Two or More Signs Plus Itch May Define Hand Eczema

Lorraine L. Janeczko, MPH

August 08, 2022

Considering hand eczema (HE) to be at least two signs plus itch may be a good first step toward defining the condition, a questionnaire-based study suggests.

"Our data emphasizes the importance of differentiating between studies assessing the HE prevalence based on self-reported HE versus self-reported signs," Yasemin Topal Yüksel, MD, and co-authors from Bispebjerg and Frederiksberg Hospital at the University of Copenhagen, write in Contact Dermatitis. "For a specific set of diagnostic criteria for HE, we consider two signs or more combined with itch as a promising first step."

Various definitions of hand eczema exist in the literature, and the clinical diagnosis of HE is determined by the clinician's overall impression, not a specific set of criteria, the authors write.

The accuracy of self-reported HE is unclear, and how well self-reported signs and symptoms of skin lesions that indicate HE correlate with self-reported HE is also unknown.

To help develop standardized diagnostic HE criteria that providers can use to distinguish between HE and other skin conditions such as dry or hardened skin, Yüksel and her colleagues analyzed healthcare workers' self-reports of having signs and symptom of HE and compared them with their self-reports of having the condition HE.

The researchers invited 1663 healthcare workers — nurses, auxiliary nurses, physicians, biotechnicians, midwives, and physiotherapists — at four local hospitals to complete a digital questionnaire about their skin health in February 2021, whether or not they had a history of HE.

The 795 workers who responded were asked about how their hands had changed between March 2020 and February 2021 during the COVID-19 pandemic, including whether they had dryness, erythema, fissures, itch, scaling, stinging, or vesicles. They were also asked, "Have you had HE since 1st of March 2020?" The authors correlated the respondents' self-reported signs and symptoms with their self-reporting of having the condition HE and found that:

  • Overall, 11.9% of participants reported HE.

  • Of these, 91.4% reported at least one skin sign, compared with 32.3% of respondents who did not self-report HE.

  • The highest sensitivity and specificity occurred with erythema (77.4% sensitivity and 78.2% specificity) and itch (78.5% sensitivity and 78.6% specificity), both separately and combined. When two or more signs — erythema, scaling, fissures and vesicles — were combined with itch, sensitivity reached 52.7% and specificity reached 93.9%.

The authors call for further related research. "Future steps should include expert panel discussions and a clinical diagnostic accuracy study with dermatologist-diagnosed HE followed by external validation for determination of a final set of standardized diagnostic criteria for HE," they write.

Identifying and Mitigating HE During the Pandemic

Shanina C. Knighton, PhD, RN, CIC, infection preventionist, nurse scientist, and adjunct assistant professor in the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, told Medscape Medical news that during the COVID-19 pandemic, identifying hand eczema among healthcare workers is important. "During the pandemic, workloads may have increased beyond previous levels," she said by phone. "Cleaning, sanitizing, and other products are being used with greater frequency."

"Regarding hand eczema among healthcare workers, the greater frequency with which their skin comes in contact with products may cause conditions they already have to flare up," she added.

Shanina C. Knighton, PhD, RN, CIC

Knighton, who was not involved in the study, advises that healthcare facilities have dermatologists available to evaluate the use of the products that workers come in contact with and how those products affect their skin. "Having a dermatologist available during the staff onboarding process and throughout their employment is necessary because issues like hand eczema can hinder not only individuals at work but also their quality of life when they're outside the work setting," she said.

"Among healthcare workers, hand eczema may be affected not only by the products they come in contact with at work, but also by those they use away from work, which may be harsh to their skin," she added.

"We need to acknowledge that we have a significant number of healthcare workers living in poverty who may need to wash their clothes and other items by hand. Their hands come in contact with harsh chemicals even before they touch the hand sanitizer and other products at work," she noted. "I don't think those factors are often considered."

Knighton advises healthcare workers to speak with their facilities' infection preventionists, quality and safety officers, and medical and nursing leadership.

"Be an advocate for your own health and realize that hand health is very important," she advises.

The authors and Knighton report no relevant financial relationships.

Contact Dermatitis. Published online July 9, 2022. Full text

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