact dermatitis (ICD) with or without atopy was found in 22 patients, allergic contact dermatitis (ACD) with or without atopy was found in 12, and idiopathic hand eczema was found in 12. There was a significant association of FLG mutations with ICD with or without atopy, ACD without atopy, and idiopathic subtypes. FLG mutations were associated with more severe hand eczema. S2889X mutation is commoner in patients than in controls. FLG polymorphisms are associated with specific subtypes of hand eczema and severe disease.