A Case of Hand Eczema Cured by Intake of Coix-seed Reactive Derivatives (CRD) / 日本補完代替医療学会誌

In this report, we presented the case of a 45-year-old man who developed intractable eczema on the thumb-index interdigital fold for over 3 years. Coix-seed Reactive Derivatives(CRD) was administrated at a dose of 2.2g/day per day. The lesion cured markedly within 7 months. Although CRD intake seemed to be effective in this case, further studies are needed to define the optimal dose of this food.

Efficacy and Safety of Alitretinoin Therapy in Korean Elderly Patients with Chronic Hand Eczema: A Retrospective Single Center Study

BACKGROUND: Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea. METHODS: We retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician's global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests. RESULTS: The mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of ‘clear’ or ‘almost clear.’ There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%). CONCLUSION: Alitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE.

Clinical Features and Awareness of Hand Eczema in Korea

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.

Efficacy and Safety of Alitretinoin for Chronic Hand Eczema in Korean Patients

BACKGROUND: Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that a 24-week treatment course of oral alitretinoin is effective and well tolerated for CHE treatment. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of oral alitretinoin in Korean CHE patients. METHODS: A total of 27 patients with moderate to severe CHE took 30 mg of alitretinoin daily for 12 weeks. The primary efficacy parameter was the physician's global assessment (PGA). The response was defined as a patient being "clear" or "almost clear" of disease. The secondary efficacy parameters were the modified total lesion symptom score (mTLSS) and the patients' global assessment (PaGA). All adverse events and laboratory abnormalities were recorded during the treatment period. RESULTS: Alitretinoin led to CHE symptom improvement in 44.4% of patients. The PGA, mTLSS, and PaGA scores correlated well with each other. Reported adverse events were typical retinoid class effects and headache was the most common. CONCLUSION: Taking 30 mg of oral alitretinoin daily for 12 weeks was found to be effective in treating Korean patients with CHE, compared with the 24 week-treatment shown in previous studies.

To Study Quality of Life in Hand Eczema Patients Using Skindex Score.

Background: Hand Dermatitis affects a significant portion of the population. The disease is severely distressing and has chronic course with negative impact on quality of life. Aim: To evaluate the clinical profile and quality of life in hand eczema patients. Materials and Methods: A total of hundred patients, clinically diagnosed as a case of Hand Eczema of different age and sex groups participated in this study. The patient’s quality of life was assessed by a self administered questionnaire using skindex-16. Results: It was seen that increased severity of the eczema might have become more tolerated with increasing age. Males had significantly more severe hand Eczema. The total skindex QoL mean score was 31.4. Of the three domains included in our study the symptoms domain was the most affected (mean percentage score 2.27), followed by emotional (mean 1.93) and functioning (mean 1.74). Responders reported being bothered most by itching, hurting due to skin condition, and hard to do work. After adjustment for potential confounders, poorer QoL was significantly associated with female gender (mean 31.45), unmarried group (mean 32.33), rural origin (mean 32.07), long duration between 1-5 years (51%). Individuals who elected to change jobs because of their skin condition reported worse QoL. Conclusion: We suggest that quality of life modification and emotional support should be included as a part of treatment for hand eczema. Educational programs are recommended for patients who are more vulnerable to having poorer QoL to prevent further impairment, as well as further studies of QoL in Indian patients for specific diseases using disease-specific instruments.

Wet-work Exposure: A Main Risk Factor for Occupational Hand Dermatitis

Wet-work can be defined as activities where workers have to immerse their hands in liquids for >2 hours per shift, or wear waterproof (occlusive) gloves for a corresponding amount of time, or wash their hands >20 times per shift. This review considers the recent literature on wet-work exposure, and examines wet-work as a main risk factor for developing irritant contact dermatitis of the hands. The aim of this paper is to provide a detailed description of wet-work exposure among specific occupational groups who extensively deal with water and other liquids in their occupations. Furthermore, it highlights the extent and importance of the subsequent adverse health effects caused by exposure to wet-work.

Hand eczema: An update.

Eczema, the commonest disorders afflicting the hands, is also the commonest occupational skin disease (OSD). In the dermatology outpatient departments, only the severe cases are diagnosed since patients rarely report with early hand dermatitis. Mild forms are picked up only during occupational screening. Hand eczema (HE) can evolve into a chronic condition with persistent disease even after avoiding contact with the incriminated allergen / irritant. The important risk factors for hand eczema are atopy (especially the presence of dermatitis), wet work, and contact allergy. The higher prevalence in women as compared to men in most studies is related to environmental factors and is mainly applicable to younger women in their twenties. Preventive measures play a very important role in therapy as they enable the affected individuals to retain their employment and livelihood. This article reviews established preventive and therapeutic options and newer drugs like alitretinoin in hand eczema with a mention on the etiology and morphology. Identifying the etiological factors is of paramount importance as avoiding or minimizing these factors play an important role in treatment.

Hand eczema: Correlation of morphologic patterns, atopy, contact sensitization and disease severity.

Background: Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological forms of hand eczema have been described, but categorization into one of them is not always possible. Aims: To study the morphological patterns of hand eczema, relationship of atopy with hand eczema, and the implications of contact sensitization with respect to severity and diagnosis of hand eczema. Methods: Hundred consecutive patients of hand eczema attending the contact dermatitis clinic of the institute were recruited over a two year period from 2004-05. Objective assessment was done using hand eczema severity index (HECSI) and all the patients were patch tested using Indian standard series. Results: Unspecified type of hand eczema with no definite morphologic picture was seen in 62% followed by pompholyx in 14%. Hand eczema severity was not found to be statistically associated with age, sex, and atopic status of the patient. Positive patch test to one or more allergen was present in 65% of patients. The most common allergens were potassium dichromate (25%), fragrance mix (16%), nickel sulphate (14%), and PPD (13%). There was no significant correlation between patch test positivity and hand eczema severity or atopic status of the patient. Among the morphological patterns pompholyx was strongly associated with an atopic status (P=0.004). Conclusions: Hand eczema was seen twice more commonly in men. Atopic and non-atopic patients of hand eczema had no difference in the severity of disease. Contact sensitivity to different allergens did not correlate with increased eczema severity.

Irritancy potential of 17 detergents used commonly by the Indian household.

Background: Detergents are used by almost every household in the developed and developing world. Soap and most detergents are anionic surfactants and attack the horny layer of the skin and increase its permeability with little or no inflammatory change and may result in hand eczema, which is very distressing and incapacitating. Aim: To evaluate the irritant potential of common household detergents (laundry and dish wash) used by the Indian population using a 24-hour patch test and to convincingly educate the patients on the detergents less likely to cause irritation in the particular individual. Methods: Seventeen commonly used detergents found in Indian market were included in the study, of which, 12 were laundry detergents (powders - seven, bar soap - five) and five were dish wash detergents (powder - one, liquid - one, bar soap - three). The irritant potential of the 17 detergents were evaluated in 30 volunteers. Thirty microliters of each of the detergent bar solutions, distilled water (negative control), and 20% SDS (positive control) were applied to Finn chambers with a micropipette and occluded for 24 hours. Erythema, scaling, and edema were graded in comparison to the reaction at the negative control site (distilled water) for each volunteer separately. The scoring of erythema / dryness and wrinkling on a 0 - 4 point scale and edema on another 0 - 4 point scale was based on the Draize scale. The pH of each of the detergent solutions was determined using litmus papers (Indikrom papers from Qualigens fine chemicals). Results: The difference between detergents (F value) was significant for erythema / dryness and wrinkling (F = 3.374; p = 0.000), but not significant for edema (F = 1.297; p = 0.194). [Table 2] lists the means for erythema / dryness and wrinkling, and edema. The F value of the totals of the means for erythema / dryness and wrinkling and edema was significant (F = 2.495; p = 0.001). The pH of all the detergents was found to be alkaline except Pril utensil cleaner which tested acidic (pH 6). The positive control, 20% SDS also tested acidic (pH 6). Conclusion : Similar to patch testing in allergic contact dermatitis, 24-hour patch testing with detergent solutions (8% w/v), will educate the patient on what detergent to avoid. This may bring down the total medication requirement and frequent hospital consultations for these patients.

The Patch Test as a Useful Tool for Avoiding Suspected Allergens in Patients with Hand Eczema / 대한피부과학회지

BACKGROUND: Hand eczema is a common skin disease in the general population. The etiology of hand eczema is obscure and many causative factors have been proposed. However, there are only a few reported studies of the relevance of contact allergy in hand eczema. Objective: The purpose of this study was to evaluate the diagnostic value of the patch test for patients with hand eczema. METHODS: We analyzed the clinical characteristics and the results of the patch tests of the 37 patients with hand eczema and we then compared these with the clinical subtypes. RESULTS: 26 patients (70.3%) showed a positive test to one or more allergens. The common allergens were nickel sulfate (35.1%), mercury ammonium chloride (21.6%), and cobalt chloride (18.9%). The positive rates for a patch test were 82.4% for the vesicular form, 77.8% for the fissured form, 20.0% for the hyperkeratotic form and 66.7% for pompholyx, respectively. We found more significant improvement of the clinical symptoms in the vesicular group (57.1%) than that in the non-vesicular group (9.3%) after avoiding the verified allergens. CONCLUSION: This study shows that the patch test is a useful tool for the detection of contact allergens and it must be performed for the patients with hand eczema, and especially for those patients with the vesicular type.

The Patch Test as a Useful Tool for Avoiding Suspected Allergens in Patients with Hand Eczema / 대한피부과학회지

BACKGROUND: Hand eczema is a common skin disease in the general population. The etiology of hand eczema is obscure and many causative factors have been proposed. However, there are only a few reported studies of the relevance of contact allergy in hand eczema. Objective: The purpose of this study was to evaluate the diagnostic value of the patch test for patients with hand eczema. METHODS: We analyzed the clinical characteristics and the results of the patch tests of the 37 patients with hand eczema and we then compared these with the clinical subtypes. RESULTS: 26 patients (70.3%) showed a positive test to one or more allergens. The common allergens were nickel sulfate (35.1%), mercury ammonium chloride (21.6%), and cobalt chloride (18.9%). The positive rates for a patch test were 82.4% for the vesicular form, 77.8% for the fissured form, 20.0% for the hyperkeratotic form and 66.7% for pompholyx, respectively. We found more significant improvement of the clinical symptoms in the vesicular group (57.1%) than that in the non-vesicular group (9.3%) after avoiding the verified allergens. CONCLUSION: This study shows that the patch test is a useful tool for the detection of contact allergens and it must be performed for the patients with hand eczema, and especially for those patients with the vesicular type.

A Clinical Study of Patients with Hand Eczema / 대한피부과학회지

BACKGROUND: Hand eczema is a common dermatosis, yet it is has diverse etiologic factors and clinical manifestations, and it is usually recalcitrant to treatment. There are only infrequent population-based clinical and epidemiological studies on hand eczemain the medical literature. OBJECTIVE: The purpose of this study was to investigate the clinical manifestations and influences of occupation, concomitant allergic diseases, various aggravating factors and seasonal changes for patients with hand eczema. In addition, we tried to categorize the patients with hand eczema by the morphological characteristics. METHODS: A total of 189 patients who showed clinical manifestations of hand eczema were included in this study. We retrospectively reviewed the clinical characteristics of all the patients and we performed patch tests with the Korean standard series for 24 patients. RESULTS: The mean duration of the disease was 37.3 months. Housewives were the largest group (32.8%) by occupation, followed by students (23.8%). Bilateral involvement on both hands (83.1%) was significantly more common than unilateral involvement (16.9%). All the patients were categorized into 4 morphological types: the recurrent vesicular type, the hyperkeratotic type, the dry type, and others, and these occurred in 50.3%, 24.3%, 23.8%, and 1.6% of the patients, respectively. The most common aggravating factor was wet work at 24.3 percent. Of the 24 patients for whom the patch test was performed, 20 patients showed a positive reaction to more than one allergen and nickel sulfate was the most common allergen in these patients. CONCLUSION: This study demonstrated the various clinical characteristics of Korean patients with hand eczema. It is especially remarkable that they had a long clinical course and a higher positive rate on standard patch tests.

Usefullness of Choyoto for Hand Eczema / 日本東洋医学雑誌

We analyzed the differences between responder and non-responder groups using Choyoto for hand eczema. In 7 cases the drug was effective, and in 6 cases it was not. Most patients in the effective group had white-complexioned skin, and the eczema tended to localize on the hands. In contrast, most patients in the non-effective group had with sleep difficulties and/or a smoking habit. In addition, they showed marked symptoms of Oketsu such as dark red gingiva, indicating that many of the non-effective hand eczema cases had elevated Oketsu scores. It was shown that objective and subjective symptoms could be indicators for the choosing of Choyoto for hand eczema treatment.

Occupational Contact Urticaria Syndrome Induced by Cefotiam Dihydrochloride in a Nurse

We herein report a case of occupational contact urticaria syndrome induced by cefotiam di-hydrochloride in a nurse. She had generalized pruritic wheals accompanied by palpitations and tachypnea during the preparation of cefotiam solution. A scratch patch test with cefotiam di-hydrochloride, a major component of cefotiam ingredient showed multiple erythema and wheals within 5 minutes, accompanied by palpitations and tachypnea. No delayed type reaction was observed. Based on her clinical history and scratch test result, we diagnosed her condition as contact urticaria syndrome caused by cefotiam.

Stratum Corneum Ceramides and Free Amino Acids in the Lesion of Scaly Hand Eczema / 대한피부과학회지

BACKGROUND: Lipids of horny layer forming multiple lamellar structure in the intercellular space acts as a skin barrier having a primary protective function and keeps softness and flexibility of the skin by absorbing and maintaining moistures. Among the intercellular lipids, ceramides mainly contribute to this important role. In xerotic eczema, atopic dermatitis, psoriasis, ichthyosis, and experimentally induced scaly lesion showing dryness and scales, the amount of ceramides is decreased or distribution of ceramide is changed. In addition to lipids, free amino acids, a component of NMFs, serve as a water retainer and are decreased in ichthyosis or experimentally induced scaly lesion. Hand eczema has dry and scaly lesion showing impaired skin barrier and low water content. So, changes of ceramides or free amino acids can be considered in the lesion of hand eczema. OBJECTIVE: The purpose of this study was to confirm the relationship between the development of hand eczema and changes of ceramides or free amino acids. METHOD: The lipids and free amino acids in scales from lesion of hand eczema were analyzed by using high performance thin layer chromatography and amino acid analyzer. RESULTS: Amounts of total lipids extracted were 0.63+/-0.33 microgram/cm2 in hand eczema and 0.44+/-0.26 microgram/cm2 in control. There was no difference between the two groups. Cholesterol sulfate, glucosyl ceramide, cholesterol, triglyceride, sterol ester, and n-alkane showed no difference between hand eczema and control. But ceramides were significantly decreased in hand eczema(11.0+/-5.5%) compared with control(21.4+/-8.0%)(p<0.05). Especially, ceramide type IV was significantly decreased in hand eczema (6.6+/-5.3%) compared with control(15.6+/-6.2%)(p<0.05) but ceramide type III in hand eczema did not differ from control. Amounts of total free amino acids in 10mg of scale were 10.4+/-3.1nmol in hand eczema and 9.5+/-3.0nmol in control. There was no significant difference between the two groups. CONCLUSION: Dry skin and scales in hand eczema are related to the decrease of total amount of ceramides and ceramide type IV than amino acids in horny layer. To clarify the exact pathogenesis of hand eczema, further investigations on all types of ceramides and their defect in the process on biosynthesis of ceramides will be necessary.

Stratum Corneum Ceramides and Free Amino Acids in the Lesion of Scaly Hand Eczema / 대한피부과학회지

BACKGROUND: Lipids of horny layer forming multiple lamellar structure in the intercellular space acts as a skin barrier having a primary protective function and keeps softness and flexibility of the skin by absorbing and maintaining moistures. Among the intercellular lipids, ceramides mainly contribute to this important role. In xerotic eczema, atopic dermatitis, psoriasis, ichthyosis, and experimentally induced scaly lesion showing dryness and scales, the amount of ceramides is decreased or distribution of ceramide is changed. In addition to lipids, free amino acids, a component of NMFs, serve as a water retainer and are decreased in ichthyosis or experimentally induced scaly lesion. Hand eczema has dry and scaly lesion showing impaired skin barrier and low water content. So, changes of ceramides or free amino acids can be considered in the lesion of hand eczema. OBJECTIVE: The purpose of this study was to confirm the relationship between the development of hand eczema and changes of ceramides or free amino acids. METHOD: The lipids and free amino acids in scales from lesion of hand eczema were analyzed by using high performance thin layer chromatography and amino acid analyzer. RESULTS: Amounts of total lipids extracted were 0.63+/-0.33 microgram/cm2 in hand eczema and 0.44+/-0.26 microgram/cm2 in control. There was no difference between the two groups. Cholesterol sulfate, glucosyl ceramide, cholesterol, triglyceride, sterol ester, and n-alkane showed no difference between hand eczema and control. But ceramides were significantly decreased in hand eczema(11.0+/-5.5%) compared with control(21.4+/-8.0%)(p<0.05). Especially, ceramide type IV was significantly decreased in hand eczema (6.6+/-5.3%) compared with control(15.6+/-6.2%)(p<0.05) but ceramide type III in hand eczema did not differ from control. Amounts of total free amino acids in 10mg of scale were 10.4+/-3.1nmol in hand eczema and 9.5+/-3.0nmol in control. There was no significant difference between the two groups. CONCLUSION: Dry skin and scales in hand eczema are related to the decrease of total amount of ceramides and ceramide type IV than amino acids in horny layer. To clarify the exact pathogenesis of hand eczema, further investigations on all types of ceramides and their defect in the process on biosynthesis of ceramides will be necessary.

The Recovery of Epidermal Barrier after Stratum Corneum Injury and the Changes of Epidermal Lipid Contents in Hand Eczema and Normal Subjects / 대한피부과학회지

BACKGROUND: In eczematous skin it is expected that altered defense mechanisms are employed against an injury, which mechanisms include alterations in the stratum corneum barrier function and lipid contents. OBJECTIVE: To investigaten aspect of pathophysiology of hand eczema by comparing the water holding capacities and transepidermal water loss(TEWL) after injuries on the skin and by comparing the epidermal lipid contents between hand eczema and normal subjects. METHODS: The water holding capacities were checked by corneometer, and the TEWL were checked after epidermal barrie! destruction with acetone or adhesive tapes. The epidermal lipids were extracted with acetone, ther (1: 1 v/v) mixture solvent and analysed by HP- TLC. RESULTS: The water holdingapacities were decreased in eczema of the palm, but the recoveries of TEWL and the lipid content did not differ between hand eczema and normal subjects. CONCLUSION: The water holding capacities were decreased in the eczematous skin. But there were no significant differencies in the recovery of destructed epidermal barrier and the epidermal lipid contents.

Site Variation of Transepidermal Water Loss Measurement on the Normal Skin of Hands in Human Volunteers

BACKGROUND: Transepidermal water loss(TEWL) measurement is widely used in monitoring the degree of skin irritation. There have been many reports of site variation of TEWL between different body sites. However, there have been no reports concerning site variation on the different parts of the hand, which is important for the evaluation of hand eczema. OBJECTIVE: This study was done to better understand site variation of TEWL on the hands. METHODS: TEWL measurement has been performed on the mid-forearm and seven different sites of the hands in 20 normal human volunteers using an evaporimeter. RESULTS: A marked site variation has been observed and high values observed on most parts of the hands compared to forearms. CONCLUSION: Site selection should be seriously considered in any kind of study concerning TEWL measurement of hands.