Hand Eczema Severity Index Score Research Articles

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.

Impact of an eHealth Smartphone App on Quality of Life and Clinical Outcome of Patients With Hand and Foot Eczema: Prospective Randomized Controlled Intervention Study.

Chronic hand and foot eczema is a polyetiological dermatological condition. Patients experience pain, itching, and sleep disturbances and have a reduced quality of life. Skin care programs and patient education can improve the clinical outcome. eHealth devices offer a new opportunity to better inform and monitor patients. This study aimed to systematically analyze the effect of a monitoring smartphone app combined with patient education on the quality of life and clinical outcome of patients with hand and foot eczema. Patients in the intervention group received an educational program; attended study visits on weeks 0, 12, and 24; and had access to the study app. Patients in the control group attended the study visits only. The primary end point was a statistically significant reduction in Dermatology Life Quality Index, pruritus, and pain at weeks 12 and 24. The secondary end point was a statistically significant reduction in the modified Hand Eczema Severity Index (HECSI) score at weeks 12 and 24. This is an interim analysis at week 24 of the 60-week randomized controlled study. In total, 87 patients were included in the study and randomized to the intervention group (n=43, 49%) or control group (n=44, 51%). Of the 87 patients, 59 (68%) completed the study visit at week 24. There were no significant differences between the intervention and control groups regarding quality of life, pain, itch, activity, and clinical outcome at weeks 12 and 24. Subgroup analysis revealed that, compared with the control group, the intervention group with an app use frequency of fewer than once every 5 weeks had a significant improvement in the Dermatology Life Quality Index at weeks 12 (P=.001) and 24 (P=.05), in pain measured on a numeric rating scale at weeks 12 (P=.02) and 24 (P=.02), and in the HECSI score at week 12 (P=.02). In addition, the HECSI scores assessed on the basis of pictures taken by the patients of their hands and feet correlated strongly with the HECSI scores recorded by physicians during regular personal visits (r=0.898; P=.002) even when the quality of the images was not that good. An educational program combined with a monitoring app that connects patients with their treating dermatologists can improve quality of life if the app is not used too frequently. In addition, telemedical care can at least partially replace personal care in patients with hand and foot eczema because the analysis of the pictures taken by the patients correlates strongly with that of the in vivo images. A monitoring app such as the one presented in this study has the potential to improve patient care and should be implemented in daily practice. Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963.

The impact of hand eczema severity on quality of life in workers engaged in lock making: A cross-sectional study from tertiary care hospital

Objectives: Hand eczema is a frequent condition that dermatologists commonly encounter. It leads to considerable impact on quality of life (QOL) by significant functional impairment, disruption of work, and discomfort in the working population. The symptoms range from a minor discomfort to a serious debilitating and long-term conditions. Workers engaged in lock making constitute an economically poor section of society. They are exposed to different kinds of allergens, hence are predisposed to develop hand eczema. The aim of this study was to study the impact of hand eczema on the QOL in workers engaged in lock making. Materials and Methods: A total of 65 workers engaged in lock making and suffering from hand eczema, who visited the out-patient department of dermatology for 6 months, were included in this study. Data on QOL were obtained through a questionnaire devised by Finlay et al. Hand eczema severity index (HECSI) was used to assess the severity of disease. Associations were drawn regarding Dermatology Life Quality Index (DLQI) and HECSI scores with age, sex, duration of disease, number of episodes of illness, and number of sick leaves. Results: Sixty-five patients suffering from hand eczema and engaged in lock making participated in this study, of which 52 (80%) were male and 13 (20%) were female. The commonest age group affected was 36–40 years (41.53%). The most common morphological pattern seen was hyperkeratotic palmar eczema in 50.7% (n = 33) patients followed by chronic dry fissured eczema in 35.3% (n = 23). The mean HECSI score was 19.52 (Standard deviation [SD] = 9.416) and mean DLQI score was 9.92 (SD = 2.426). A significant association of DLQI was seen with duration of disease (P = 0.011), number of episodes of eczema (P = 0.003), and number of sick leaves taken (P = 0.005). Similarly, HECSI score showed significant association with duration of disease (P = 0.002) but not with number of episodes of eczema (P = 0.056). No significant association was found between hand eczema severity and QOL. Being a OPD-based study, it may not truly reflect the community data. Patch test could not be done as workers were poor and could not afford it. Conclusion: Lock makers with hand eczema showed considerable impairment of their QOL. Further, they are more prone to absenteeism from work.

Baricitinib treatment of severe chronic hand eczema: Two case reports

Baricitinib treatment of severe chronic hand eczema: Two case reports

26900 A phase 2b trial evaluating the efficacy of delgocitinib cream for the treatment of chronic hand eczema (CHE) using and validating the Hand Eczema Severity Index (HECSI)

Aim: To evaluate the effect of different doses of the pan-JAK inhibitor delgocitinib cream in patients with mild-severe CHE by applying clinically relevant thresholds based on the HECSI score for severity assessment and, using the same data to validate HECSI.

Synergistic Effects of the 308-nm Excimer Light and Topical Calcipotriol for the Treatment of Chronic Hand Eczema: A Randomized Controlled Study

Background: Though topical corticosteroid is a standard treatment for chronic hand eczema (CHE), it can cause many adverse effects. Topical calcipotriol and monochromatic 308-nm excimer light (MEL) are new alternative therapies for several dermatoses, including CHE. Objective: This study aims to compare the efficacy of the combination of MEL and topical calcipotriol versus topical calcipotriol alone. Methods: One hand of the participants was randomly assigned to be irradiated with MEL twice weekly and topical calcipotriol applied twice daily while the other hand was assigned to receive only topical calcipotriol twice daily for 8 weeks. Then, only petrolatum ointment was applied during the 4-week follow-up period. Hand Eczema Severity Index (HECSI) and modified Total Lesion Symptom Score were assessed by a blinded investigator, and a visual analogue scale score of itching symptoms was graded by the participants. Results: In total, 36 hands from 18 subjects completed the protocol. On the combination-treated sides, the mean HECSI score was significantly reduced by 25% (p = 0.015) from the 4th week. Then, it was gradually decreased to 57 and 65% (p < 0.001) at the 8th week and at the follow-up visit, respectively. For the monotherapy-treated sides, the mean HECSI score was reduced to 41% (p = 0.001) and 49% (p < 0.001) at the 8th and 12th week, accordingly. At the end of the treatment period, itching scores were significantly decreased by around 64% (p < 0.001) and 51% (p = 0.002) on the combination-treated and the monotherapy-treated sides. No serious and persistent adverse reactions were found. Conclusion: The combined MEL and topical calcipotriol may be considered as an alternatively effective treatment for CHE.

Hand eczema treatment: Change behaviour with text messaging, a randomized trial.

Irritant contact dermatitis is the most common type of hand eczema. Effective treatment usually involves avoidance of irritants and use of appropriate topical medication. In this study, the effectiveness of using text messaging addressing preventive behaviours and appropriate medication adherence was evaluated. Patients who were admitted to Istanbul Training and Research Hospital Dermatology Department March 1, 2015 to July 31, 2015, and diagnosed with hand eczema were enrolled. Patients were randomly divided into the SMS group and the non-SMS group. Text messages were sent to the mobile phones of the patients in the SMS group. Severity of hand eczema, compliance to treatment, patients' information level, adherence to preventive behaviours, and the protective behaviour score were evaluated at baseline, and at the 4th and 8th week. Eighty-one patients with hand eczema were included in the study. After 8 weeks, the decrease in the Hand Eczema Severity Index score was 70.2% (SD 35.2) in the SMS group and 38.9% (SD 67.7) in the non-SMS group (P = .017). Sending SMS to patients increased the use of moisturizer. There was no statistically significant difference in other behaviours. This study demonstrated that text messaging improves the treatment success and specifically the frequency of moisturizer use in patients with hand eczema.

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;

Effectiveness of a skin care programme for the prevention of contact dermatitis in healthcare workers (the Healthy Hands Project): A single-centre, cluster randomized controlled trial.

BackgroundHealthcare workers (HCWs) are at risk of developing hand dermatitis (HD). Guidelines recommend moisturizers to prevent HD, but in practice their effectiveness has been poorly investigated.ObjectivesTo assess whether an intervention aimed at improving skin care leads to a reduction in HD severity.MethodsIn this 1‐year randomized controlled trial, 9 wards (285 HCWs) were allocated to an intervention group (IG), and 10 wards (216 HCWs) were allocated to the control group (CG). The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCWs. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (HECSI) score (ΔHECSI) and change in natural moisturizing factor (NMF) level (ΔNMF).ResultsAt 12 months, the rates of loss to follow‐up were 41% and 39% in the IG and the CG, respectively. The HECSI score was reduced in the IG by −6.2 points (95%CI: −7.7 to −4.7) and in the CG by −4.2 points (95%CI: −6.0 to −2.4). There was no significant difference in ΔHECSI or ΔNMF between the groups. Relative improvement in the HECSI score was significantly higher in the IG than in the CG (56% vs 44%). In a subgroup of HCWs with mild HD, the IG showed a larger HECSI score decrease than the CG (P < 0.001).ConclusionAlthough there was no significant effect on the primary outcomes, the intervention showed overall positive effects on the HECSI score.

Hand eczema in nurses, nursing auxiliaries and cleaners-A cross-sectional study from a tertiary hospital in western India.

Healthcare workers have a high risk of developing hand eczema. To determine the prevalence and severity of dermatologist-determined hand eczema among healthcare workers, carry out patch testing, and correlate the findings with impairment in quality of life (QoL) and demographic and vocational factors. Seven hundred and ten healthcare workers (279 nurses, 246 cleaners, and 185 nursing auxiliaries) were screened for the presence of hand eczema. Severity of eczema was calculated with the Hand Eczema Severity Index (HECSI), and QoL was measured with the Dermatology Life Quality Index (DLQI). Individuals with hand eczema were also patch tested. The point and 1-year prevalences of hand eczema were 7.2% and 18.9%, respectively. Hand eczema was significantly associated with atopic dermatitis. The mean HECSI score was 9.39; it was significantly higher in patients with atopic dermatitis and those with recurrent hand eczema. The mean DLQI score was 5.37. Cleaning staff had significantly greater impairment in QoL. HECSI and DLQI scores were positively correlated. Patch testing showed that thiuram mix, antibiotics and cleansers as sensitizers were over-represented in healthcare workers as compared with controls. Hand eczema was particularly common in hospital cleaners and staff with atopic dermatitis. Further studies are needed to address the burden of occupational hand eczema and develop guidelines for its management at a national level.

Efficacy and safety of intralesional triamcinolone acetonide in the treatment of chronic hand eczema

This randomized controlled clinical trial was conducted to assess the efficacy and safety of intralesional triamcinolone acetonide in the treatment of chronic hand eczema comparing with topical clobetasol propionate. A total 60 patients of chronic hand eczema were recruited in the study. Thirty patients (Group A) were treated with intralesional triamcinolone acetonide and the rest 30 (Group B) with topical clobetasol propionate. Severity and improvement were assessed using Hand Eczema Severity Index (HECSI) score. The patients of both groups were followed up at 4th week and 12th week. In Group A, median HECSI score at baseline, 4th week and 12th week were 3, 20 and 20 respectively; whereas these scores were 54, 10 and 8 in Group B. In both groups, HECSI score was decreased gradually but the rate was higher in Group B than Group A (p&lt;0.05). Thinning of skin, an adverse effect, was seen in patients of both the intralesional triamcinolone acetonide (10%) and topical clobetasol propionate (16.7%) groups (p&gt;0.05). The result of this study demonstrates that intralesional triamcinolone acetonide is effective and safe in treating chronic hand eczema but less effective than the topical clobetasol.

Photographic Documentation and Hand Eczema Severity Index for Severity Assessment of Hand Eczema.

Hand eczema (HE) is a fluctuating disease, and an objective assessment of HE severity is coveted. This study was undertaken to test the association between Hand Eczema Severity Index (HECSI) score and panel scores of photographs taken by dermatologists. A total of 33 patients with mild HE were included. The patients were part of an intervention study, and HECSI scores and standardized photographs were taken at baseline and at follow-up after 5 months. Actual change in HECSI score was compared with rating of change from photographs. A total of 15 dermatologists were engaged in blinded evaluation of photographs. The highest correlation coefficients between delta HECSI scores and delta panel scores of photographs in the first and second evaluation rounds were found for moderate improvement and moderate worsening, rs = -0.46 (P = 0.009) and 0.52 (P = 0.003), respectively, and major worsening, r = 0.41 (P = 0.021). With respect to minor changes, no statistically significant correlations were found (P > 0.05). In patients with mild HE, photographic assessment was found useful for major and moderate changes only. Further studies would need to be performed in patients with moderate or severe HE, to evaluate whether clinical photographs are able to capture similar changes as HECSI scores.

Impact of hand eczema severity on quality of life: a hospital based cross-sectional study

Introduction: Hands are important organs of expression, communication, and are necessary for household and workrelated activity. Thus, hand eczema can deteriorate quality of life. This study aims to find impact of hand eczema severity on quality of life. Methods: A cross-sectional study was done in a tertiary care hospital in Punjab from January to July, 2014. A total of 69 hand eczema patients of either gender aged ≥16 years were enrolled after taking an informed consent. Disease severity was assessed by hand eczema severity index (HECSI) score; and quality of life by dermatology life quality index (DLQI) questionnaire. The data was evaluated using statistical tests like frequency, chi-square, oneway ANOVA, t-test etc. Results: Out of 69 patients, 63.8% were males and 36.2% females. The commonest age group affected was 21-40 years (55.1% cases). Aggravating factors were reported by 76.8% patients, the commonest trigger being summer season (47.8%) followed by soaps and detergents (21.7%). The mean±S.D. for DLQI was 6.22±5.42 and for HECSI was 18.54±17.05. There was no statistically significant impact of age, occupation and duration of disease on DLQI or disease severity except gender (p-value being 0.028 for DLQI; 0.035 for HECSI). There was no significant correlation between HECSI score and DLQI. Conclusion: Majority of the patients with hand eczema had a significant impairment of their quality of life. There was a statistically significant impact of gender on hand eczema severity; although no correlation was found between DLQI and HECSI score in this study.

Hand eczema and stratum corneum ceramides.

Hand eczema (HE) is a multifactorial disease, comprising different aetiological conditions and different morphologies. There are two aetiologically distinct groups of HE recognised: exogenous, such as contact dermatitis (allergic and/or irritant HE) and endogenous, such as the classic hyperkeratotic HE. Differences in the skin barrier properties of these two conditions could theoretically be expected. To examine whether differences exist in the lipid profile and the susceptibility of the stratum corneum (SC) in patients with allergic/irritant HE and those with hyperkeratotic HE. Using cyanoacrylate, SC samples were taken from 23 patients with allergic/irritant HE and 15 with hyperkeratotic HE for lipid analysis by high-performance thin-layer chromatography (HPTLC). Samples were also taken from adjacent, unaffected skin. Severity of HE was assessed by the Hand Eczema Severity Index (HECSI), and skin barrier susceptibility was assessed by measuring transepidermal water loss (TEWL) after a 24-hour patch test with sodium lauryl sulfate (SLS). No statistically significant difference was found between groups for the lipid analysis or for skin susceptibility to SLS. We found a significantly higher HECSI score for hyperkeratotic HE compared with irritant or allergic HE (P=0.02). There appears to be no difference in skin barrier between allergic/irritant HE (exogenous eczema) and hyperkeratotic HE (endogenous eczema) with regard to SC lipids or susceptibility to SLS.

Evidence-based training as primary prevention of hand eczema in a population of hospital cleaning workers.

Skin disorders accounted for one third of all recognised occupational diseases in Denmark in 2010. Wet work is a risk factor for the development of occupational hand eczema. The consequences of occupational hand eczema include sick leave, loss of job and impaired quality of life. The aim of the present study was to investigate exposures related to cleaning and the effect of an evidence-based educational intervention on the prevention of hand eczema among hospital cleaners. The intervention consisted of a 1 hr course in hand protective behaviour. All full-time cleaners working at Bispebjerg Hospital in January 2013 were invited to participate. The outcome measures were self-reported skin behaviour, exposures, knowledge of skin protection and hand eczema severity index (HECSI). One hundred and five cleaners were invited to participate, of these 86 (82%) were included. At follow-up after 3 months there was a shift towards fewer daily hand washings and hand disinfections (p < 0.001 and p = 0.001 respectively). The number of correct answers to the knowledge questions rose from 6.3 to 7.3 (p = 0.006). The mean HECSI score decreased from 2.8 to 1.8 at follow-up (p = 0.002). Data indicates a positive effect of a low-cost on-site educational intervention for hospital cleaners.

Economic evaluation of an integrated care programme for patients with hand dermatitis

Hand dermatitis has a large impact on society as a whole. To evaluate the cost-effectiveness of integrated, multidisciplinary care as compared with usual care (UC) for patients with moderate to severe chronic hand dermatitis after 52 weeks. Patients (n = 196) visiting the dermatology department at one of the participating hospitals for hand dermatitis were randomized to integrated care (IC) or UC. IC was provided by a multidisciplinary team, and integrated clinical and occupational care to optimize treatment of hand dermatitis. Effect outcomes were clinical assessment of hand dermatitis with the Hand Eczema Severity Index (HECSI), and disease-specific quality of life, work performance and quality-adjusted life-years with the EQ-5D. Incremental cost-effectiveness ratios (ICERs) were calculated. The ICER indicates the additional investment needed to gain one unit of effect. The HECSI difference between both groups after 52 weeks was 8.7 (standard error 5.3, 95% confidence interval -1.8-18.9). No differences were found on secondary outcome measures. Mean total costs with IC (€ 3613; SD 798) were significantly higher than with UC (€ 1576, SD 430). The ICER for improvement in HECSI score was -247. IC was not considered to be cost-effective as compared with UC. The probability that IC was cost-effective was 90% at a ceiling ratio of € 1500 per additional point improvement in HECSI score. Integrated care was neither cost-effective, nor effective after 12 months follow-up, in contrast to our findings after 6 months. Decision makers should decide whether the clinical benefits of integrated care on the short term outweigh the higher costs compared to usual care.

Fingerprint Changes and Verification Failure Among Patients With Hand Dermatitis

To determine the prevalence of fingerprint verification failure and to define and quantify the fingerprint changes associated with fingerprint verification failure. Case-control study. Referral public dermatology center. The study included 100 consecutive patients with clinical hand dermatitis involving the palmar distal phalanx of either thumb and 100 age-, sex-, and ethnicity-matched controls. Patients with an altered thumb print due to other causes and palmar hyperhidrosis were excluded. Fingerprint verification(pass/fail) and hand eczema severity index score. Twenty-seven percent of patients failed fingerprint verification compared with 2% of controls. Fingerprint verification failure was associated with a higher hand eczema severity index score (P.001). The main fingerprint abnormalities were fingerprint dystrophy (42.0%) and abnormal white lines (79.5%). The number of abnormal white lines was significantly higher among the patients with hand dermatitis compared with controls(P=.001). Among the patients with hand dermatitis, theodds of failing fingerprint verification with fingerprint dystrophy was 4.01. The presence of broad lines and long lines was associated with a greater odds of fingerprint verification failure (odds ratio [OR], 8.04; 95% CI, 3.56-18.17 and OR, 2.37; 95% CI, 1.31-4.27, respectively),while the presence of thin lines was protective of verification failure (OR, 0.45; 95% CI, 0.23-0.89). Fingerprint verification failure is a significant problem among patients with more severe hand dermatitis. It is mainly due to fingerprint dystrophy and abnormal white lines. Malaysian National Medical Research Register Identifier: NMRR-11-30-8226

Impact of hand eczema severity on quality of life

Background:Hand eczema is a common disease seen in dermatological practice comprising of a spectrum ranging from mild disease to a severe distressing and chronic course with a negative impact on the quality of life.Aim:To assess the impact of hand eczema severity on quality of life.Materials and Methods:Patients with hand eczema were enrolled in a prospective study. Disease severity was assessed by hand eczema severity index (HECSI) score and quality of life by dermatology life quality index (DLQI) questionnaire.Results:Forty-six patients participated of which 22 (47.8%) were males and 24 (52.2%) females. The commonest age group affected among men and women was 50-59 years (31.8%) and 40-49 years (41.7%) respectively. History of atopy was found in 23.9% and 63% had persistent disease. In 28 (60.9%), the trigger was washing soaps and detergents of which 21 (87.5%) were housewives. Of those employed, 27.7% reported loss of work days. The mean HECSI score was 14.46 (S.D = 20.98) and mean DLQI score was 9.54 (S.D = 5.62). Gender, age, occupation and duration of disease did not significantly affect the quality of life or disease severity. Increased episodes of eczema (>4 episodes/year) showed a statistically significant correlation with DLQI (P value = 0.021). There was no significant correlation between HECSI score and DLQI in this study.Conclusion:Majority of the patients with hand eczema had a significant impairment of their quality of life. The impairment of quality of life in this study was mainly dependent on increased frequency of the eruptions and not on hand eczema severity.

Clinical characteristics and consequences of hand eczema – an 8‐year follow‐up study of a population‐based twin cohort

Few population-based clinical follow-up studies on hand eczema are reported. 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. 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. 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%. The clinical picture and consequences of hand eczema vary; however, the majority experience chronic symptoms.

The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability

There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE. Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment. ICC for intraobserver agreement was 0.90. Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.