Hand eczema and patch testing – A clinico-allergiological study

Abstract

Background: Hand eczema is a common and distressing condition. Most of the cases of hand eczema have a multifactorial etiology. Most of the cases of hand eczema are irritant contact dermatitis due to irritants like soaps and detergents, but a large number of cases occur due to contact allergy to specific substances. Patch testing is an important diagnostic tool for identification of the probable allergens responsible for the eczema. Objectives: The aim of this study was to study the patterns of hand eczema and to identify the most common allergens causing dermatitis using patch testing. Patients and methods: Thirty consecutive patients (M: F=11: 19) with hand eczema were examined, detailed history was taken, and the pattern of dermatitis was noted. All of them were subjected to patch testing using the Indian Standard Series. Results: The study included 11 (36.67%) men aged between 23and 54 years and 19 (63.33%) women aged between 28 and 49 years. The majority of patients were in the21-50 years age group (86.67%; n=26). The most common occupational group among females was housewives (63.15%, n=12) while among the males the most common occupational group was farm workers (54.54%, n=6). Discoid eczema was the commonest morphological pattern seen in 36.67% (n=11) of cases, followed by hyperkeratotic eczema in 30% (n=9). On performing a patch test, 21(70%) patients showed positive reaction to one or more allergens. In our study, positivity through patch test was found to be highest for nickel (33.33%), followed by potassium dichromate (28.57%), paraphenylenediamine, parthenium, fragrance mix and cobalt chloride. Potassium dichromate was the most common allergen in males while among females, nickel was the predominant allergen. Conclusions: Hand eczema is a common problem predominantly seen in females in the middle age groups. It can be both due to exposure to irritants and due to development of contact sensitivity to various allergens with nickel and chromates being the most commonly implicated agents.

Prevalence of dermatoses among hairdressers and beauticians in Srinagar, the capital city of Kashmir, India

“…Hand eczema was the most commonly encountered dermatosis and this was consistent with previous studies [6,8,9]. Three patterns of hand eczema were encountered: classic hand eczema, presenting with scaly plaques on the palmar surfaces of the hands, occurring due to exposure to a myriad of allergens; interdigital eczema, involving the web spaces of the fingers, seen in cases frequently involved in wet work such as shampooing clients and spa treatments, occurring typically due to the passage of hair between the hairdresser's fingers during these procedures, increasing exposure to irritants; and threading eczema, most commonly seen in the form of linear fissures with scaling and involving the lateral aspect of the distal phalanx of the index finger, occurring due to constant friction caused by a thread twisted around the index finger in threading procedures such as hair removal.…”

Plantar dysidrosis: epidemiological, clinical and mycological study of 112 cases

“…Le recueil des données a été fait par une fiche d'exploitation relevant les données épidémiologiques et cliniques. Tous les sujets inclus dans l'étude ont été adressés au laboratoire de Parasitologie mycologie (5,4) ; eczéma de contact (5,4) ; sport (5,4%) ; tabac (12,5%) ; bains maures (17,9%) ; diabète (31,3) ; obésité (7,1%) ; hyperhydrose (6,3%) ; port de chaussures fermés (9,8%). L'atteinte plantaire était unilatérale dans 63,6% des cas, associées à une atteinte du dos des pieds (7,3%), une atteinte palmaire (10,9%), un intertrigo interorteil (44,5%), une atteinte unguéale (65,5%).…”

“…Le caractère multifactoriel dans l'étiologie de la dysidrose est fort probable [4]. La dysidrose peut être aussi soit une localisation palmoplantaire d'un eczéma de contact systémique, soit une réaction «ide» à un eczéma de contact à distance [5]..…”

“…certaines dysidroses semblent s'améliorer par la toxine botulique et l'ionophorèse [8]. Le travail en milieu chaud et humide, en particulier lorsque les mains sont en contact répété avec des produits irritants, favorise les poussées de dysidrose, qui s'aggravent en milieu occlusif (gants en caoutchouc) Sensibilisation aux métaux dont le nickel [5].…”

A phytotherapeutic approach to hand and feet dyshidrosis using vegetables (espcially mashed celeriac applied topically)

“…But some, like dyshidrotic eczema, look and act slightly different than others. It is possible to have dyshidrotic eczema and another form of eczema such as contact dermatitis, at the same time [1].…”