Prevalence and Morphology of Hand Eczema in Patients with Atopic Dermatitis

Simpson, Eric L.; Thompson, Michele M.; Hanifin, Jon M.

doi:10.2310/6620.2006.06005

Cited by 54 publications

(42 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It may affect any area of the hand, although most cases entail dermatitis on the dorsal and volar surface of the wrists and on the dorsum of the hands and fingers [32]. Involvement of the flexor side of the wrist is not always present, although it still quite characteristic [29] (Figure 6).…”

Section: Hand Eczemamentioning

confidence: 99%

Atopic Dermatitis in Adults: A Diagnostic Challenge

Salvador¹,

Romero‐Pérez²,

Encabo-Durán³

2017

J Investig Allergol Clin Immunol

150

View full text Add to dashboard Cite

Atopic dermatitis (AD) has a prevalence of 1%-3% in adults. Adult-onset AD has only been defined recently, and lack of familiarity with this condition and confusion regarding the appropriate terminology persist. AD may first appear in childhood or de novo in adults and is characterized by pronounced clinical heterogeneity. The disease often deviates from the classic pattern of flexural dermatitis, and there are forms of presentation that are specific to adults, such as head-and-neck dermatitis, chronic eczema of the hands, multiple areas of lichenification, or prurigo lesions. Although diagnosis is clinical, adult-onset AD frequently does not fit the traditional diagnostic criteria for the disease, which were developed for children. Thus, AD is often a diagnosis of exclusion, especially in de novo cases. Additional diagnostic tests, such as the patch test, prick test, skin biopsy, or blood test, are usually necessary to rule out other diseases or other types of eczema appearing concomitantly with AD. This article presents an update of the different forms of clinical presentation for AD in adults along with a proposed diagnostic approach, as new treatments will appear in the near future and many patients will not be able to benefit from them unless they are properly diagnosed. Key words: Atopic dermatitis. Adult. Diagnosis. Patch testing. Prick testing. ResumenLa dermatitis atópica (DA) en el adulto tiene una prevalencia del 1-3%. Es una entidad de reciente acuñamiento, que no todo el mundo conoce y sobre la que existe una gran confusión terminológica. Puede iniciarse en la infancia o presentarse de "novo" en el adulto. Presenta una gran heterogeneidad clínica y con frecuencia no sigue el patrón clásico de dermatitis flexural. Además, existen formas de presentación más propias de adulto como son la dermatitis de la cabeza y el cuello, eczema crónico de manos, áreas de liquenificación múltiple o lesiones de prurigo. Aunque su diagnóstico es clínico, muchas veces la DA del adulto no cumple los criterios diagnósticos "clásicos" de DA, pues están pensados para niños. Por eso, suele ser un diagnóstico de exclusión, sobre todo los casos de "novo". Suele precisar de la realización de pruebas diagnósticas para descartar otras enfermedades distintas u otro tipo de eczema sobreañadido a la DA. Las pruebas diagnósticas que pueden resultar útiles para ello son: pruebas epicutáneas, prick test, biopsia cutánea y una analítica sanguínea. Realizamos una actualización de las distintas formas de presentación clínica de la DA del adulto y establecemos unas pautas para llegar a su diagnóstico, pues en un futuro inmediato, con la aparición de nuevos tratamientos, muchos de estos pacientes no podrán beneficiarse de los mismos por no estar adecuadamente diagnosticados. Palabras clave: Dermatitis atópica. Adulto. Diagnóstico. Pruebas epicutáneas. Prick test.

show abstract

Section: Hand Eczemamentioning

confidence: 99%

Atopic Dermatitis in Adults: A Diagnostic Challenge

Salvador¹,

Romero‐Pérez²,

Encabo-Durán³

2017

J Investig Allergol Clin Immunol

150

View full text Add to dashboard Cite

show abstract

“…Before the filaggrin era, there were several attempts to identify the phenotype of atopic hand eczema (2)(3)(4)(5). In 1944 Nexmand observed 100 patients with AD over a mean period of 6 months and found that 24%, 9% and 34% had dermatitis on the volar aspect ofthe wrists, and the dorsal aspects ofthe fingers and hands, respectively, whereas no patients had palmar hand eczema (3).…”

mentioning

confidence: 99%

Filaggrin Null-mutations May be Associated with a Distinct Subtype of Atopic Hand Eczema

Thyssen¹,

Carlsen²,

Johansen³

et al. 2010

Acta Derm Venerol

View full text Add to dashboard Cite

Null-mutations in the profilaggrin gene are associated with atopic dermatitis (AD) and palmar hyperlinearity (1). Before the filaggrin era, there were several attempts to identify the phenotype of atopic hand eczema (2-5). In 1944 Nexmand observed 100 patients with AD over a mean period of 6 months and found that 24%, 9% and 34% had dermatitis on the volar aspect ofthe wrists, and the dorsal aspects ofthe fingers and hands, respectively, whereas no patients had palmar hand eczema (3). These findings were confirmed in more recent studies: Fartasch et al. showed that palmar hyperlinearity was a phenotypic marker of atopic dermatitis in 17 (34%) of 49 patients (4), and Simpson et al. showed that among 777 consecutive patients with AD, hand dermatitis mainly affected the dorsal hand surfaces and the volar wrists, whereas vesicular lesions ofthe palms and sides of fingers were found in only 4.3% (5). Taken together, in a subgroup of patients with AD, hand eczema is characterized by dermatitis on the dorsal aspects of the fingers and hands, palmar hyperlinearity and, rarely, by palmar vesicles.Most patients who have attended our tertiary referral contact dermatitis and AD clinic within the past 3 months have been genotyped for the two most prevalent filaggrin null-mutations, R501X and 2282del4. So far, approximately 200 patients have been tested. In this relatively small patient series, a striking phenotype of atopic hand eczema was observed in 8 patients. All had severe generalized AD and asthma. Their atopic hand eczema was characterized by dermatitis on the dorsal aspects ofthe hands and sometimes on the volar aspects ofthe wrists as well as palmar hyperlinearity (Fig. 1). In two patients, there were signs of mild palmar dermatitis with a few vesicular lesions. Light palmar scaling was observed in one patient. Two ofthe patients were related (father and son) and had identical distribution of their hand eczema. Of note, we found that all 8 patients with this specific phenotype had null-mutations in the filaggrin gene (of which 5 were heterozygotic for either mutation, and 3 were compound heterozygotic), whereas no patients with wildtype filaggrin status had a similar clinical expression. Thus, we speculate that the special phenotype of atopic hand eczema identified in previous reports may be explained consistently by null-mutations in the profilaggrin gene.Prospective studies are clearly warranted to confirm our clinical observations. If they are confirmed, atopic hand eczema in patients with null-mutations in the profilaggrin gene represents a distinct clinical subtype that may be easy to diagnose. It is possible that patients Acta Derm Venereol 90 Fig. /. Patients with the atopic hand eczema subtype defined by mandatory null-mutations in the profilaggrin gene typically had asthma, generalized atopic dermatitis, hand eczema on the dorsal aspects ofthe hands and fingers, palmar hyperlinearity. and absence of palmar hand eczema.with filaggrin null-mutations and atopic hand eczema should be treated differently than, fo...

show abstract

“…Atopik dermatitli (AD) hastalarda da eller, nadir olmayarak, etkilenir. Aktif AD'li hastalarda, el tutulumunun prevalansı yaklaşık %60 olarak bulunmuştur (1). Şüphesiz, AKD'de neden olan spesifik antijenin belirlenmesinde, yama testinin önemli bir yeri vardır.…”

Section: Introductionunclassified

Patch and Prick Tests in Hand Eczema: Results of A Sixty Seven Patient Series

Karaman¹,

Topal²,

Aksungur³

2017

tdd

View full text Add to dashboard Cite

Objective: The patch and prick tests have a place in the management of patients with hand eczema. In this study, we investigated whether some of the clinical features patients with hand eczema could provide us with the predictability of skin test results. Methods: In Çukurova University Faculty of Medicine, 67 consecutive patients with hand eczema; evaluated in terms of duration of disease, morphology and severity. All of the patients were undergoes patch tested with the European Standard Series, and needle testing with routine aeroallergens. Results: Patch test with at least one allergen was positive in 46.3% of the patients; wheras this rate was 23.9% for prick test. The likelihood of having a contact sensitivity of patients complaining of hand eczema for at least three years was statistically more significant [odds ratio (OR) 0.9]. Although statistically not significant, it is less likely to be sensitized to patients with keratotic and/or licheniform hand eczema (OR 0.3). The severity of hand eczema was not predictive of patch test, there was no indicator of needle test positivity. Conclusion:We strongly recommend patch testing in all patients with prolonged hand eczema. Keywords: Hand eczema, patch test, prick test, diagnosis, risk factors, allergic contact dermatitis Amaç: El egzamalı hastaların tanı ve tedavisinde, yama ve iğne testlerinin yeri vardır. Bu çalışmamızda, el egzamalı hastalardaki bazı klinik özelliklerin, deri testlerinin sonuçlarını öngörmemizi sağlayıp sağlayamayacağını araştırdık. Yöntemler: Çukurova Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalı'na başvuran 67 ardışık, el egzamalı hasta; hastalık süresi, morfolojisi ve şiddeti açısından değerlendirildi. Hastaların hepsine, Avrupa Standardı Serisi ile yama testi, rutin aeroallerjenler ile iğne testi yapıldı. Bulgular: Hastaların %46,3'ünde en az bir alerjen ile yama testi pozitif iken, iğne testi için bu oran %23,9 idi. En az üç yıldır el egzamasından yakınan hastaların, bir kontakt duyarlılığa sahip olma olasılığı istatistiksel olarak daha anlamlıydı [odds oranı (OR) 0,9]. İstatistiksel olarak anlamlı olmamakla birlikte, keratotik ve/veya likenifiye el egzamalı hastalarda duyarlanma olasılığı daha düşüktü (OR 0,3). El egzamasının şiddeti, yama testi sonuçlarını öngörememekteydi ve iğne testi pozitifliği açısından bir belirteç yoktu. Sonuç: Uzamış el egzaması olan tüm hastalarda, yama testi yapılmasını özellikle öneriyoruz. Anahtar kelimeler: El egzaması, yama testi, iğne testi, tanı, risk faktörleri, alerjik kontakt dermatit

show abstract

Prevalence and Morphology of Hand Eczema in Patients with Atopic Dermatitis

Cited by 54 publications

References 14 publications

Atopic Dermatitis in Adults: A Diagnostic Challenge

Atopic Dermatitis in Adults: A Diagnostic Challenge

Filaggrin Null-mutations May be Associated with a Distinct Subtype of Atopic Hand Eczema

Patch and Prick Tests in Hand Eczema: Results of A Sixty Seven Patient Series

Contact Info

Product

Resources

About