The purpose of the study was to evaluate a self-administered questionnaire on hand dermatitis that was developed to identify persons with hand dermatitis in epidemiological studies. A total of 109 nurses were subject to dermatological examination of the hands within 1 month of returning the questionnaire. 2 types of questionnaire diagnoses were made: a 'symptom-based' diagnosis and a 'self-reported diagnosis'. These were compared to the medical diagnosis of hand dermatitis. The prevalence of hand dermatitis in the 12 months before the study, based on the medical diagnosis, was 18.3%. The prevalence according to the symptom-based diagnosis and the self-reported diagnosis was 47.7% and 17.4%, respectively. The sensitivity and specificity of the symptom-based diagnosis were 100% and 64%, respectively. It is concluded that the symptom-based diagnosis can be used as screening instrument for the detection of cases in large study populations, if followed by dermatological examination of persons with a positive diagnosis. The sensitivity and specificity of the self-reported diagnosis were 65% and 93%, respectively. It is concluded that the self-reported diagnosis can be used to obtain a rough estimate of the prevalence, although comparison of prevalence figures between study populations may be distorted due to a difference in reporting of hand dermatitis. The results of the study illustrate the size of the differences in prevalence estimates that may arise as a result of differences in the definition and method of diagnosing hand dermatitis.

In 1979, the inhabitants of a geographically defined area were examined for skin disorders of the hands and forearms. In 1982 this cohort was invited for re-examination. In persons with eczema, patch testing was performed. Irritant factors were found to play a rôle in 73% of the cases, whereas a contact allergy could be detected in 30%. The most frequent allergens were nickel sulphate (20%), potassium dichromate (6%) and cobalt chloride (4%). In some persons with a definite history of allergy to metals, no positive patch test with nickel, chromate or cobalt could be obtained; other mechanisms may be involved. Significantly more positive patch tests were found among persons with an eczema of longer than 2 years duration compared with persons with eczema present for a shorter period of time, indicating that many cases of eczema are primarily of irritant nature, but later complicated by sensitisation. In 41%, the eczema was healed. A poor healing tendency was observed in those with a combination of irritant and allergic eczema. Relatively few ascribed healing to medical treatment.

The susceptibility of the skin to various irritants was investigated with the aim of determining the role of the barrier function of the stratum corneum, skin dryness and whether a history of atopic dermatitis (AD) was a factor. The transepidermal water loss (TEWL) was measured using an evaporimeter and skin hydration using a Corneometer and by visual scoring. The group with a history of AD (n = 20) had a lower pre-exposure barrier function and a higher TEWL value following irritant exposure than the group with a history of allergic contact dermatitis (n = 18) and a control group (n = 18). Clinically dry skin was more susceptible than normal skin, though no difference was noted in the pre-exposure barrier function. The increased susceptibility to irritants in those with a past history of AD was probably due to impaired barrier function and/or the presence of a dry skin.

Synopsis Of 1609 individuals who were interviewed and asked whether they had experienced adverse reactions to cosmetics or toiletry products in the preceding 5 years, 196 (12.2%) claimed to have experienced some such reaction. Females (n= 124) mostly attributed their complaints to soap (41%), facial creams (33%), deodorant (25%), shampoo (16%) and eye shadow (11%). Men (n= 72) complained about adverse effects from soap (49%), aftershave (22%), deodorant (19%) and shower foam (12%). Both in women and in men, most reactions were localized on the face (60% resp. 33%), followed by the hands (19% resp. 21%) and the axillae (18% resp. 14%). The majority of patients could solve the problem by stopping the use of the suspected product and purchasing a different brand. Nevertheless, medical consultation was sought by more than 30% of all patients. Presumably, the majority of all adverse effects were caused by irritation; contact allergic reactions are infrequent.

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